THE SIGNIFICANCE OF CENTRAL VISUAL FIELD DEFECTSIN PRIMARY OPEN-ANGLE GLAUCOMA

Abstract

Introduction: In primary open-angle glaucoma (POAG), the focus has traditionally been on peripheral visual field defects. However, over the past 15 years, it has become apparent that the central visual field is affected at an early stage in POAG. The fundamentals and the most important risk factors will be presented.
Methods: This study is a literature review. Databases including PubMed, Scopus, Web of Science, and
Springer were searched using the terms “central visual field” and “glaucoma” for the period from 2000
to 2025. Duplicates were removed. The selected literature focused on the role of lamina cribrosa, ocular
microcirculation, and neurodegeneration in glaucoma.
Results: Approximately 50% of retinal ganglion cells (RGCs) are responsible for the central 16° of the
visual field alone, and around 40% of these cells are affected in POAG. This leads to abnormalities in the
central visual field even in the early stages of POAG. The problem is that the 24-2 or 30-2 visual field
program does not adequately detect these central disturbances. The degeneration of RGCs and their nerve
fibers is a complex process involving mechanical (intraocular pressure), vascular, and, above all, inflammatory processes.
Conclusion: Central RGC loss is not only associated with early central visual field defects, but also leads to
color vision defects, contrast sensitivity defects, crowding, and reading difficulties, which significantly impair patients’ everyday lives. Therefore, in addition to adjusting intraocular pressure to the individual target
pressure range, it is particularly important to have general systemic diseases such as arterial hypertension
and diabetes mellitus optimally controlled by an internist and to avoid a nocturnal drop in blood pressure.
Key words: central visual field, lamina cribrosa, glaucoma, neurodegeneration, microcirculation.