The Glenn A. Fry Award Lecture. Early losses of visual function in glaucoma.

Getting back to the questions raised by Dr. Enoch 12 years ago, I believe that we have made significant progress in the early psychophysical detection of glaucoma and that we are either on the right track or considerably closer to it. The continuing progress in conventional automated perimetry has improved the overall quality of visual field testing in the ophthalmic community, as well as providing standardization and state-of-the-art analysis procedures for everyone. We have certainly not solved the problem of early detection of glaucoma, but we now have more sensitive procedures that are available for existing clinical instrumentation. SWAP has clearly shown that it is able to detect glaucomatous losses several years before they are evident by conventional automated perimetry, and results from the other test procedures mentioned earlier are also very encouraging. Thus, although we may not yet have the pot of gold, we have been able to pick up a few valuable nuggets along the way. This leads me to believe that the current approaches are on the right track. However, Dr. Enoch's message should also serve to remind us that there are few panaceas for early detection of functional loss in glaucoma. Our progress to date has been influenced by our greater understanding of the properties of visual mechanisms and the pathophysiology of glaucoma. It has also been driven by clever and innovative approaches and new test procedures, as well as advances in technology. However, it has also been based on a considerable amount of research effort in the form of long-term prospective longitudinal studies of large populations of normal observers, patients with various stages of glaucomatous damage, and patients at risk of developing glaucoma. Answers to all of the issues pertaining to the ultimate clinical value of psychophysical procedures for early detection of glaucoma do not come quickly, but they are of vital importance to ocular health care. I hope that my brief discussion of new developments in psychophysical detection of glaucoma has convinced you that significant progress has been made, and that some of you will be motivated to join in this important research endeavor.