青光眼高危因素与阈值野视野的相关性

目的：探讨原发性青光眼高危因素与自动静态阈值视野改变之间的关系。方法：550例（1043眼）可疑青光眼患者,根据诊断的主要因素,分为浅前房组、异常杯盘比组、高组压组及症状性疑青光眼,分别接受Octopusl-2-3型全自动视野的检查。结果：原发性青光眼的高危因素依次异常杯盘比（45．8％）,高眼压（30．4％）,症状组（21．3％）,浅前房组（2．5％）。其静态阈值视野改变的阳性率分别为62．8％、60．5％、59．0％和73．9％,各组间阳性率差异无显著性（P＞0．05）。结论：仔细检查所有可疑青光眼患者的静态阈值视野并随访其改变,对青光眼的早期诊断具有重要的意义。     

灯盏细辛对青光眼神经保护作用的临床研究

目的　评价灯盏细辛对眼压已控制的青光眼神经保护作用。方法　采用前瞻性、随机、双盲、安慰剂对照的研究方法 ,将眼压已控制的中晚期青光眼患者共 45例 ( 4 5眼 ) ,分层随机分为年龄匹配的灯盏细辛治疗组 ( 2 3例 )和安慰剂对照组 ( 2 2例 )。治疗组口服灯盏细辛 (EBHM) 2片 ,3次 /d ,对照组口服安慰剂 ,连续 6个月 ,每月复诊 1次。治疗前及每月复诊均检查矫正视力、眼压、视乳头杯盘比 (C/D)、自动静态阈值视野、血压和脉搏。结果　EBHM组与对照组在 6个月中平均眼压分别为 14 17mmHg± 2 5 0mmHg( 8～ 2 1mmHg)和 14 5 2mmHg± 1 94mmHg( 8～ 19mmHg) (P =0 5 98)。治疗 6个月后EBHM组平均敏感度 (MS)增加 1 42dB ,对照组MS下降 0 95dB(P =0 0 0 0 )。EBHM组和对照组视野进步率分别为 5 6 5 2 %和 4 5 5 % (P =0 0 0 1)。结论　灯盏细辛为一安全、无毒副作用的中草药 ,具有提高青光眼患者MS和部分改善原有视野缺损的作用 ,可作为视神经保护剂应用于治疗眼压已控制的青光眼。     

m—ERG一阶kernel反应对青光眼的诊断价值

目的 :应用多焦视网膜电图 (m ERO)一阶kernel反应 (FOK) ,检测青光眼视功能损害 ,评价其在青光眼中的诊断价值及其与视野、视盘改变的相关性。方法 :根据 1987年全国青光眼协作组拟定的标准 ,并结合视野选择了 42只青光眼和 16只可疑青光眼共 5 8只眼 ,分为早期、中期、晚期青光眼和可疑青光眼四组 ,同时选择了 3 3只正常眼 ,检测m ERG的FOKP波、N波的振幅和峰时 ,并进行统计学处理。结果 :观察了四组青光眼与正常对照组的m ERG的FOK ,结果显示 ,1、FOK的P波振幅、N波振幅、N波峰时 ,在正常对照组与三个青光眼组间有显著性差异 (P <0 0 5 ) ,与可疑组间无显著性差异 (P >0 0 5 )。P波峰时在正常对照组与其它组间无显著性差异 (P >0 0 5 ) ,但其在鼻上、鼻下、颞下三个象限正常对照组与各期青光眼组有显著性差异 (P <0 0 5 )。 2、FOK的异常检出率 (敏感性 )分别在早、中、晚期 ,可疑青光眼组和正常对照组 ,P波振幅的敏感性分别为 73 3 % ,62 5 % ,10 0 % ,62 5 %。特异性为 72 7% ,N波振幅的敏感性分别为 66 7% ,5 6 3 % ,90 9% ,5 0 % ,特异性为 63 6%。P波峰时的敏感性分别为 73 3 % ,10 0 % ,90 9% ,43 8% ,特异性为 5 1 5 % ,N波峰时的敏感性分别为 5 3 3 % ,5 0 % ,90 9% ,43 8%     

