In Humphrey visual field testing, a patient with suspected glaucoma has a mean deviation (MD) of -8 dB and a pattern standard deviation (PSD) of 7 dB. The glaucoma hemifield test (GHT) reports 'outside normal limits.' The RNFL shows diffuse thinning on OCT. How would this field be classified on the Hodapp-Parrish-Anderson (HPA) scale?

• A Early glaucomatous field loss (MD better than -6 dB with no central scotoma)
• B Advanced glaucomatous field loss (MD worse than -12 dB)
• C Moderate glaucomatous field loss (MD -6 to -12 dB) ✓
• D Borderline — not classifiable without additional testing

Explanation

The Hodapp-Parrish-Anderson criteria classify glaucomatous visual field loss based on MD, PSD, and location/depth of defects relative to fixation. Moderate glaucomatous field loss is defined as MD between -6 dB and -12 dB. An MD of -8 dB falls in this range. Early loss has MD better than -6 dB (less than 6 dB depression), and advanced loss has MD worse than -12 dB. The elevated PSD (>7 dB is high) and abnormal GHT further support localised glaucomatous damage. Classification guides the aggressiveness of management.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.