Screening for Glaucoma in a Medical Clinic With Photographs of the Nerve Fiber Layer

Purpose: To evaluate nerve fiber layer photography as a method for glaucoma screening in a general medical clinic setting. Methods: One hundred seventy-one persons who attended an academic hospital medical clinic were administered a questionnaire and underwent a complete eye examination, including automated perimetry and photography of the optic disc and nerve fiber layer. Results: Eighteen patients were diagnosed as having primary glaucoma; one, secondary glaucoma; and 21 were suspected of having glaucoma. Nerve fiber layer photographs were taken on 145 persons (85%) and were readable in 136 (80%) of the sample of 171 subjects. Nerve fiber layer atrophy was detected on masked evaluation in 64% of those with glaucoma, in 28% of those suspected of having glaucoma, and in 16% of persons who did not meet the criteria for glaucoma. Conclusions: Nerve fiber layer photography can be carried out as a screening method and can identify a substantial proportion of those with glaucoma. It compares favorably with tonometry, cup-disc ratio estimation, or screening visual field examination for glaucoma detection.