Glaucoma avanzado. Guía de práctica clínica / Advanced glaucoma. Clinical practice guideline

objetivo Realización de una guía de práctica clínica actualizada que sirva de orientación para la detección, el manejo y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Métodos Tras la definición de los objetivos y alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Se realizó una revisión de la literatura publicada hasta el momento, incluyendo guías de práctica clínica internacionales, utilizándose las herramientas AMSTAR-2 (Assessment of Multiple systematic Rewiews) y «Risk of Bias» de Cochrane para la evaluación de la calidad de la información de forma independiente por, al menos, 2 revisores. El nivel de evidencia y la elaboración del grado de recomendación se establecieron siguiendo la metodología del Scottish Intercollegiate Guidelines Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección, el seguimiento y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Conclusiones A pesar de que la evidencia científica existente es escasa y el nivel de evidencia para muchas de las preguntas planteadas no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de las recomendaciones existentes para el manejo del glaucoma avanzado en el adulto (AU)

Objective To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR-2 (Assessment of Multiple systematic Rewiews) and Cochrane «Risk of bias» tools by at least 2 reviewers, recommendations were formulated following the Scottish Intercollegiate methodology Guideline Network (SIGN). Results Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma (AU)

Progresión en glaucoma. Guía de práctica clínica / Glaucoma progression. Clinical practice guide

Objetivo Ofrecer una serie de recomendaciones generales que sirvan de orientación en la evaluación y el manejo de la progresión glaucomatosa en la práctica clínica diaria a partir de la evidencia clínica de calidad existente. Métodos Tras la definición de los objetivos y del alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Una vez evaluada toda la evidencia clínica existente con las herramientas AMSTAR2 (Assessment of Multiple systematic Rewiews) y Risk of bias de Cochrane de forma independiente por al menos dos revisores, se pasó a la formulación de recomendaciones siguiendo la metodología del Scottish Intercollegiate Guideline Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección y el seguimiento de la progresión glaucomatosa con los distintos métodos disponibles y para el tratamiento de los pacientes. Conclusiones A pesar de que para muchas de las preguntas el nivel de evidencia científica disponible no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de los diferentes aspectos existentes relacionados con la evaluación y el manejo de la progresión glaucomatosa (AU)

Objective To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR2 (Assessment of Multiple Systematic Reviews) and Cochrane «Risk of bias» tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. Results Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression (AU)

Advanced glaucoma. Clinical practice guideline.

OBJECTIVE: To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.

Glaucoma progression. Clinical practice guide.

OBJECTIVE: To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.

«Enfermedad verde¼: el reto diagnóstico del glaucoma. Reporte de caso / "Green disease": the diagnostic challenge in glaucoma. Case report

Presentamos un caso clínico de glaucoma conocido como «enfermedad verde¼ y discutimos el reto diagnóstico documentado en la literatura por medio de un reporte de caso clínico. La individualización y evaluación interdimensional de los pacientes tanto con sospecha como con diagnóstico de glaucoma es clave, ya que el uso de diferentes técnicas de examen ayuda a disminuir los diagnósticos erróneos, teniendo en cuenta que las ayudas diagnósticas son un complemento al criterio médico.

We present a clinical case of glaucoma known as the "green disease" and discuss the diagnostic challenge documented in the literature through a clinical case report. The individualization and interdimensional evaluation of patients with both suspicion and diagnosis of glaucoma is key, since the use of different examination techniques helps to reduce misdiagnoses, taking into account that diagnostic aids are a complement to medical criteria.

Correlación entre las estrategias SITA Estándar 24 -2 y SITA Faster 24 -2 para evaluar el daño campimétrico en pacientes con Glaucoma Primario de Ángulo Abierto

RESUMEN Introducción: Las estrategias de SITA Estándar fueron aprovechadas por más de dos décadas, pero buscando aun mejorar el tiempo sin perder la calidad, se volvió a crear una nueva estrategia más corta, a la cual llamaron estrategia FASTER. Objetivo: Determinar la correlación entre las estrategias SITA Estándar 24 -2 y SITA Faster 24 -2 para evaluar el daño campimétrico en pacientes con Glaucoma Primario de Angulo Abierto. Metodología: Estudio observacional analítico. RESULTADOS: Se analizó 74 resultados de análisis del campo visual utilizando dos técnicas SITA Estándar 24 - 2 y SITA Faster 24 - 2. El tiempo de prueba para la estrategia SITA Estándar fue de 379,64 ± 72,75 segundos y para la estrategia SITA Faster 170,93 ± 49,17 (p<0,0001), probando una reducción de tiempo del 55% para la segunda. Los valores de desviación media, desviación patrón estándar y el índice de campo visual no mostraron diferencias estadísticamente significativas entre ambas pruebas. La Prueba de Hemicampo de glaucoma con el cálculo del índice Kappa de Cohen arroja un valor de 0,316 con un intervalo de confianza del 95 % de (0,098 - 0,534) lo que indica que es estadísticamente significativo. Discusión: Los resultados generales indican que es posible reemplazar la estrategia SITA Estándar 24 -2 con la estrategia SITA Faster 24 - 2. Este cambio será especialmente útil para aumentar la frecuencia de exámenes campimétricos, determinante para una detección más temprana de la progresión del glaucoma y así mejorar las conductas terapéuticas que se toman con los pacientes que acuden a nuestro servicio.

