Screening for glaucoma in a medical clinic with photographs of the nerve fiber layer
F. Wang, H. A. Quigley and J. M. Tielsch
Dana Center for Preventive Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins University, Baltimore, Md.
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.
