Progression of early glaucomatous visual field loss as detected by blue- on-yellow and standard white-on-white automated perimetry

Objective. - To determine whether blue-on-yellow perimetry reveals progression of glaucomatous damage before it is evident with standard white- on-white perimetry. Design. - A Humphrey field analyzer (Humphrey Instruments, San Leandro, Calif) was modified to perform blue-on-yellow perimetry to isolate and measure the sensitivity of short wavelength- sensitive mechanisms. Participants were tested annually with standard white- on-white automated perimetry and blue-on-yellow automated perimetry for 5 years. Patients. - Sixteen patients with early glaucomatous visual field loss in one or both eyes and 62 age-matched normal control subjects. Results. - At baseline, 25 (78.1%) of the 32 eyes exhibited larger deficits with blue-on- yellow perimetry, five (15.6%) had equivalent loss with both tests, and two (6.3%) had larger deficits with standard white-on-white perimetry. Seven (21.9%) of the 32 eyes demonstrated evidence of progressive visual field loss with standard white-on-white perimetry in 5 years, while the other 25 eyes (78.1%) were relatively stable. Deficits with blue-on-yellow perimetry were twice as large as deficits with white-on-white perimetry in the stable group and were three to four times as large in the group with progressive field loss. Conclusions. - Blue-on-yellow perimetry is effective in predicting which patients with early glaucomatous visual field loss are most likely to have progressive loss. The rate of progressive loss is greater with blue-on- yellow perimetry than with standard white-on-white perimetry.