ABSTRACT Introduction: SITA Standard strategies were used for more than two decades, but still seeking to improve time without losing quality, a new shorter strategy was created again, which they called the FASTER strategy. Objective: To determine the correlation between the SITA Standard 24-2 and SITA Faster 24-2 strategies to evaluate the visual field damage in patients with Primary Open Angle Glaucoma. Methodology: Analytical observational study. Results: 74 visual field analysis results were analyzed using two techniques SITA Standard 24 - 2 and SITA Faster 24 - 2. The test time for the SITA Standard strategy was 379.64 ± 72.75 seconds and for the SITA strategy Faster 170.93 ± 49.17 (p <0.0001), proving a 55% time reduction for the second. The mean deviation, standard deviation and visual field index values do not show statistically significant differences between both tests. The Glaucoma Hemifield Test with the calculation of the Cohen's Kappa index gives a value of 0.316 with a 95% confidence interval of (0.098 - 0.534) which indicates that it is statistically significant. Discussion: The overall results indicate that it is possible to replace the SITA Standard 24-2 strategy with the SITA Faster 24-2 strategy. This change will be especially useful to increase the frequency of campimetric examinations. A greater frequency of examinations is important for earlier detection of glaucoma progression and thus improve the therapeutic behaviors that are taken with the patients who come to our service.

Meningioma del Tubérculo Selar: Foraminotomía Óptica Precoz Por Vía Pterional Transsilviana / Sellar Tubercle Meningioma: Early Optic Foraminotomy By Transsylvian Pterional Route

Introducción: Los meningiomas constituyen aproximadamente el 10-15%1 de las neoplasias cerebrales, y el 7% de ellos presentan una inserción supraselar. Los meningiomas del tubérculo selar presentan adherencia en este, en el surco quiasmático o en el limbo esfenoidal2,3. Descripción del caso: Mujer de 45 años que consulta por cefalea y déficit severo de la visión del ojo izquierdo, constatado por campimetría visual. En RM se observa imagen extraaxial, en relación al tubérculo selar, con lateralización hacia la izquierda, ingresando al conducto óptico de ese lado. Se realizó abordaje pterional izquierdo, con acceso transsilviano a las cisternas óptica y carotídea izquierdas. Se individualiza la lesión color parduzca en el espacio interóptico, que desplaza hacia lateral y superior el nervio óptico izquierdo. Se retira duramadre que cubre el techo del conducto óptico y luego con fresa diamantada se descomprime4 el mismo de modo precoz, antes de la disección microquirúrgica del meningioma. Con aspirador ultrasónico se lleva a cabo el vaciamiento intratumoral, y luego separamos la capsula tumoral de la aracnoides y las estructuras neurales y vasculares. Luego de la exéresis completa de la lesión, se retira duramadre del tubérculo selar y se realiza fresado del mismo para evitar recurrencias en el sitio de implantación. Resultados: En RM postoperatoria se observa resección completa de la lesión; además la paciente refiere mejoría notoria de su visión que se constata en examen físico. Se confirma dicha mejoría en campimetría visual a los 3 meses postoperatorios. Conclusión: La descompresión precoz del conducto óptico en los meningiomas del tubérculo selar es una maniobra quirúrgica útil para prevenir una mayor lesión del nervio durante la extirpación del tumor; además permite resecar fragmentos intracanaliculares.