原发性开角型青光眼患者近视屈光状态的分析

目的 :探讨近视与原发性开角型青光眼的关系。方法 :原发性开角型青光眼 311例 6 15眼 ,分为正视 (屈光度≤± 0 .5D)、远视 (屈光度 >+0 .5D) ,近视 (屈光度≥ - 0 .75D)三组 ,近视组又分为轻度近视 (- 0 .75D≤屈光度 <- 3D)、中度近视 (- 3D≤屈光度 <- 6D)、高度近视 (屈光度≥- 6D)三组。分析近视患病比例 ,比较各组年龄、病程、症状、眼压、杯盘比 (C/D)及视野的差别。结果 :正视 16 4例 32 4眼 (占 5 2 .6 8% ) ;远视 6例 12眼 (占 1.95 % ) ;近视 14 1例 2 79眼 (占 4 5 .37% ) ,其中轻度近视 4 8眼 (占 7.81% ) ,中度近视80眼 (占 13.0 1% ) ,高度近视 15 1眼 (占 2 4 .5 5 % )。轻度、中度和高度近视组平均年龄分别为 (4 5 .35± 13.30 )岁、(4 0 .14± 13.76 )岁和 (4 0 .86± 17.16 )岁 ,正视组和远视组平均为(4 9.33± 16 .2 2 )岁和 (6 1.0 0± 10 .5 1)岁。中度和高度近视组平均年龄均明显较正视组年轻 (t=- 3.4 ,P =0 .0 0 1;t=-3.6 ,P =0 .0 0 0 )。正视组早期青光眼视野损害比例为 16 .5 1% ,而近视组仅为 3.92 %。近视组中 2 6 .2 % (37/ 14 1)的患者将最初视力下降误以为是近视加深。各组病程、最大用药眼压及杯盘比统计学比较均无意义。结论 :近视是原发性开角性青光眼的高危因素     

青光眼500例的危险因素与中心阈值视野的损害

目的:探讨发生青光眼危险因素与中心阈值视野改变的关系。方法:500例(980眼)可疑青光眼按危险因素分组,分别采用日本Topcon SBP2020自动视野SDT340程序检测中心30°阈值视野。结果:混合组、异常杯盘比组、高眼压组和症状组中心视野损害率分别为70.0%,48.3%,47.5%和35.8%,混合组与其他3组比较差异非常显著(P<0.01);近视性屈光不正患者与远视性屈光不正阈值视野损害比较差异非常显著(P<0.01);各年龄段中心阈值视野损害比较无差异(P>0.05)。结论:近视性屈光不正患者比远视性屈光不正患者中心阈值视野损害多;眼压增高伴有视乳头改变是发生视野损害的主要危险因素。     

视野检查在先天性青光眼疗效评价中的应用

目的探讨视野在原发性先天性青光眼疗效观察中的价值.方法对17例28眼先天性青光眼的视野资料进行回顾性分析,并就视力、眼压、杯盘比值、手术次数、手术年龄等因素与视野的关系进行探讨.结果初次检查视野的年龄4～16岁,平均11.52±3.47岁,视野检查距手术的时间1～14年,平均6.7年.矫正视力≥0.4者占78.579%,其中＞0.8者占46.439%.22眼具有青光眼性视野缺损,占78.579%,其中旁中心暗点5眼,鼻侧阶梯9眼,弓形缺损6眼,管视和/或颞岛7眼.早、中、晚三期视野损害所占比例分别为:32.14%、21.439%、25.00%.8例13眼有视野随访,随访时间3～13年,平均6.6年,6眼有视野进展.手术次数≥2次组的视野损害较≤1次手术组重(P＜0.05).杯盘比值≥0.6组的视野损害明显重于C/D＜0.6组(P＜0.05).结论视野是评价先天性青光眼疗效的一个重要指标,先天性青光眼患者经训练后能够完成视野检查.     

青光眼住院病人的构成及变化

目的 :了解青光眼住院病人的内部构成比变化 ,为青光眼的防治研究提供新的流行病学资料。方法 :1996 7～ 2 0 0 2 6期间在本院住院的青光眼患者 5 2 2 2例 ,按出院诊断、性别、年龄分组 ,分析其内部构成及变化趋势。结果 :原发性闭角型青光眼、原发性开角型青光眼、皮质类固醇性青光眼、先天性青光眼、继发性青光眼各占青光眼总数的5 4 42 %、 2 1 73 %、 3 3 5 %、 6 3 2 %和 14 17%。急性闭角型青光眼的构成比 ( 2 2 5 4% )逐年下降 ,原发性开角型青光眼的构成比则逐年升高 (P <0 0 5 ) ;在原发性青光眼患者 (包括GIG)中 ,年龄大于 40岁的占 80 97% ,其中闭角型青光眼占82 0 9% ,年龄小于 40岁的 ,开角型青光眼占 89 62 %。闭角型青光眼患者男∶女 =1∶1 5 3 ,开角型青光眼患者男∶女 =2 5 5∶1;皮质类因醇性青光眼患者的年龄主要集中在 10～ 3 0岁 ,占 77 71%。结论 :闭角型青光眼仍然是我国青光眼的主要类型 ,但开角型青光眼的防治研究不能忽视 ,40岁以上的女性人群应特别注意闭角型青光眼的筛查 ,40岁以下的男性群体则是开角型青光眼防治的重点。     

