Korean J Ophthalmol Vol.25, No.1, 2011 compressing the optic chiasm or the optic nerve. Because le- sions that damage the body of the optic chiasm characteristi- cally produce bitemporal hemianopia [15], bitemporal field changes were the most common field defects on presentation in pituitary adenoma. However, according to tumor size and optic chiasmal position, a variety of field defects from mon- ocular superior temporal defects to bilaterally constricted fields can be produced [6]. In our study, there were 29 pa- tients (74%) with VF defects and bitemporal hemianopsia was also the most common type. In addition, there were sev- en monocular VF defects respecting the vertical meridian and three homonymous hemianopsia. Hershenfeld and Sharpe [16] reported that the cause of 64% of monocular hemianopsia was pituitary adenoma and several authors re- ported that it can cause homonymous hemianopsia [6,17]. Therefore brain imaging should be considered if patients showed not only binocular but also monocular VF defects re- specting the vertical meridian. Currently the automated perimetry is the gold standard for VF testing and most automated perimetry is superior to Goldmann perimetry in terms of sensitivity and quantifica- tion of the VF defects [7,18,19]. In addition, many studies showed that automated perimetry was comparable to Goldmann perimetry in detecting VF abnormalities in neuro- logical diseases [7-9]. A recent study compared SITA Fast strategy with Goldmann perimetry in the detection and char- acterization of VF defects in neuro-ophthalmic practice [20]. They showed that the SITA Fast strategy was useful in de- tection and quantification of central VF defects, and might be preferable to Goldmann perimetry in patients with neu- ro-ophthalmic disorders. There are few studies which evaluated automated peri- metry in patients with pituitary adenoma [13,21] and these studies used the full-threshold strategy. An increased varia- bility of the full-threshold strategy has been demonstrated in elderly populations and patients with VF defects [22,23]. In our study, we used a SITA strategy that was recently devel- oped and shortens testing time for the standard Humphrey strategy but does not seem to affect variability [12]. It is known that increasing the test duration may influence the ac- curacy of the information obtained because of visual fatigue. For examination of the central 30o of VF in normal in- dividuals, the SITA standard reduced the test time by up to 50% in comparison with the full-threshold strategy [24,25]. In our study, the average test time of the central 24o of VF was only 5.87 minutes per eye. The relationship of pituitary tumor size and VF defects has been reviewed in several studies. Rivoal et al. [6] demon- strated that patients with VF abnormality had larger tumors and only the size of the adenoma was a significant factor for VF defects. Thomas et al. [13] demonstrated that the severity of field defects and visual loss were related to tumor size. Our results support those of previous studies that there is close correlation between tumor size and VF defects. However, we used different parameters from previous stud- 40 ies to evaluate a more accurate correlation. Because a tumor is a three dimensional structure, we measured the tumor by volume not by area. To quantify VF defects, we used the MD and PSD values of Humphrey perimeter. MD provides useful information concerning overall abnormality of a single field, as well as information regarding the worsening or improve- ment of fields over time. PSD shows the pattern of a localized abnormality [26]. Both of the parameters are expressed nu- merically, so those are useful to quantify the VF defects more accurately. Gedik et al. [21] also used the MD and PSD for evaluating VF defects and found there was no significant cor- relation between tumor size and MD or PSD. However dif- ferent from our study, they used a 30-2 full-threshold strategy. As mentioned above, full-threshold strategy has some weak- nesses and in the peripheral rim of points, a 30-2 program could have edge or lens rim artifact and response variability [26]. In summary, we used the SITA strategy to analyze VF of pituitary macroadenoma. Like the results of other VF programs, most of the VF defects were monocular or binocular hemi- anopsia respecting the vertical meridian. Furthermore, using the Humphrey parameters we measured VF defects quantita- tively and there was a high correlation between the tumor volume and the severity of VF defects. We think the SITA strategy can be a fast and quantitative method in evaluating central VF defects of patients with pituitary macroadenoma. 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