title: Initial parafoveal versus peripheral scotomas in glaucoma: risk factors and visual field characteristics.
abstract: OBJECTIVE
  To assess risk factors for an initial parafoveal scotoma (IPFS) compared with an initial nasal step (INS) in glaucoma.
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  Sixty-nine patients with glaucoma with an isolated IPFS and 53 patients with an isolated INS.
  
  
  METHODS
  On the basis of 2 reliable, consistent 24-2 Swedish interactive threshold algorithm standard visual fields (VFs), 2 groups of patients with glaucoma were studied: those with an IPFS in 1 hemifield (≥3 adjacent points with P<5% within the central 10 degrees of fixation, ≥1 point with P<1% lying at the innermost paracentral points, and no VF abnormality outside the central 10 degrees) and those with an INS in 1 hemifield (≥3 adjacent points with P<5% in the nasal periphery outside 10 degrees of fixation, the nasal-most point with P<1%, and no VF abnormality within the central 10 degrees). Clinical characteristics and systemic factors were recorded from charts and compared between the 2 groups.
  
  
  METHODS
  Maximum untreated intraocular pressure (IOP), disc hemorrhage (DH) detection during follow-up, systemic risk factors, and VF mean deviation (MD) and pattern standard deviation (PSD).
  
  
  RESULTS
  Maximum untreated IOP (21.6±4.5 vs. 28.3±9.6 mmHg; P<0.001) was significantly lower, and frequency of DH detection (44% vs. 17%; P=0.001) and systemic risk factors (hypotension, migraine, Raynaud's phenomenon, and sleep apnea; 16%, 23%, 24%, and 9% vs. 0%, 4%, 9%, and 0%; P=0.001, 0.002, 0.025, and 0.030, respectively) were significantly higher in patients with an IPFS than in patients with an INS. There were no significant differences in age, gender, family history of glaucoma, refractive error, central corneal thickness, and disc area between the 2 groups (all P>0.1). Mean deviation was similar between the 2 groups (P=0.346), but PSD was significantly greater in the IPFS group than in the INS group (P=0.043).
  
  
  CONCLUSIONS
  Eyes with an IPFS differ from those with an INS. These findings may help clinicians identify patients at higher risk of early central field loss.
authors.affiliation: Department of Ophthalmology, the New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA. sungchulpark1225@gmail.com
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Park
authors.forename: Carlos Gustavo
authors.initials: CG
authors.lastname: De Moraes
authors.forename: Christopher C W
authors.initials: CC
authors.lastname: Teng
authors.forename: Celso
authors.initials: C
authors.lastname: Tello
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D005584:Fovea Centralis / Q000473:pathology*; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D012166:Retinal Hemorrhage / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D012607:Scotoma / Q000175:diagnosis*; D014065:Tonometry, Ocular; D014786:Vision Disorders / Q000175:diagnosis*; D058609:Visual Field Tests; D014794:Visual Fields; D055815:Young Adult