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Previous investigations have demonstrated that when short wavelength light is detected exclusively by short wavelength sensitive mechanisms (SWS or S cone pathways), patients with ocular hypertension (elevated intraocular pressure) or early glaucomatous damage exhibit losses of sensitivity at the fovea and throughout the central 30 degrees of the visual field. We have recently developed a technique for measuring the sensitivity of short wavelength sensitive mechanisms throughout the central visual field by means of a modified automated perimeter. In order to determine the clinical significance and prognostic value of short wavelength sensitivity losses measured with this procedure, we conducted a prospective longitudinal five year investigation of 22 patients with early glaucomatous visual field loss (44 eyes), 38 ocular hypertensive patients (76 eyes) and 62 age-matched normal control subjects (124 eyes). All participants were evaluated annually with standard automated perimetry (AP) and short- wavelength-sensitive perimetry (SWSP). At the beginning of the study, 67 out of 76 eyes in the ocular hypertension patients had normal results for both AP and SWSP tests, while nine out of 76 had normal AP results but abnormal SWSP findings. Five years later, five out of nine ocular hypertensive eyes with initial SWSP abnormalities have developed evidence of glaucomatous visual field loss on standard AP testing. The abnormalities on AP testing occurred in the same general location as those found in earlier years for SWSP evaluations. None of the ocular hypertensive eyes with normal SWSP results in year one developed abnormal AP deficits after five years. Seven out of the 44 eyes of early glaucoma patients demonstrated reproducible evidence of progression of visual field loss on standard AP testing. In all seven instances, the SWSP deficits were larger than the AP abnormalities at the beginning of the study, and the progression of AP sensitivity losses over five years followed the pattern of SWSP deficits obtained in earlier years. These findings provide strong evidence that SWSP abnormalities are an early indicator of glaucomatous damage and are predictive of impending glaucomatous visual field loss for standard AP testing.
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