Figure 3-33 Advanced glaucomatous visual field loss with retention of a small central island of vision (foveal threshold: 33 dB) and retention of inferotemporal visual field (right eye). (Visual field courtesy of G. A. Cioffi, MD.)

Manual Perimetry

Since computerized static perimetry has shown itself to be at least as good as the best-quality manual perimetry tests for the detection and quantification of glaucomatous defects, manual perimetry is seldom used today in the management of glaucoma. However, it remains helpful in documenting defects outside the central 30° and in monitoring end-stage visual field loss.

Anderson DR. Perimetry With and Without Automation. 2nd ed. St Louis: Mosby; 1987.

Other Tests

Several other tests may be helpful in selected patients.

Ultrasound biomicroscopy (UBM) may provide information about anterior segment anatomy in several types of glaucoma. The test employs shorter-wavelength sound waves than does conventional ocular ultrasonography, limiting penetration through the sclera but increasing the resolution. UBM allows detailed examination of the anterior segment, the posterior chamber, and the ciliary body (Fig 3-34). Anterior segment optical coherence tomography (AS-OCT) may also provide images of the anterior segment and angle. However, although the resolution of AS-OCT is better than that of UBM, penetration through the sclera is minimal with AS-OCT, reducing its ability to provide images of the ciliary body and adjacent structures.

Figure 3-34 Pupillary block as shown by ultrasound biomicroscopy. Note the anterior bowing of the peripheral iris on the left compared with the central iris on the right.