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IMPORTANCE: This study evaluates two rapid electrophysiological glaucoma diagnostic tests that may add a functional perspective to glaucoma diagnosis. BACKGROUND: This study aimed to determine the ability of two office-based electrophysiological diagnostic tests, steady-state pattern electroretinogram and short-duration transient visual evoked potentials, to discern between glaucomatous and healthy eyes. DESIGN: This is a cross-sectional study in a hospital setting. PARTICIPANTS: Forty-one patients with glaucoma and 41 healthy volunteers participated in the study. METHODS: Steady-state pattern electroretinogram and short-duration transient visual evoked potential testing was conducted in glaucomatous and healthy eyes. A 64-bar-size stimulus with both a low-contrast and high-contrast setting was used to compare steady-state pattern electroretinogram parameters in both groups. A low-contrast and high-contrast checkerboard stimulus was used to measure short-duration transient visual evoked potential parameters in both groups. MAIN OUTCOME MEASURES: Steady-state pattern electroretinogram parameters compared were MagnitudeD, MagnitudeD/Magnitude ratio, and the signal-to-noise ratio. Short-duration transient visual evoked potential parameters compared were amplitude and latency. RESULTS: MagnitudeD was significantly lower in glaucoma patients when using a low-contrast (P = 0.001) and high-contrast (P < 0.001) 64-bar-size steady-state pattern electroretinogram stimulus. MagnitudeD/Magnitude ratio and SNR were significantly lower in the glaucoma group when using a high-contrast 64-bar-size stimulus (P < 0.001 and P = 0.010, respectively). Short-duration transient visual evoked potential amplitude and latency were not significantly different between the two groups. CONCLUSIONS AND RELEVANCE: Steady-state pattern electroretinogram was effectively able to discern between glaucomatous and healthy eyes. Steady-state pattern electroretinogram may thus have a role as a clinically useful electrophysiological diagnostic tool.
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Eletrorretinografia/métodos , Potenciais Evocados Visuais/fisiologia , Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular/fisiologia , Idoso , Estudos Transversais , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Campos Visuais/fisiologiaRESUMO
PURPOSE: To determine the outcomes of Ahmed glaucoma valve (AGV; New World Medical Inc) and Baerveldt glaucoma implant (BGI; Advanced Medical Optics) surgery in the setting of neovascular glaucoma (NVG). DESIGN: Single-center, retrospective study. PARTICIPANTS: Consecutive patients who underwent AGV or BGI surgery for the treatment of NVG and had ≥6 months of follow-up. METHODS: Chart review of AGV and BGI surgical outcomes in patients with NVG. MAIN OUTCOME MEASURES: Progression to no light perception (NLP) vision and 6-month surgical failure, which was defined as intraocular pressure (IOP) >21 mmHg with medications or <5 mmHg at 2 consecutive visits, or glaucoma reoperation. RESULTS: A total of 152 eyes (91 AGV, 61 BGI) were included with an average follow-up of 29.6 ± 25.8 months. Baseline demographics and clinical characteristics were comparable between groups. At month 6, failure was similar between AGV and BGI eyes (21.6% vs. 25.9%; P = 0.552), but glaucoma medication use was lower in BGI eyes (P < 0.001). At the final visit, 18.7% of AGV and 14.8% of BGI eyes progressed to NLP vision (P = 0.530), and medication use was lower in BGI eyes (P < 0.0001). Multivariate analysis identified lower preoperative visual acuity (VA) (P = 0.001), failure to receive panretinal photocoagulation within 2 weeks of surgery (P = 0.003), and bilaterality of the underlying ischemic retinal pathology (P = 0.026) as the strongest predictors of NLP outcome. Age, sex, race, NVG etiology, tube type, preoperative IOP, extent of synechial angle closure preoperatively, preoperative hyphema, IOP at the first NLP visit, and final IOP were not significant predictors of NLP vision. CONCLUSIONS: Eyes with AGV and BGI had comparable outcomes in NVG, although fewer medications were required in BGI eyes to control IOP. Progression to NLP vision was associated with poor baseline VA, delayed retinal treatment, and bilaterality of the underlying ischemic retinal pathology.