蓝-黄视野计与标准的白-白视野计对早期原发性开角型青光眼视野的对比研究

目的　评价蓝 -黄视野计 (blue- on- yellow perim etry,B/ Y)又称短波长视野计 (short- wavelength auto-mated perim etry,SWAP)与标准的白色视野计 (white- on- white perimetry,W/ W)在早期青光眼视野损害诊断中的意义。方法　利用 Hum phrey- - 75 0型全自动视野计 C- 30 - 2全阈值检测程序对 2 0例 (4 0只眼 )正常人、2 0例 (36只眼 )可疑青光眼、18例 (32只眼 )确诊的早期原发性开角型青光眼 (primary open- angle glaucoma,POAG)分别进行 W/ W与 B/ Y的视野检查。结果　正常人、可疑青光眼、早期青光眼 B/ Y检测的全视网膜光敏感度均值 (MS)低于 W/ W检测的结果 ,两者有显著性意义 (t=11.6 8,P <0 .0 1;t=14 .0 1,P <0 .0 1;t=14 .6 8,P <0 .0 1)。B/ Y检测光敏感度缺损均值 (MD)与 W/ W检测的结果 ,正常人组无显著性意义 (t=1.0 4 ,P <0 .0 1) ,其它两组有显著性意义 (t=4 .88,P <0 .0 1;t=3.378,P <0 .0 1)。W/ W检查正常人组与可疑性青光眼的 MS差别无显著意义 (t=2 .5 4 ,P >0 .0 1) ,B/ Y有显著意义 (t=5 .5 7,P <0 .0 1)。两组的 MD差别均有显著意义 (t=3.16 ,P <0 .0 1,t=6 .2 6 ,P <0 .0 1) ;W/ W与 B/ Y检查正常人组与早期青光眼组的 MS差别有显著意义 (t=6 .4 7,P <0 .0 ;t=10 .19,P     

原发性开角型青光眼HRT视盘参数和视野缺损的关系

目的 :探讨原发性开角型青光眼视盘参数和视野平均缺损之间的关系。方法 :用海德堡视网膜断层扫描仪和自动视野计测定 5 5名原发性开角型青光眼患者的视盘参数 (杯盘面积比、盘沿面积、盘沿容积、视杯容积、视杯形态测量、视杯高度变异轮廓和平均神经纤维层厚度 )和静态光阈值。视盘参数与视野平均缺损作相关分析和多元线性回归分析。结果 :盘沿面积与平均缺损显著相关 (r =0 3 5 0 ,P <0 0 5 )。盘沿面积每减少 1mm2 ,视野缺损绝对值增加 8 0 81dB。本研究没有发现其它 6个参数与平均缺损相关关系的显著性。结论 :盘沿面积在HRT众多参数中最能反映青光眼的视野平均缺损程度。     

原发性开角型青光眼视网膜神经纤维层检查的临床分析

目的　观察分析各期原发性开角型青光眼 (POAG)病例视网膜神经纤维层 (RNFL )的形态学改变 ,探讨其对 POAG的早期诊断、病情估计、治疗效果、预后判断等方面的临床意义。方法　 (1)随机选择 1992年～2 0 0 3年间青光眼专科门诊确诊为 POAG患者的眼底照相图片计 2 70例 (5 4 0只眼 ) ,进行回顾性统计分析。 (2 )按杯盘比值 (C/D)分为三组 :C/D<0 .6者为早期组 ,C/D=0 .6～ 0 .8者为进展期组 ,C/D>0 .8者为晚期组 ,观察各期POAG神经纤维层的形态学改变特点 ,进行分析评估。 (3)部分病例结合视野和 HRT 检查 ,对三种检查法的敏感性进行比较分析。(4 )视野检查用 75 0型 HU MPHREY视野分析仪 ,眼底照相用 TOPCON TRC- 5 0 VT型眼底照相机。结果　在早期组 30 3只眼中 96 .7% (2 93/30 3)为神经纤维层稀疏或裂隙样缺损 ,3.3% (10 /30 3)为裂隙状加楔形缺损。在进展期 2 17只眼中 89.8% (195 /2 17)为神经纤维层稀疏或裂隙样缺损 ,6 % (13/2 17)为裂隙样加楔形缺损 ,1.8% (4 /2 17)为裂隙样或楔形缺损加弥漫性萎缩 ,2 .3% (5 /2 17)为弥漫性萎缩 ,晚期 2 0只眼中 5 0 % (10 /2 0 )为弥漫性萎缩 ,2 0 % (4 /2 0 )为裂隙样及楔形缺损加弥漫性萎缩 ,裂隙样缺损加楔形缺损占 15 % (3/2 0 ) ,而梳状或裂隙样缺损仅     

