The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 1, January/February 2017 Original Study - Clinical

Assessing Precision of Hodapp-Parrish-Anderson Criteria for Staging Early Glaucomatous Damage in an Ocular Hypertension Cohort: A Retrospective Study

Chakravarti, Tutul

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From The Eye and Glaucoma Care and Vivekananda Institute of Medical Sciences, West Bengal, India.


Reprints: Tutul Chakravarti, MBBS, DO, DNB, PG DIP (In Epidemiology), Eye and Glaucoma Care, 18/32, Dover Lane, Kolkata-29, Pin-700 029, West Bengal, India. E-mail:;



Purpose: The aims of the study were (1) to stage early glaucomatous field defects following Hodapp-Parrish-anderson (HPA) criteria in an ocular hypertension (OH) cohort with 7-year follow-up and (2) to recognize the limitation(s) of this staging system.


Design: A retrospective review of subjects with OH.


Methods: A retrospective review of the visual fields of 183 OH subjects was conducted. A Humphrey Field Analyzer was used for standard automated perimetry in all these participants, tested once every half year for 7 years or until the onset of conversion (study end point). Only nerve fiber bundle glaucomatous abnormalities were identified as per the Ocular Hypertension Treatment Study guideline and considered as converted glaucoma cases from OH. Subsequently, those fields were classified as possible, probable, and definite glaucoma cases following hpa criteria. This study also recognized the limitations of Glaucoma Hemifield Test (GHT) interpretation and the depth and distribution of real scotoma. The criterion for reproducible abnormalities was 3 consecutive abnormal fields with defects in a similar location.


Results: Early glaucomatous defects were identified in 22 patients (27 fields) of 183 OH subjects. Seven of 27 eyes were identified as possible glaucoma, 12 as probable glaucoma, and 8 as definite glaucoma. The GHT was interpreted as within normal limits for 5 cases, borderline for 11 cases, and outside normal limits for 11 cases.


Conclusions: Hodapp-Parrish-Anderson criteria can recognize subtle nerve damage to diagnose early glaucoma. Visual field abnormalities classified as definite glaucoma cases are less prone to false labeling than normal fields, whereas field defects identified as probable/possible glaucoma may remain underdiagnosed for imprecise GHT interpretations and poor specification of cluster analysis in pattern standard deviation.

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