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Implantes para Drenagem de Glaucoma , Glaucoma Neovascular , Seguimentos , Glaucoma Neovascular/etiologia , Humanos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PRECIS: Patients with Centers For Medicare and Medicaid Services (CMS)-defined severe glaucoma often have clinically useful remaining retinal nerve fiber layer (RNFL), suggesting that structurally based rather than functionally based criteria would be more appropriate to use as guidelines for the utilization of optical coherence tomography (OCT) imaging. PURPOSE: RNFL OCT in glaucomatous eyes with advanced structural damage can reach a floor after which there is no further detectable thinning of RNFL. Insurers are considering limiting coverage for OCT in "severe stage glaucoma" defined by CMS. However, CMS definitions of severe glaucoma are based primarily on visual field criteria. Many of these patients may have preserved RNFL in other sectors. This study aims to assess the clinical utility of RNFL measurements by OCT in eyes with CMS-defined severe glaucoma. PATIENTS AND METHODS: Medical records of patients with CMS-defined severe glaucoma were consecutively reviewed. Data collected included average/sectoral RNFL thickness, and visual field mean deviation. Previous estimates of RNFL floor and test-retest variability for Cirrus OCT were used to establish 3 threshold values of RNFL. Data analysis included descriptive statistics, χ analysis, and analysis of variance. RESULTS: A total of 129 eyes qualified (age: 71±12 y; mean deviation: -13.5±4.3 dB; average RNFL: 60.9±7.9 µm), A majority (66%) of eyes met severe glaucoma criteria with defects in both hemifields; 34% met only paracentral defect criteria. The proportion of eyes that had significant remaining average, superior, or inferior RNFL, estimated by thresholds 1 to 3, was 21% to 54%, 29% to 51%, and 16% to 37%, respectively. At least 1 vertical quadrant had significant remaining RNFL in 35% to 66% of eyes, depending on the threshold used. CONCLUSIONS: Our data demonstrate a substantial portion of eyes with CMS-defined severe glaucoma have measurable RNFL above the floor in at least 1 vertical quadrant that may be longitudinally monitored for progression. The presence of CMS-defined severe glaucoma does not exclude the potential utility of OCT to monitor progression.
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Centers for Medicare and Medicaid Services, U.S./classificação , Glaucoma/classificação , Glaucoma/diagnóstico , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Campos Visuais/fisiologiaRESUMO
PRECIS: Baerveldt glaucoma drainage device demonstrated a greater reduction in intraocular pressure (IOP) than Ahmed in patients with uveitic glaucoma. The most common cause of failure was uncontrolled IOP in Ahmed and hypotony in the Baerveldt group. PURPOSE: To compare the efficacy and safety of Ahmed and Baerveldt glaucoma drainage devices in uveitic glaucoma. MATERIALS AND METHODS: The retrospective comparative study included patients with uveitic glaucoma who underwent Ahmed or Baerveldt glaucoma drainage device implantation with a minimum follow-up of 3 months. Success was defined as IOP ≥6 and ≤21 mm Hg and >20% reduction on 2 consecutive visits after the third month with (qualified success) or without (complete success) medications and no further glaucoma surgery or loss of vision. IOP, number of medications, visual acuity, complications, and interventions were compared between groups. RESULTS: In total, 137 eyes of 122 patients (67 Ahmed, 70 Baerveldt) were included. The preoperative IOP and number of medications in the Ahmed group (32.7±10.3 mm Hg; 4.1±1.3) were similar to Baerveldt (32.1±10.2 mm Hg; 4.3±1.3; P=0.73, 0.35). These at the last follow-up were (18.1±9.8 mm Hg; 2.1±1) in Ahmed and (12.7±6.9 mm Hg; 1.3±1.3) in Baerveldt groups (P=0.04, 0.01). The Baerveldt had greater IOP reduction (60.3% vs. 44.5%) and complete success rate (30% vs. 9%) with higher complication rate (51.4% vs. 20.9%) (all P≤0.05). The de novo glaucoma reoperation rate was 19% in the Ahmed group and 4% in the Baerveldt group (P=0.006). Hypotony resulted in failure in 7 eyes (10%) in the Baerveldt group and none in the Ahmed group (P=0.013). CONCLUSIONS: Higher complete success rate and significantly greater reduction in mean IOP and number of medications were observed in the Baerveldt group, but with a higher rate of complications including hypotony.
