Visual field, if the visual acuity is sufficient; nerve fiber layer retinal test (GDX), pachymetry, tomography of optic nerve and ocular pressure, need you to know if glaucoma is or not progressing.

Thanks a lot for your answer. What do you do as a functional test if visual acuity is not sufficient for a visual field test? The other examinations which you are describing and which mainly focus on structural changes are often too expensive in my setting.

Usually central visula field test (Humphrey Field Analyzer, Central 10-1) is suitable for advanced-stage glaucoma.  But if visual acuity is too low for reliable visual field test, visual acuity itself can be a significant parameter for the follow-up. In addition, probably measurement of CFF (central flicker frequency) is not so expensive and can be used for assessment of the functional damage.

Thanks a lot, I'll look into that

Why not try Tangent or Bjerrum screen in very advanced disease  - also useful if patient a little slow with responses or low educational level.

Thanks a lot for your helpful answer! This is very interesting and helpful!

In chidren:biometric changes, refractive changes and IOP under general anethesia. Have you experience in no

contact tonometry?

Thank you very much for your reply. You mention important structural changes in children with glaucoma. Concerning IOP, in children we also use iCare, often replacing IOP under general anaesthesia. What are your experiences with functional tests such as VA, contrast sensitivity, Amsler-Grid, Visual Field etc.?

To quantify and follow up in advanced glaucoma is diagnostic challenge. Visual field examination is either unreliable or impossible.

Only when central island of vision remains , visual field tests of the central degrees should be chosen( central Humphery 10-2 program with a size lll or size V  while carefully examining the cardinal points around fixation, as well as quadrant totals)

Listen to your patients- they will say "Its getting darker".The patient who notices decline in activities such as reading and driving may help certify results of a functional and structural tests( changes in neuroretinal rim)

a small word on Amsler grid as you asked about it repeatedly: in my experience amsler grid CAN show a defect that is located in or reaching the (para)central area, and in these cases can be used to confirm the extent of the central scotoma. However many (or even most) patients with advanced or end-stage VF defects and proven central scotoma on a 10° VF test will report their amsler as being 'normal', even when explicitely drawn attention to the area of a proven scotoma. This presumably due to cortical processing (see: Bull Soc Belge Ophtalmol. 2003;(287):65-71.

New insights into the subjective perception of visual field defects.

Hoste AM1.)

mostly objective methods like OCT, field will probably be of low yield in advanced glaucoma

Amsler grid is used for central visual field defect- very useful in age-related macular degeneration, but not in glaucoma

Visual field testing is a gold standart, more progressive techniques blue on yellow and sure monitoring nerve fiber thickness based on OCT, 3D OCT- Heidelberg engineering, etc.

Good luck !