24-2 Perimetry Outperforms 10-2 in Detecting Glaucomatous Damage

The 24-2 standard automated perimetry test should be the preferred method of assessing glaucomatous damage.

The standard automated perimetry (SAP) 24-2 test more accurately detects glaucomatous damage compared with the 10-2 test, as confirmed by optical coherence tomography (OCT), according to a study published in Ophthalmology Glaucoma

Researchers analyzed 1375 pairs of 10-2 and 24-2 SAP tests from 569 eyes of 339 participants (52.5% women). In total, 440 (77%) eyes received a diagnosis of glaucoma, while the remaining 129 (23%) eyes served as controls. All participants underwent comprehensive ophthalmic examinations including 10-2 and 24-2 SAP within 30 days of each other.  

The team quantified glaucomatous severity based on OCT macula ganglion cell layer (mGCL) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness and used the area under the receiver operating characteristic curve (AUC) to compare 10-2 and 24-2 metrics for distinguishing healthy eyes from eyes with glaucoma, at different stages of disease severity. 

[T]his study found that SAP testing with the 24-2 pattern was generally superior to 10-2 testing for detecting glaucoma damage, as measured by OCT.

According to the report, the overall AUC for mean deviation (MD) for the 24-2 test (0.808) was significantly higher compared with the 10-2 SAP (AUC: 0.742; P <.001). An analysis of different stages of disease severity revealed that the 24-2 test outperformed the 10-2 in identifying structural macular damage, particularly in earlier disease stages. 

For identification of eyes with early damage (1st quartile), the 24-2 MD had an AUC of 0.658 vs 0.590 for 10-2 MD (P =.018). And for identification of eyes with advanced damage (4th quartile), the 24-2 MD had an AUC of 0.954 vs 0.903 for 10-2 MD (P =.013). The team observed similar trends when glaucoma severity was defined according to structural macular damage with mGCL thickness.

“[T]his study found that SAP testing with the 24-2 pattern was generally superior to 10-2 testing for detecting glaucoma damage, as measured by OCT,” according to the researchers. “Our findings suggest that the 24-2 test should in general be the preferred method for visual function assessment in glaucoma.”

Study limitations include a single center design and strict inclusion of participants who had primary open-angle glaucoma. 

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Onyekaba NAE, Estrela T, Naithani R, McCarthy KM, Jammal AA, Medeiros FA. Comparison of 10-2 and 24-2 perimetry to diagnose glaucoma using OCT as an independent reference standard. Ophthalmol Glaucoma. Published online September 7, 2022. doi:10.1016/j.ogla.2022.08.017