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Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Implantação de Prótese , Uveíte/complicações , Idoso , Feminino , Seguimentos , Glaucoma/etiologia , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Tonometria Ocular , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
OBJECTIVE: To determine the test-retest repeatability of minimum rim width and retinal nerve fibre layer thickness measurements obtained by spectral-domain optical coherence tomography using the Anatomic Positioning System protocol in glaucoma patients and controls. Also, to assess the ability of the minimum rim width and retinal nerve fibre layer thickness to diagnose glaucoma in 2 circular peripapillary locations. METHODS: Spectral domain optical coherence tomography scans of the optic nerve head were obtained twice during the same visit using the Anatomic Positioning System eye-tracking protocol. The minimum rim width and retinal nerve fibre layer thickness were measured at 3 circular diameters (3.5 mm, 4.1 mm, and 4.7 mm). Intraclass correlation coefficients and area under the receiver operating characteristic were calculated for these parameters. RESULTS: A total of 36 glaucomatous eyes and 59 control eyes were included in the analysis. The intraclass correlation coefficients of minimum rim width and retinal nerve fibre layer thickness global measurement for 3.5 mm and 4.1 mm circles ranged between 0.98 and 1.00 and for 4.7 mm circle was between 0.76 and 1.00. The minimum rim width had an area under the receiver operating characteristic of 0.97, while the retinal nerve fibre layer thickness measurements had an area under the receiver operating characteristic of 0.95, 0.95, and 0.96 for the 3.5 mm, 4.1 mm, and 4.7 mm circles, respectively. CONCLUSIONS: The minimum rim width and retinal nerve fibre layer thickness measurements using the Anatomic Positioning System protocol had overall excellent reproducibility and diagnostic performance. Using this protocol and the novel minimum rim width parameter may be useful in more accurate diagnosis and follow-up of patients with glaucoma.
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Glaucoma/diagnóstico , Pressão Intraocular/fisiologia , Disco Óptico/patologia , Posicionamento do Paciente/instrumentação , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Idoso , Estudos Transversais , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROCRESUMO
PURPOSE: The purpose of this study was to determine how clinical measures, performance-based measures and subjective assessments of vision-related quality of life (VRQoL) are affected in patients with rapid glaucoma progression. METHODS: Prospective longitudinal study that included 153 patients diagnosed with moderate glaucoma. A subset of patients that presented with rapid glaucoma progression (n=22), defined as visual field (VF) mean deviation (MD) loss >2.0 dB/y, were compared with patients with nonrapid progression (n=131). Groups were compared using t tests, χ, or Fisher exact test. Main outcome measures were visual acuity (VA), VF MD, retinal nerve fiber layer thickness (RNFL), contrast sensitivity (CS), Compressed Assessment of Ability Related to Vision (CAARV), and Rasch calibrated National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores. RESULTS: At baseline, patients who progressed rapidly had lower measurements of VA (P=0.041), VF MD (P<0.001), Pelli-Robson score (P=0.004), Spaeth/Richman Contrast Sensitivity (SPARCS) score (P=0.001), RNFL thickness (P=0.009), CAARV total score (P<0.001), and NEI-VFQ-25 composite score (P=0.03). A multivariable logistic regression was performed and showed VF MD to be the only baseline independent predictor of rapid progression. After 1 year, patients who progressed rapidly also had a significant decrease in SPARCS score (P=0.04). CONCLUSIONS: Factors associated with rapid glaucoma progression included worse VF MD decreased scores of performance-based measures and subjectively worse VRQoL. After 1 year, rapid progressors had a significant reduction in contrast sensitivity as measured by SPARCS.
