VF Fluctuation Occurs in Myopes More Than Emmetropes

The VFI is meant to eliminate the confounding variable of cataracts by disregarding any reduction in sensitivity unless it is outside of the normal range for pattern deviation. It also weighs central visual field loss more heavily than peripheral visual field loss. The VFI can allow a clinician to understand what visual field changes are specific to glaucomatous damage. Photo: Danica Marrelli, OD. Click image to enlarge. Detecting glaucomatous progression is critical for timely intervention, but differentiating between normal fluctuation and pathological changes in the visual field (VF) can be challenging at times. There are broadly two different types of fluctuation seen in VFs: short-term and long-term. Short-term fluctuation is defined as the variability between multiple VF tests performed on the same day that’s not due to disease progression. Long-term fluctuation is defined as the variability between different VF tests taken during different days or months where the change is not due to disease progression.Some degree of visual field fluctuation is expected in all patients, with more occurring in eyes with increased severity of glaucomatous damage. These patient populations who commonly show fluctuations should be examined carefully to prevent incorrect diagnoses so that detection of true progression is not delayed and to prevent erroneous assumptions that disease progression has occurred.In a recent study published in Journal of Ophthalmology, researchers investigated if glaucomatous eyes with high myopia (≤-5.00D) show greater visual field fluctuation compared with glaucomatous eyes without myopia (-2.00D to +2.00D). The visual field index (VFI) plot, mean deviation (MD) and threshold sensitivity on the glaucoma progression analysis were collected to quantify fluctuation. There was a statistically significant difference in MD and VFI fluctuation between myopic glaucoma groups and emmetropic glaucoma groups but not in threshold sensitivity.Four or more Humphrey visual field tests over several clinic visits were analyzed in 156 eyes. The average number of VFs in the emmetropic glaucoma group was 4.83; in the myopic glaucoma group, it was 5.62. The average amount of time in between each visual field test was 451 days in the emmetropic glaucoma group and 438 days in the myopic glaucoma group. The myopic glaucoma group had a mean age of 53.61, compared with the emmetropic glaucoma group with a mean age of 63.53, which was statistically significant. Additionally, the emmetropic glaucoma group included 51 patients (65.38%) that identified as Black or African American, compared with the myopic glaucoma group with 26 patients (33.33%). The researchers speculated that differences between groups could impact the results.Although myopic eyes showed greater fluctuation in MD (1.50) and VFI (0.037) compared with emmetropic glaucoma eyes (MD = 1.13) (VFI = 0.026), threshold sensitivity analyses did not reach statistically significant differences between myopic (1.61) and emmetropic glaucoma eyes (1.34). One-way ANOVA tests found statistically significant MD and VFI fluctuation differences (MD = -0.29; VFI = -0.30) but not threshold sensitivity fluctuation differences (-0.19).Although this study highlighted that myopic glaucoma patients demonstrate statistically significant VF fluctuation, this study does have limitations and may not apply to patients on the extreme ends of the visual field spectrums. Also, patients with other ocular diseases or trauma were not included in this study, so clinicians should consider the patient’s full history when looking for visual field fluctuation.“Physicians should incorporate more frequent visual field tests and a thorough examination of other clinical findings such as optic nerve appearance, retinal nerve fiber layer thickness, intraocular pressure and a patient’s own assessment of their vision to guide clinical decision-making for myopic glaucoma patients,” the researchers concluded in their paper.Click here for the journal source. Barten M, Cantor LB. Comparison of visual field fluctuation between myopic and emmetropic glaucoma patients. J Ophthalmol. September 21, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.