Rational therapy of
all chronic glaucomas demands a reliable method of
determining the
rate of deterioration of the glaucoma. We have developed staging systems to
assess the amount of optic nerve damage and the amount of visual field loss.
Both scales have 8 stages, 0 indicating no damage, and 7 indicating
far-advanced damage. The disc staging system is based on assessment of the
width of the neuroretinal rim, modified for the size of the optic disc. The
visual field grading system is based on the number of abnormal spots on the
Humphrey visual field, using the corrected pattern standard deviation, with
additional weighting of the four central spots.
Both the disc
staging system and the field staging system are adequately reproducible and
reliable. Both correlate with each other and with the “clinical impression” of
the severity of the glaucoma.
Universal
acceptance of a single method of estimating optic nerve and visual field damage
would enhance communication between physicians and medical centers and would
presumably result in an improvement in patient care.