Introduction: Meningiomas constitute approximately 10-15%1 of the brain neoplasms and 7% of them present a suprasellar insertion. The meningiomas of the sellar tubercle present adherence in its, in the chiasmatic sulcus or sphenoid limbus2,3. Case description: A 45-year-old woman consulted for headache and severe vision deficit of the left eye, confirmed by visual field campimetry. In MRI an extraaxial image is observed, in relation to the sellar tubercle with lateralization to the left, entering the optic canal. A left pterional approach was performed, with transsylvian access to the left optic and carotid cisterns. The brownish lesion is individualized in the interoptic space, which displaces laterally and superiorly the optic nerve. The dura mater that covers the roof of the optic canal is removed at the beginning of the surgery, and then, with a diamond bur, the optic canal is decompressed4, before the microsurgical dissection of the meningioma. With an ultrasonic aspirator, the tumor debulking is carried out, and then the tumor capsule was separated from the arachnoid and the neural and vascular structures. Finally, the duramater of the tuberculum sellae was removed and the tubercle was drilled to avoid recurrences at the implantation site. Results: In a postoperative MRI, complete resection of the lesion was observed. The patient reported a noticeable improvement in her vision that was confirmed by a physical examination. Confirming this improvement in visual field campimetry was done 3 months postoperatively. Conclusion: Early decompression of the optic canal is essential to avoid further injury during tumor removal of a tuberculum sellae meningioma, as well as allowing the resection of intracanalicular fragments.

Comparison of macular retinal sensitivity and its contribution to the foveal sensitivity between diabetic and non-diabetic patients with normal visual acuity.

PURPOSE: To compare the retinal sensitivity and evaluate its contribution to the foveal sensitivity in patients with and without diabetes who maintain normal visual acuity. METHODS: Observational, descriptive, cross-sectional and prospective study in 20 subjects without diabetes (group 1) and 23 with type 2 diabetes mellitus (group 2) that had no ocular abnormalities. Retinal sensitivity was measured with the macular threshold test by the Humphrey's computerized perimeter. The mean sensitivity in each of the 16 points and the foveal sensitivity were compared between groups using the Mann-Whitney's U test; the correlation between retinal sensitivity and foveal sensitivity was analyzed by the Spearman's test and the contribution of each point to the foveal sensitivity was identified by multiple regression. RESULTS: Sixty eyes were evaluated, 30 in group 1 and 30 in group 2; the mean foveal sensitivity was 34.77±0.5dB in group 1 and 32.87±0.6 in group 2. The highest sensitivity of the temporal visual field had an inferior paracentral location (point 3) in both groups. In the linear regression analysis, points which contributed to the foveal sensitivity were 1 in group 1 and points 7 and 15 in group 2. CONCLUSIONS: Subjects without diabetes have a significantly higher sensitivity in the temporal retina compared with those with diabetes; points with highest mean retinal sensitivity do not correspond to the central four. The reduced sensitivity in point 1 decreases the mean foveal sensitivity in subjects with diabetes, because this variable correlates with lower perimetry points.

Alterações da campimetria, tomografia de coerência óptica e função visual em pacientes portadores de esclerose múltipla / Campimetry changes, optical coherence tomography and visual function changes in patients with multiple sclerosis

RESUMO Objetivos: Determinar a freqüência e as características das alterações em exame oftalmológico, em exame de Tomografia de coerência óptica (OCT) do nervo e mácula e Campimetria em pacientes com Escrelose Multipla(EM). Métodos: Foram examinados 60 olhos sendo 30 de pacientes com o diagnóstico de EM e 30 de pacientes controles, atendidos no Hospital de Base do Distrito Federal. Os pacientes foram avaliados quanto aos parâmetros: características e alterações do exame oftalmológico, do OCT do nervo e da macula e Campimetria. Resultados: Os pacientes com EM apresentaram piores resultados em todos os parâmetros avaliados. No exame de campo visual Foram encontradas perdas localizadas em 50%. Em relação ao OCT de nervo óptico foi observado redução da camada de fibras nervosas em quadrantes temporal (p=0,0251) e inferior (p=0,0041), o OCT de mácula revelou diminuição da CFN principalmente nos quadrantes nasal interno (p=0,0002) e externo (p=0,0016),inferior interno (p=0,0007) e superior externo (p=0,0108) e interno (p=0,0046). Os pacientes com menores valores de espessura macular também tiveram piores resultados no campo visual (p=0,0001). Conclusão: Este estudo demonstrou que a EM é uma doença capaz de ocasionar alterações nos exames de OCT e Campo visual mesmo na ausência de sintomas visuais relatados pelos pacientes. A realização de exames como campo visual e de OCT de macula e nervo podem ser uma ferramenta útil para estimar o comprometimento pela doença e auxiliar no seguimento desses pacientes.

