title: Long-term perimetric fluctuation in patients with different stages of glaucoma.
abstract: OBJECTIVE
  To evaluate the long-term perimetric fluctuation (LF) in patients with different stages of glaucoma according to the Glaucoma Staging System 2 (GSS2).
  
  
  METHODS
  This multicentre retrospective study included 161 eyes of 161 stable glaucoma patients undergoing four visual-field tests (Humphrey SITA-Standard program over the central 24° or 30°) over a 2-year period. For each patient, the stage of the disease was classified according to GSS2. LF was then calculated as the mean of the standard deviations of point-to-point threshold sensitivities in the four repetitions. LF in GSS2 stages was compared using the t test. Results LF progressively increased from stage 0 to stage 4, and then decreased at stage 5. Stage 4 had a peak of 3.19 ± 0.94 dB, with statistically significant differences compared with all the other stages. The lowest LF (1.65 ± 0.60 dB) was found for normal subjects, whereas similar data were found for borderline patients and those at stages 1 and 5 (2.09 ± 0.58, 2.13 ± 0.57 and 2.22 ± 0.89 dB, respectively; p > 0.13). Visual fields with generalised defects had a lower LF (1.90 ± 0.81) than those with mixed (2.84 ± 0.87, p = 0.0003) and localised (2.63 ± 0.72, p = 0.004) defects. Conclusions In this study, the authors showed that the lower the visual-field defect, the lower was LF, except at stage 5 of GSS2. As test-retest changes exceeding LF could represent a sign of progression, the authors suggest that clinicians using this classification system calculate LF, in order to better differentiate true progression from variability.
authors.affiliation: Eye Clinic, San Paolo Hospital, Milan, Italy. fogagnolopaolo@googlemail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Fogagnolo
authors.forename: Chiara
authors.initials: C
authors.lastname: Sangermani
authors.forename: Francesco
authors.initials: F
authors.lastname: Oddone
authors.forename: Paolo
authors.initials: P
authors.lastname: Frezzotti
authors.forename: Michele
authors.initials: M
authors.lastname: Iester
authors.forename: Michele
authors.initials: M
authors.lastname: Figus
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferreras
authors.forename: Simona
authors.initials: S
authors.lastname: Romano
authors.forename: Stefano
authors.initials: S
authors.lastname: Gandolfi
authors.forename: Marco
authors.initials: M
authors.lastname: Centofanti
authors.forename: Luca
authors.initials: L
authors.lastname: Rossetti
authors.forename: Nicola
authors.initials: N
authors.lastname: Orzalesi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields / Q000502:physiology*