[7ontheline]

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Thanks for the reply. I guess to clarify, what I mean is, if a patient has NO cupping (0.1), and had pressures of 28 or even 30, can they have field loss? Let's assume you have a patient you've seen for 10 years and each year he comes in his pressures creep up 1-2mmHG from 18 to 30 over a 10 year span but his ONH looks exactly the same (which is easy to tell bc there is NO cupping). Is it possible for him to have field loss from POAG?

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In this case it is pretty unlikely that he will have field loss. However, I would still get a baseline set of VFs because he certainly seems like he may be headed towards glaucoma. Better to have at least one documented normal field in a patient like this who you are certainly going to monitor. Optic nerve drusen are a possibility also if his nerve appears crowded with no cup whatsoever. I would absolutely have a corneal thickness measurement as well. If it comes back at 600 I feel a lot better. If it is 500 I may even start treatment because the results of the OHTS study give this guy a high probability of advancing to glaucoma (don't remember exact numbers, but I think around 20%) - although if his cup is so small and his fields are normal I might wait. It would depend on what the patient wanted also.