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Glaucoma/diagnóstico , Qualidade de Vida/psicologia , Transtornos da Visão/diagnóstico , Visão Ocular/fisiologia , Adulto , Idoso , Sensibilidades de Contraste , Progressão da Doença , Feminino , Glaucoma/fisiopatologia , Glaucoma/psicologia , Humanos , Pressão Intraocular/fisiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Perfil de Impacto da Doença , Inquéritos e Questionários , Transtornos da Visão/fisiopatologia , Transtornos da Visão/psicologia , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologiaRESUMO
AIMS: To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2). METHODS: A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants' local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis. RESULTS: Of 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (±SD) of 60.6±11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2. CONCLUSIONS: This screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg. TRIAL REGISTRATION NUMBER: NCT02390245.
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Glaucoma de Ângulo Aberto/diagnóstico , Exame Físico/métodos , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Técnicas de Diagnóstico Oftalmológico , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Philadelphia , Fotografação , Tonometria Ocular , Acuidade Visual/fisiologiaRESUMO
PURPOSE: We compare the prevalence of glaucoma in professional wind versus non-wind instrument players in the Philadelphia Orchestra. Visual field changes in individuals with glaucoma and glaucoma suspects were evaluated, and the results were correlated with cumulative practice time. METHODS: In this cross-sectional, observational study, fifty-one Philadelphia Orchestra musicians were enrolled and categorized as wind or non-wind instrument players. All study participants underwent screening fundus photography. Participants with optic discs suspicious for glaucoma underwent further evaluation, including standard automated visual field perimetry and a comprehensive eye examination by a glaucoma specialist. RESULTS: Of the 51 musicians enrolled, 9 of the 21 wind instrument players (43%) and 8 of the 30 non-wind instrument players (27%) were suspected of developing glaucoma in at least one eye (P = 0.25), with examinations performed on 12 of the 17 returning musicians (71%) for further confirmation. Wind instrument players exhibited significantly higher Octopus visual field mean defect scores (1.08 ± 1.5 dB) than non-wind instrument players (-0.43 ± 0.7 dB; P < 0.001). There was a significant association between cumulative hours playing wind instruments and visual field mean defect (P < 0.001). CONCLUSION: Among members of the Philadelphia Orchestra, the difference in prevalence of glaucoma suspicious optic discs between wind and non-wind instrument players was not significant. The clinical significance of the greater visual field mean defect found in wind instrument players, and the association between the degree of visual field mean defect and the cumulative practice-time of playing wind instruments, needs further investigation.
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PURPOSE: To assess the accuracy of surrogate decision making for elective cataract surgery. SETTING: Comprehensive Ophthalmology Department of Tertiary Care Hospital. METHODS: Decisions regarding elective cataract surgery of currently competent, elderly patients were compared with the predictions of patient-identified surrogate decision makers in scenarios of current state of mental health and progressive dementia. Patients were identified (age >50 years, Mini-Mental Status Score >20, absence of significant noncataract pathology) consecutively at a scheduled clinic visit to a single provider. Preferences for cataract surgery in the current state of health and hypothetical progressive dementia were assessed on a Likert scale. The same interviewer contacted patient-identified surrogate decision makers within 48 hours. Independently, a survey of community ophthalmologists was performed. The concordance of surrogate predictions with patient preferences (32 pairs) was assessed using percentage agreement, the kappa coefficient with dichotomous Likert scale data, and chi-square analyses (concordance beyond chance). RESULTS: In their current state of health, most patients said they would prefer to have surgery if they were deemed to have a visually significant cataract, which was accurately predicted by surrogates (72% agreement, kappa = 0.65, chi square = 16.5). In a hypothetical dementia scenario, contrary to perceptions of patients and their surrogates, proxies were unable to accurately represent a patient's wishes for elective cataract surgery (34% agreement, kappa = 0.23, chi square = 14.4). Physicians tended to withhold intervention in the dementia scenario. CONCLUSIONS: The findings suggest that current methods of decision making in elective surgery for patients unable to make autonomous decisions may be seriously flawed. This extends previous findings of inaccuracy with the substituted judgment approach to end-of-life issues to reflect elective surgical scenarios.
