[Prevalence of chronic open-angle glaucoma in a county in Tunis].
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Abstract Current best practice for primary open‐angle glaucoma case‐finding comprises history‐taking, disc examination, intraocular pressure measurement and suprathreshold visual field analysis (SVFA). An alternative case‐finding technique was formulated replacing SVFA with computerised quantitative disc assessment, using the Heidelberg retinal tomograph II (HRT II). Each approach was adopted by four optometrists who screened 29 POAG and 37 normal patients. Average sensitivities and specificities were similar in the two groups [sensitivity 71% (SVFA) vs 69% (HRT II); specificity 94% both groups]. Our inclusion of pre‐perimetric glaucoma cases limited the sensitivity of the optometrists in this study. There was evidence to suggest that the optometrists tended to miss early changes at the optic disc such as disc haemorrhage, nerve fibre layer defects and subtle neuroretinal thinning.
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BACKGROUND: Primary open angle glaucoma is characterized by quantifiable parameters including the intraocular pressure, the aqueous outflow facility, and geometric measurements of the optic disc and visual defects. Despite this, diagnosis remains controversial.OBJECTIVE: To review the current concepts in the diagnosis of primary open angle glaucoma and adapt them to situations where high technology facilities are lacking.DATA SOURCE: Information was obtained from journals/medline, Hinari, the American Academy of Ophthalmology preferred practice pattern CD, and reputable textbooks using publications from 1972 to 2007.RESULTS: The Preferred Practice Pattern Committee of the American Academy of Ophthalmology recommends that the comprehensive initial glaucoma evaluation (history and physical examination) includes comprehensive adult eye evaluation with special attention to those factors that specifically bear on the diagnosis such as the optic disc, nerve fibre layer and visual field evaluation, open anterior chamber angles on gonioscopy and absence of secondary causes of glaucoma. Intraocularpressure is no longer relied on in the diagnosis of primary open angle glaucoma. Sequential evaluation of optic disc cup and size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of peripapillary atrophy, and presence of retinal or optic disc haemorrhages enhance the ability to detect glaucomatous damages. CONCLUSION: A simple systematic approach in examination of the optic discs and visual field will improve accurate diagnosis of glaucoma.Key words: Glaucoma, diagnosis, optic disc, visual fields, review article.WAJM 2009; 28(3): 141–147.
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To determine if eyes with larger optic disc area are more likely to have open-angle glaucoma or to have glaucoma at lower intraocular pressure (IOP).Data were collected from a population-based sample of adults residing in East Baltimore, consisting of demographic information, ocular examinations, automated and static/kinetic visual field tests, IOP as measured by applanation tonometry, and image analysis of the optic disc. Optic disc area was calculated using refractive error to correct magnification. Open-angle glaucoma was defined by visual field and optic disc criteria. One eye from each of 75 patients with glaucoma was compared to those of 3,518 subjects without glaucoma.Although optic disc area was somewhat larger among patients with glaucoma than control subjects, in a regression model adjusting for age, gender, and race, the significance of this difference had a probability of 0.06. Among patients with glaucoma, disc area was not related to IOP level measured at study examination.Disc area is a weak risk factor for open-angle glaucoma. Disc area did not differ between patients with glaucoma who had lower IOP and those who had higher IOP among a group with glaucoma that were identified in a population survey.
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