Highlight
- The 10-2 visual field test does not significantly outperform the 24-2 test in detecting global or quadrant-level progression in early glaucoma.
- Pointwise analysis reveals the 10-2 test is more sensitive for detecting progression with steeper decline in central visual field points.
- Patients with worse baseline central vision defects on the 10-2 test benefit from monitoring with this test for early detection of faster progression.
Study Background
Glaucoma is a leading cause of irreversible blindness worldwide, characterized by progressive optic neuropathy and corresponding visual field (VF) loss. Early detection of visual field progression is essential to guide timely therapeutic interventions to preserve vision. Normal automated perimetry with the Humphrey Field Analyzer often uses the 24-2 test pattern, which examines the central 24 degrees of the visual field with test points spaced 6 degrees apart. However, the 10-2 test, with a denser grid assessing the central 10 degrees at 2-degree intervals, has been suggested as a potentially more sensitive tool to detect central visual field progression, especially in early glaucoma.
Despite theoretical advantages, the added clinical value of the 10-2 test for routine monitoring remains unclear. Determining whether 10-2 testing offers incremental benefit over the standard 24-2 test in detecting early progression could influence clinical practice guidelines and resource allocation for glaucoma care.
Study Design
This prospective longitudinal study included 96 patients with open-angle glaucoma exhibiting early visual field damage and 56 healthy control subjects. Participants underwent both 24-2 and 10-2 Humphrey Field Analyzer tests every 4 months over a median follow-up period of approximately 4.5 years, resulting in a median of 11 to 13 pairs of tests per participant. The analysis focused on the central 12 test locations of the 24-2 test, matching the 10-2 test area, to facilitate direct comparison.
Visual field progression was assessed by calculating slopes of mean deviation (MD) — a global and quadrant-level summary measure — and pointwise total deviation values over time. Various threshold criteria for pointwise slope changes were employed to define progression. The primary outcome measures were the area under the receiver operating characteristics curve (AUC) to distinguish glaucoma patients from healthy controls and the overlap in individuals identified as progressing by each test at matched specificity levels.
Key Findings
The study found no significant difference in AUC values between the 24-2 and 10-2 tests for global MD slopes (P = 0.25) or quadrant-level analyses (P > 0.11), indicating comparable performance in detecting progression at these aggregate levels. At a high specificity threshold of 90% for global MD slope, only 53% of patients identified as progressing by either test overlapped, with less overlap observed at the quadrant level.
In pointwise analyses, performance was equivalent between tests when progression criteria used slope cut-offs above -1.25 dB/year. However, with stricter progression definitions (slope cut-offs ≤ -1.25 dB/year), the 10-2 test demonstrated significantly higher AUC values than the 24-2, suggesting better sensitivity for detecting faster localized central visual field deterioration.
Furthermore, patients progressing exclusively on the 10-2 test with steeper pointwise slopes had worse baseline 10-2 MD but not 24-2 MD, indicating the 10-2 test better identifies progression in individuals already exhibiting central field deficits.
Expert Commentary
The findings highlight the nuanced role of 10-2 testing in glaucoma management. While the standard 24-2 test remains sufficient for general surveillance of early glaucoma progression at global and quadrant summary levels, the 10-2 test provides enhanced detection capabilities for patients with focal central visual field damage.
This aligns with known patterns of glaucomatous damage preferentially affecting the macular region in some patients, where a denser test grid may uncover subtle but clinically significant changes overlooked by the sparser 24-2 pattern. The study’s long follow-up and robust inclusion criteria strengthen the reliability of these conclusions.
Nevertheless, resource considerations and patient burden must be acknowledged. Routine use of the 10-2 test in all early glaucoma patients may not be warranted; instead, targeting patients with known central defects or those at risk of rapid progression may be the most efficient approach.
Limitations include the study’s focus on early glaucoma and the exclusion of more advanced cases where the 10-2 test might have different utility. Future research might explore integration with structural imaging modalities to optimize progression detection further.
Conclusion
This study provides evidence that while the 10-2 visual field test does not add significant value over the 24-2 test for detecting global or quadrant-level progression in early glaucoma, it reveals clinically important progression at the pointwise level in patients with central visual field defects. Clinicians should consider incorporating 10-2 testing selectively for patients demonstrating worse or localized central field loss at baseline who may be at higher risk for accelerated disease progression. Tailoring visual field monitoring strategies in this manner can enhance early intervention and preserve vision in glaucoma patients.
Funding and Clinical Trials
Details concerning funding sources or registered clinical trials were not provided in the original report.
References
1. Tomita R, Salh D, Dyachok OM, et al. Value of 10-2 Visual Field Testing for Detecting Progression in Patients with Glaucoma. Ophthalmology. 2026 Jul 6. PMID: 42409179.
2. Hood DC, De Moraes CGV, Teng CC, et al. Glaucomatous damage of the macula. Prog Retin Eye Res. 2013;32:1-21.
3. Gardiner SK, Demirel S, Johnson CA. Comparison of visual field pointwise linear regression and permutation analyses in detecting glaucomatous progression. Invest Ophthalmol Vis Sci. 2014;55(6):3679-3684.
4. Lee J, Sung KR, Kim SH, et al. Diagnostic power of central 10-2 visual field testing compared with 24-2 test for detection of early glaucomatous visual field defects. Ophthalmology. 2015;122(9):1793-1800.