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Extração de Catarata/normas , Tomada de Decisões , Procedimentos Cirúrgicos Eletivos/normas , Consentimento do Representante Legal , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Glaucoma is a leading cause of irreversible blindness worldwide. The reduction of intraocular pressure has been well established as an effective treatment to prevent both the development and the progression of all forms of glaucoma. Bimatoprost 0.03% ophthalmic solution, introduced in 2001, is a synthetic prostamide with the unique mechanism of improving both uveoscleral and trabecular outflow. Comparative studies with other pharmacotherapies have shown favorable results for bimatoprost as a potent ocular hypotensive agent that is generally well tolerated. Common side effects include conjunctival hyperemia, eyelash growth, iris pigmentation and periorbital changes. Hyperemia rates were reduced following the introduction of bimatoprost 0.01%. Bimatoprost should be used with caution in those with higher risk of developing ocular inflammation and macular edema. However, the perceived risk of bimatoprost in these patient populations is likely greater than the actual risk observed in practice. Bimatoprost is currently in the center of several clinical trials including its use for dermatologic applications and sustained-release therapies for the treatment of ocular hypertension and glaucoma.
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PURPOSE: To evaluate rates of adherence to free follow-up eye exam appointments among participants in the Philadelphia Glaucoma Detection and Treatment Project. PATIENTS AND METHODS: Ophthalmologists and testing equipment were brought directly to participants at risk for glaucoma at 43 community sites in Philadelphia. Those diagnosed with glaucoma-related pathology were recommended to return for follow-up to be reexamined on site. Rates of adherence and clinical and demographic risk factors for adherence were evaluated. RESULTS: Five hundred thirty-one participants were diagnosed with glaucoma-related conditions and recommended to attend community-based follow-up exams. Follow-up adherence rate was 61.2% (n=325/531). Significant factors associated with greater eye exam appointment adherence, based on our univariable analysis, included final diagnosis of glaucoma (risk ratio [RR]=1.33; 95% confidence interval [CI], 1.13-1.57), male sex (RR=1.19; 95% CI, 1.04-1.36), white race (RR=1.26; 95% CI, 1.08-1.48), age (RR=1.17; 95% CI, 1.00-1.37) recommendation for glaucoma medication (RR=1.52; 95% CI, 1.35-1.71), recommendation for laser peripheral iridotomy (RR=1.18; 95% CI, 1.02-1.35), diagnosis of age-related macular degeneration (RR=1.42; 95% CI, 1.13-1.77) and an increased intraocular pressure (>22 mm Hg in the worse eye) (RR=1.23; 95% CI, 1.06-1.42). On the basis of our multivariable model, diagnosis, sex, and recommended glaucoma medications were significantly associated with follow-up adherence. CONCLUSIONS: This study demonstrates that individuals living in underserved urban communities would take advantage of free eye exams in community sites and return for follow-up eye exams in these same settings. Future studies could investigate interventions to improve eye exam appointment adherence in community-based settings to detect glaucoma-eye conditions.
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Glaucoma/diagnóstico , Glaucoma/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Idoso , Agendamento de Consultas , Serviços de Saúde Comunitária/organização & administração , Feminino , Seguimentos , Glaucoma/fisiopatologia , Pesquisas sobre Atenção à Saúde , Humanos , Pressão Intraocular/fisiologia , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Philadelphia , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN: Screening program results for a prospective randomized clinical trial. METHODS: Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS: From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities. CONCLUSION: An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.
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Técnicas de Diagnóstico Oftalmológico , Glaucoma de Ângulo Aberto/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Índice de Massa Corporal , Serviços de Saúde Comunitária/organização & administração , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/epidemiologia , Hemoglobinas Glicadas/metabolismo , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/epidemiologia , Doenças do Nervo Óptico/epidemiologia , Philadelphia/epidemiologia , Médicos de Atenção Primária/organização & administração , Estudos Prospectivos , Tonometria Ocular , Acuidade Visual/fisiologiaRESUMO
Glaucoma is a multifactorial degenerative optic neuropathy that can progress at variable rates and afflict all age groups. It is the second leading cause of blindness worldwide. The disease is commonly divided into 2 major subtypes, open angle and angle closure. Diagnosis of glaucoma is made by a combination of identifying characteristic changes of the optic nerve, functional testing such as visual fields, and structural imaging of the optic nerve. Management is aimed at reducing intraocular pressure (IOP). Patients with known risk factors should be referred to an ophthalmologist for complete evaluation.