ABSTRACT Objectives: To determine the frequency and characteristics of alterations in ophthalmologic examinations of optic nerve and macula coherence tomography (OCT), and Campimetry in multiple sclerosis (MS) patients. Methods: Sixty eyes were examined, 30 of which were diagnosed with MS and 30 of the control patients, all attended at the General Hospital of the Federal District of Brazil. The patients were evaluated regarding the parameters: characteristics and alterations of the ophthalmological examination, OCT of the nerve and macula and Campimetry. Results: Patients with MS presented worse results in all parameters evaluated. On visual field examination localized losses were found in 50% of the cases . In relation to OCT of the optic nerve it was observed a reduction of the nerve fiber layer in temporal quadrants (p = 0.0251) and lower (p = 0.0041). The macular OCT revealed a decrease in the CFN, mainly in the internal nasal quadrants (p = 0.0002) and external (p = 0.0016), internal inferior (p = 0.0007) and external superior (p = 0.0108) plus internal (p = 0.0046). Patients with lower values of macular thickness also had worse results in the visual field (p = 0.0001). Conclusion: This study demonstrated that MS is a disease capable of causing changes in OCT and visual field tests even in the absence of visual symptoms reported by patients. Examinations such as visual field and OCT of macula and nerve can be a useful tool to estimate the damage by the disease and to assist in the follow-up of these patients

Campimetrías necesarias para obtener factores confables en un campo visual para diagnóstico de glaucoma en el Hospital San Francisco de Quito durante el período agosto 2012 - abril 2013 / Necessary campimetries to obtain trustworthy factors in a visual field for the diagnosis of glaucoma in the San Francisco de Quito hospital during the August 2012 ­ April 2013 period

Introducción: el objetivo de este estudio fue identificar el número de campimetrías necesarias para obtener factores confiables en el diagnóstico de glaucoma. Materiales y métodos se realizó un estudio observacional retrospectivo en el Hospital San Francisco de Quito en 58 pacientes, incluyendo 116 pares de ojos, que se realizaron perimetrías blanco sobre blanco por dos o más ocasiones para diagnóstico de glaucoma, iniciando con estrategia CLIP con el perímetro Oculus Centerfeld II, en el período agosto 2012 a abril 2013. Resultados: de 116 campimetrías evaluadas, el mayor número de campimetrías confiables para diagnóstico de glaucoma se obtuvo al realizar por segunda (41,4%) y tercera (29,3%) vez este examen entre los 42-88 años, con una media de 65 años. No hubo diferencias significativas entre la edad y el número de campimetrías confiables. Conclusiones: los factores extrínsecos e intrínsecos (como el aprendizaje) del paciente juegan un rol importante al realizar y valorar la confiabilidad del campo visual para diagnóstico de glaucoma.

Introduction: the objective of this study was to identify the approximate number of campimetries necessary to obtain reliable factors for the diagnosis of glaucoma. Materials and methods: we performed a retrospective observational study at the San Francisco de Quito Hospital with 58 patients including 116 pairs of eyes, which white ­white perimetry was performed in two or more occasions for glaucoma, starting with CLIP strategy with the perimeter Oculus Centerfeld II, from august 2012 to april 2013. Results: of the 116 campimetries performed for diagnosis of glaucoma, the largest number of reliable campimetries was obtained by performing a second (41, 4%) and third (29, 3%) exam between the ages of 42 - 88 years, with an average age of 65 years. There were no signifcant differences between age and the number of reliable campimetries. Conclusions: extrinsic and intrinsic factors (such as the learning factor) of the patient play an important role when making and assessing the reliability of the visual feld of the diagnosis of glaucoma.

Confiabilidad de la campimetría manual por confrontación para detectar defectos de campos visuales en patologías neurológicas / Reliability of confrontation testing of visual fields in neurological diseases

Introduction: Different methods of assessing visual field by confrontation (VFC) with the Goldmann Perimetry (GP) are compared. Method: 52 consecutive patients evaluated in Neuropthalmology Department that met inclusion criteria. Seven tests of VFC and GP are performed on each patient. Sensitivity, specificity and degree of association of each test confrontation regarding Goldmann Perimetry is evaluated. Results: The tests were the most sensitive tests comparing fingers (58%) and compared red (55%) Color object. Greater specificity tests were counting fingers (95%), finger movement in a fixed position of the hand in different quadrants (95%), finger movement from the periphery to the center of the quadrants (93%) and test moving red pin of 5 mm (93%). The two most sensitive tests had low specificity. Conclusions: The VFC is performed routinely in all neuroopthalmology patients. Tests are of limited use for screening visual pathway pathology because of its low sensitivity but the detected alterations are sufficiently specific. The most useful tests were dynamic (moving from the periphery to the center finger or a red pin). To confirm the diagnosis and monitoring is needed as objective evidence of Goldmann Perimetry.

