Objective To elucidate the temporal relationship between detection of glaucomatous optic disc progression, as assessed by fundus photography, and visual field progression. Design Prospective, randomized, longitudinal trial. Subjects Three hundred and six study eyes with manifest glaucoma with field loss and 192 fellow eyes without any field defect at the start of the trial, of a total of 249 subjects included in the Early Manifest Glaucoma Trial (EMGT) were assessed. Methods Evaluation of visual field progression and optic disc progression during an 8-year follow-up period. Three graders independently assessed optic disc progression in optic disc photographs. Visual field progression was assessed using glaucoma change probability maps and the EMGT progression criterion. Main outcome measures Time to detection of visual field progression and optic disc progression. Results Among study eyes with manifest glaucoma, progression was detected in the visual field first in 163 eyes (52%), in the optic disc first in 39 eyes (12%) and in 1 eye (0%) it was found simultaneously with both modalities. Among fellow eyes with normal fields, progression was detected in the visual field first in 28 eyes (15%), in the optic disc first in 34 eyes (18%) and in 1 eye (1%) it occurred simultaneously. Conclusion In eyes with manifest glaucoma, progression in the visual field was detected first more than four times as often as progression in the optic disc. Among fellow eyes without visual field loss at baseline, progression was detected first as frequently in the optic disc as in the visual field.

PurposeTo compare the earliest detection of progression in visual fields and monoscopic optic disc photographs at different stages of manifest glaucoma.MethodsThis study evaluated 306 eyes in 249 patients with manifest open‐angle glaucoma included in the Early Manifest Glaucoma Trial (EMGT). All patients in the trial were followed up regularly by standard automated perimetry and monoscopic optic disc photography, and the median follow‐up time was 8 years. Progression was assessed in series of optic disc photographs and in series of visual fields using glaucoma change probability maps and the predefined EMGT progression criterion. The proportion of progressions detected first in visual fields and the proportion detected first in optic disc photographs were compared at different stages of glaucoma severity defined by the perimetric mean deviation (MD) of the baseline visual field.ResultsAssessment of 210 eyes with early visual field loss, 83 eyes with moderate field loss, and 13 eyes with advanced field loss showed that, among the eyes exhibiting progression, the progression was detected first in the visual field in 80%, 79% and 100%, respectively. The predominance of visual field progressions at all stages was still apparent when using narrower (3‐dB) MD intervals for staging.ConclusionIn the EMGT material on eyes with manifest open‐angle glaucoma, the initial progression was detected much more often in the visual field series than in the optic disc photographs at all stages of disease.

Purpose: It has been suggested that a diagnosis of glaucoma cannot be certain until progression has been demonstrated. Our aim was to evaluate the correctness of a glaucoma diagnosis established after two initial visits. Patients and Methods: Patients included in the Early Manifest Glaucoma Trial (EMGT) who had continued follow-up for at least 15 years were included in this analysis. The patients had been recruited primarily through a population screening and were diagnosed with glaucoma if the Glaucoma Hemifield Test (GHT) was outside normal limits in the same sector at two consecutive visits. A GHT classification of borderline was also diagnostic if corresponding optic disc findings were present. At least one of the following criteria had to be fulfilled during follow-up to confirm the initial diagnosis: (1) Visual field progression in at least one eye according to the EMGT criterion; (2) development of manifest glaucoma in an initially ineligible fellow eye; (3) optic disc progression in at least one eye; (4) optic disc hemorrhages in at least one eye. Results: Of the 255 patients included in the EMGT, 117 were followed for at least 15 years, representing 147 eyes eligible for our study. During follow-up, 134 eyes (91%) showed visual field progression, and, of the remaining 13 eyes, only four (3%) did not fulfill any of the criteria to confirm the diagnosis. Conclusion: A diagnosis made applying strict criteria to two initial visual field tests, supported by optic disc findings if visual field findings were borderline, was almost always correct.