Standard 24-2 Visual Fields May Underestimate Central Progression, Study Finds

Visual field testing remains a key tool in assessing glaucoma and tracking disease changes. Photo: Danica Marrelli, OD. Click image to enlarge. A recent study highlights a gap in how central visual field (VF) progression is monitored in glaucoma. Researchers found that agreement among different progression detection methods is low to moderate, with 10-2 VF testing identifying a greater proportion of central progression than the standard 24-2 test. The findings suggest that relying solely on 24-2 VF may underestimate central visual field loss, emphasizing the need to incorporate 10-2 testing alongside routine assessments to better track disease progression and guide treatment.Researchers analyzed 282 eyes from 197 patients diagnosed with primary open-angle glaucoma (POAG) who presented with central VF defects at baseline. All participants had at least two years of follow-up and a minimum of five VF tests for both 10-2 and 24-2 protocols. The study aimed to assess how various progression detection methods—ranging from clustered pointwise linear regression (PLR) to mean deviation (MD) analyses and established scoring systems like the Advanced Glaucoma Intervention Study and Collaborative Initial Glaucoma Treatment Study (CIGTS)—agree in identifying progression in the central VF.The study revealed that central VF progression was more frequently detected using 10-2 testing. Specifically, 35.1% of eyes showed progression according to 10-2 VF MD, while 20.6% progressed based on 10-2 clustered PLR. In contrast, 24-2 central VF identified progression in only 17.7% of eyes at the -0.5 dB/year threshold and 3.2% at the -1.0 dB/year threshold. Global progression was observed in 17.7% to 30.5%, according to the study authors. Agreement among different detection methods was moderate at best, with overall concordance ranging from 67.0% to 85.1%. Kappa values indicated low to moderate agreement, particularly between 10-2 and 24-2 methods (0.11-0.25) and slightly higher when comparing 10-2 with broader 24-2 metrics (0.22-0.54). Simulation analyses showed that 10-2 VF MD achieved the highest partial AUC across specificity levels.This research underscores the absence of a universally accepted method for tracking visual field progression among glaucoma patients with central visual field defects. “The greater proportion of eyes showing central progression with the 10-2 VF test suggests that the 24-2 VF may underestimate central VF progression,” the study authors wrote in their recent Translational Vision Science & Technology paper. “The low to moderate agreement between the 24-2 and 10-2 VF tests underscores the limitations of relying solely on one approach, as the 24-2 VF may not adequately assess central VF progression,” they concluded, while emphasizing the need for further research “to develop and validate standardized criteria that can reliably detect central VF progression to improve patient outcomes in glaucoma management.”Click here for the journal source. Nishida T, Weinreb RN, Walker E, et al. Comparison of Methods for Visual Field Progression in Eyes With Central Visual Field Defects. Transl Vis Sci Technol. 2025;14(11):3. 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.