Glaucoma screening
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American Roentgen Ray Society Images of Glaucoma screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]
Overview
The purpose of glaucoma screening tests is to detect those with early stage disease, so that these patients can be treated to reduce the risk of visual field loss. The patients in the pre-perimetric stage of glaucoma, screening tests only evaluate the optic nerve and the NFL
Screening
- There has been emphasis on glaucoma screening, since usually there is an insidious start of the disease (with no clear start point, POAG), and progression in many cases is slow and unnoticed b the patient.
- Additionally, there is a recognized stage of the disease in which patients are apparently in a pre-perimetric (before loss of the visual field is present) stage, bringing a challenge to the diagnosis and screening techniques.
- The purpose of glaucoma screening tests is to detect those with early stage disease, so that these patients can be treated to reduce the risk of visual field loss.
- The patients in the pre-perimetric stage of glaucoma, screening tests only evaluate the optic nerve and the NFL.[1]
- Optic nerve and retinal nerve fiber layer imaging is used to detect anatomic alterations.
- The OCT of the optic nerve; the new spectral domain OCT is now being used commonly to screen for loss of the retinal fiber layer in glaucoma. However clinical evaluation is paramount, the increase in vertical cup/disc ratio, the appearance of cup notching or hemorrhages in the disc are taken as a positive screening for glaucoma.[2]
- It is recommended that stereoscopic pictures of the optic nerve be taken with some regularity, and is considered as the most sensitive early detection method.
- Caution must be taken due to the fact that there is certain variability between observers, and to the fact that there is no gold standard unique test for the diagnosis of glaucoma, but rather a set of factors that all together lead to the diagnosis.[3]
- Every patient during a visit to an ophthalmologist is checked for visual acuity, intraocular pressure and cup/disc ratio as part of the optic nerve assessment.
- If any of those key points raises suspicion such as decreased visual acuity (with no other apparent cause), high or borderline intraocular pressure, or a characteristic glaucomatous vertical optic nerve excavation or disc hemorrhages studies are ordered for a more detailed evaluation of the optic nerve fibers and visual function.[4]
- The rate of progression through at multiple time points should be recorded since it fundamental for diagnostic and treatment decisions.
References
- ↑ Yanoff, Myron (2013). Ophthalmology. London: Elsevier/Saunders. ISBN 978-1-4557-3984-4.
- ↑ Yanoff, Myron (2013). Ophthalmology. London: Elsevier/Saunders. ISBN 978-1-4557-3984-4.
- ↑ Vidas, S; Popović-Suić, S; Novak Lauš, K; Jandroković, S; Tomić, M; Jukić, T; Kalauz, M (2017). "Analysis of Ganglion Cell Complex and Retinal Nerve Fiber Layer Thickness in Glaucoma Diagnosis". Acta clinica Croatica. 56 (3): 382–390. doi:10.20471/acc.2017.56.03.04. ISSN 0353-9466. PMID 29479903.
- ↑ "Glaucoma Screening". EyeWiki. 2016-01-04. Retrieved 2018-03-05.