Blue-on-yellow visual field and retinal nerve fiber layer in ocular hypertension and glaucoma

Ophthalmology. 1998 Nov;105(11):2077-81. doi: 10.1016/S0161-6420(98)91128-9.


Background and objective: It has been suggested that the clinically detectable changes of the blue-on-yellow (B/Y) visual field and retinal nerve fiber layer (RNFL) may precede standard white-on-white (W/W) visual field defects in the progression of glaucoma. The aim of this study was to test the relationship between the results of B/Y visual fields and semiquantitative RNFL evaluation in corresponding areas and to determine how the B/Y visual fields and RNFL scores label the normal W/W perimetry hemifields in patients with glaucoma and ocular hypertension.

Design: A cohort study.

Participants and methods: Monochromatic RNFL photographs of 32 normal subjects and 29 patients with ocular hypertension and different stages of glaucoma were assessed in a masked fashion. The B/Y and W/W visual fields (program 30-2) were examined with a Humphrey perimeter. The results of both visual fields were adjusted for the patients' age and lens transmission index measured with a lens fluorometer.

Main outcome measure: Mean deviation (MD) of visual field and semiquantitative score of RNFL loss were measured.

Results: The total and hemifield MD values of B/Y and W/W visual field showed a statistically significant correlation with diffuse and overall score of RNFL loss in corresponding areas. The hemifield MD values of B/Y perimetry obtained from "normal" W/W hemifields of patients with early glaucoma were well correlated (r = -0.56) with respective RNFL loss scores found to be abnormal in 84% of hemispheres. The difference between the hemifield MD values of B/Y perimetry obtained from normal W/WAN hemifields of patients with ocular hypertension and patients with early glaucoma was not statistically significant (analysis of variance). The respective B/Y hemifield data of normal subjects were statistically significantly different from the data of patients with ocular hypertension and early glaucoma.

Conclusions: The hemifield MD values of B/Y perimetry correlate well with semiquantitative scores of RNFL loss obtained from the corresponding hemisphere. The B/Y perimetry as well as RNFL assessment may show glaucomatous defects in a hemifield found to be normal on W/W perimetry. In subjects with ocular hypertension, the functional damage detected by B/Y perimetry may, in some cases, precede RNFL defects on conversion to glaucoma.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Double-Blind Method
  • Female
  • Glaucoma, Open-Angle / diagnosis*
  • Glaucoma, Open-Angle / physiopathology
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Nerve Fibers / pathology*
  • Ocular Hypertension / diagnosis*
  • Ocular Hypertension / physiopathology
  • Optic Nerve / pathology*
  • Photography
  • Retina / pathology*
  • Visual Field Tests / methods
  • Visual Fields*