Introducción: Se comparan distintos métodos de evaluación de campo visual por confrontación (CVC) con la Campimetría de Goldmann (CG) en pacientes derivados al Servicio de Neuroftalmología del Instituto de Neurocirugía. Método: En cincuenta y dos pacientes consecutivos que cumplen criterios de inclusión, se realizan siete pruebas de CVC y CG en cada paciente. Se evalúa sensibilidad, especificidad y grado de asociación de cada prueba de confrontación en relación a Campimetría de Goldmann. Resultados: Las pruebas de mayor sensibilidad fueron las pruebas de comparación de dedos (58%) y comparación objeto color rojo (55%). Las pruebas de mayor especificidad fueron conteo de dedos (95%), movimiento del dedo en posición fija de la mano en diferentes cuadrantes (95%), movimiento de dedo desde la periferia al centro de los cuadrantes (93%) y la prueba de movimiento de pin rojo de 5 mm (93%). Las dos pruebas de mayor sensibilidad presentaron baja especificidad. Conclusiones: Los CVC se realizan de manera rutinaria en todos los pacientes neuroftalmológicos. Son pruebas de utilidad limitada para el tamizaje de patologías de vía visual por su baja sensibilidad pero las alteraciones detectadas son suficientemente específicas. Las de mayor utilidad fueron las pruebas dinámicas (mover de la periferia al centro el dedo o un pin rojo). Para confirmar el diagnóstico y hacer el seguimiento es necesario realizar pruebas objetivas como la Campimetría de Goldmann.

Neuropatía óptica hereditaria de Leber: reporte de caso / Leber’s hereditary optic neuropathy: a case report

Las enfermedades mitocondriales pueden afectar de manera sistémica u orgánica a los pacientes. Un tipo de afección es la neuropatía óptica hereditaria de Leber, que causa una atrofia del nervio óptico y produce una disminución del campo visual y de la agudeza visual. En ocasiones, esta enfermedad no presenta hallazgos significativos en el fondo de ojo y es necesario que se le haga una exploración lo más completa posible para encontrar el problema. En este artículo se presenta el manejo que se le dio al paciente, desde el diagnóstico probable hasta que se llegó a corroborar, y lo más actual acerca de esta enfermedad.

Mitochondrial diseases can affect patients in a systematic or organic way. A type of condition is Leber’s hereditary optic neuropathy, which causes atrophy of the optic nerve and causes a reduction of the visual field and visual acuity. On occasion, this disease does not show significant findings in the fundus and it is necessary to further explore it as completely as possible in order to find the problem. In this paper we will find the way in which the patient was handled from the time of the probable diagnosis until its corroboration and the latest information about the disease.

Desenvolvimento de um instrumento automatizado para medida do campo visual do olho humano / Development of an automated instrumento for human visual field measurements

Neste artigo é descrito o desenvolvimento de um instrumento computadorizado para medidas do campo visual do olho humano. Apresentam-se detalhes da implementação do primeiro protótipo (hardware e software) e resultados preliminares em testes in vivo. Sabe-se que algumas patologias de grande risco para qualidade da visão, como o glaucoma (aumento da pressão intra-ocular), provocam lentamente a morte de células sensoriais (cones e bastonetes)na retina. Normalmente, o paciente só percebe o problema quando aproximadamente 50 por cento destas células já estiverem mortas. Um dos instrumentos que pode auxiliar no diagnóstico precoce destas patologias é campímetro automatizado. Apesar de existirem instrumentos importados que realizam este exame, eles contêm softwares que utilizam bases de dados geradas a partir de exames em população com características demográficas bastante diferentes daquelas encontradas no Brasil. Normalmente, essas bases de dados são provenientes dos EUA e Europa, mas sabe-se que a predisposição a diversas patologias está associada às condições demográficas (por exemplo, descobriu-se que na população de pele negra a incidência de glaucoma é maior quando comparada com a população de cor branca, em termos gerais e para residentes em uma mesma região geográfica). Além da raça, fatores como temperatura, clima e radiação solar podem também influenciar a sensibilidade visual. Assim, o desenvolvimento de um instrumento que incorpore uma base de dados colhida em olhos da população brasileira, possibilitará exames mais precisos no país. Apresenta-se aqui as diferentes etapas do desenvolvimento deste instrumento e os resultados preliminares.