The visual field defects characteristic of glaucoma are closely related to the anatomy of the retinal nerve fiber layer and the optic papilla! As we all know, the retinal nerve fiber layer travels in a regular pattern. The more peripheral the nerve fibers are, the more they enter the peripheral part of the optic papilla; the more they are made near the central part, the more they are made near the central part of the optic papilla; the temporal nerve fibers are bounded by the horizontal line of the macula and enter the upper and lower part of the optic papilla respectively in an arc, while the nasal nerve fibers enter the optic papilla in a straight line. In addition, the nerve fibers in the macular region all enter the temporal part of the optic papilla and occupy the temporal side of the optic papilla in a triangular shape, and also the closer to the lateral side, the more they are close to the periphery of the optic papilla, and the more the nerve fibers in the central part of the macula are located in the central part of the optic papilla which is the apex of the triangle. According to the above anatomical characteristics, when the IOP rises to the optic papilla recession, the corresponding damage is bound to occur. First of all, in the early stage of IOP elevation, the optic papilla is mildly receded by pressure, and the nerve fibers are tugged towards the peripheral part of the optic papilla, so that the central part of the optic papilla is empty, which shows a mild enlargement of the optic cup at this time. As IOP continues to rise, the optic papilla becomes ischemic, the sieve plate atrophies, and the unsupported nerve fibers are squeezed more toward the tough scleral ring in the peripheral part of the optic papilla, so that the nerve fibers in the peripheral part are squeezed and the axial pulp flow is blocked; therefore, the nerve fibers in the peripheral part are necessarily damaged. However, the degree of damage to the nerve fibers in the peripheral part of the optic papilla is not uniform, which is related to the angle between the optic nerve and the eye axis. Under this angle, the nerve fibers in the temporal and inferior temporal margins of the optic papilla are the first to be damaged, and the nerve fibers in these areas come from the lateral macula and the inferior temporal arc of the retina respectively, so the clinical manifestation at this time is the formation of the paracentral dark spot on the nasal side and the nasal ladder. If the IOP continues to rise, the lateral nerve fibers continue to crowd into the peripheral scleral ring, and the fibers in the temporal area of the macula become more and more obviously damaged, while the nerve fibers near the peripheral part of the retina are also extensively damaged, then the paracentral dark spot is displaced to the temporal side, and may develop into a fusion of the arcuate wrapped central visual area and the physiological blind spot. The peripheral visual field defect moves increasingly closer to the center, progressing to the point where only the central macular vision remains (as these nerve fibers enter the central part of the optic papilla). In general, the superior temporal and inferior temporal nerve fibers are completely separated into the optic papilla due to the presence of horizontal lines, so that when manifested as a visual field defect, the nasal visual field defect is seen to be staggered by horizontal lines, forming a staircase. In addition to the characteristic visual field defect, the optic papilla changes are actually characteristic as well. At the very beginning, there is a loss of disc rim area on the inferior temporal side, then a loss of disc rim area in the superior temporal region, then the temporal side (in fact, the temporal side is damaged earlier, only because the temporal nerve fibers come from the macula in large and dense amounts, so it is difficult to be observed from the optic papilla in the early stage), and finally the loss of disc rim area progresses to the nasal side, and finally the whole disc rim area is severely lost and the optic cup occupies the whole optic disc. The main reason for emphasizing the importance of disc rim area in the early diagnosis of glaucoma now is to consider that the disc rim area actually represents the number of nerve fibers. The smaller the disc rim area, the more layers of nerve fibers are lost, and the more severe the glaucoma is the closer it is to the advanced stage. In addition, since the number of optic nerve fibers is approximately constant, the area of the disc rim is also relatively constant, so the larger the optic disc, the larger the optic cup must be. All of the above changes in the optic papilla have been confirmed by fundus HRT testing. The above are my personal thoughts. I have tried to find ready-made answers from various books, but there are no ready-made answers, only a brief statement that visual field damage is anatomically related, so we ignore the cause of the characteristic visual field defects in glaucoma.