Videographic measurements of optic nerve topography in glaucoma

Topographic measurements of the optic nerve head were made with computerized videographic image analysis (Rodenstock Analyzer) in one eye each of 36 normal controls, 41 glaucoma suspects and 46 glaucoma patients matched for age. Glaucoma suspects had elevated intraocular pressures and normal visual fields in both eyes. Glaucoma patients had typical visual field defects. Disc measurements were corrected for the optical dimensions of individual eyes. One-way analysis of variance revealed statistically significant differences among the diagnostic groups for cup-disc ratio (P = 0.0006), disc rim area (P less than 0.0001) and cup volume (P = 0.0001). Mean (+/- SEM) disc rim area was 1.14 +/- 0.04 mm2 for controls, 1.10 +/- 0.04 mm2 for glaucoma suspects and 0.87 +/- 0.05 mm2 for glaucoma patients. Mean (+/- SEM) optic nerve cup volume was 0.35 +/- 0.02 mm3 for controls, 0.44 +/- 0.04 mm3 for glaucoma suspects and 0.60 +/- 0.05 mm3 for glaucoma patients. Planimetric measurements of disc rim area were made from manual tracings of stereoscopic disc photographs of the same eyes. There was a statistically significant correlation between the computerized videographic measurements and the manual photographic measurements of disc rim area (r = 0.73, P less than 0.0001). The broad range of values for these optic nerve structural parameters in normal eyes and their overlap with values in glaucomatous eyes prevents their use to reliably predict which patients are normal and which have glaucomatous visual field loss. New parameters are required to fully describe the depth information generated with new quantitative techniques.     

The Bristol Shared Care Glaucoma Study: reliability of community optometric and hospital eye service test measures.

BACKGROUND/AIMS: Primary open angle glaucoma patients and glaucoma suspects make up a considerable proportion of outpatient ophthalmological attendances and require lifelong review. Community optometrists can be suitably trained for assessment of glaucoma. This randomised controlled trial aims to assess the ability of community optometrists in the monitoring of this group of patients. METHODS: Measures of cup to disc ratio, visual field score, and intraocular pressure were taken by community optometrists, the hospital eye service and a research clinic reference "gold" standard in 405 stable glaucoma patients and ocular hypertensives. Agreement between and within the three centres was assessed using mean differences and intraclass correlation coefficients. Tolerance limits for a change in status at the level of individual pairs of measurements were also calculated. RESULTS: Compared with a research clinic reference standard, measurements made by community optometrists and those made in the routine hospital eye service were similar. Mean measurement differences and variability were similar across all three groups compared for each of the test variables (IOP, cup to disc ratio, and visual field). Overall, the visual field was found to be the most reliable measurement and the cup to disc ratio the least. CONCLUSIONS: Trained community optometrists are able to make reliable measurements of the factors important in the assessment of glaucoma patients and glaucoma suspects. This clinical ability should allow those optometrists with appropriate training to play a role in the monitoring of suitable patients.     

准分子激光角膜屈光手术后开角型青光眼患者的临床特征

目的：观察具有准分子激光角膜屈光手术（简称准分子术）史的开角型青光眼患者的临床特征。方法：回顾 性病例研究。纳入2005─2018年北京大学第三医院眼科中心就诊、具有准分子术史且随访2年以上的 开角型青光眼患者。记录一般情况以及特殊检查结果,选取每例视野较差的眼或双眼相似者随机1眼 作为研究眼。对视野进展分析采用非参数分析（NPA）法。采用独立样本t检验及秩和检验进行分析。结果： 共纳入33例患者,青光眼确诊均在准分子术后,手术至青光眼确诊间隔（10.3±6.1）年,确诊时年龄 （37.5±10.4）岁,最高眼压<21 mmHg（1 mmHg=0.133 kPa）者27例（82%）;中央角膜厚度为（456±47）μm。 眼底照相显示视网膜神经纤维层缺损18例（55%）,无法辨认的15例（45%）;杯/盘比为0.7±0.1。视 野平均缺损（MD）绝对值小于6的有18例（55%）,6～12有8例（24%）,12以上有7例（21%）。其中随 访2年以上21例,随访时间为（4.5±2.2）年;视野进展13例（62%）,视野进展速度为（0.5±0.6）dB/年。 视野进展组与非进展组治疗后降眼压幅度分别为（28.3±20.7）%和（15.4±11.0）%（t=-1.867,P=0.078）, 屈光回退发生率分别为92%和25%（P=0.003）。21例中屈光回退14例（64%）,屈光回退组中12例 （12/14）视野进展,无回退组中1例视野进展（1/7）（P=0.003）;屈光回退组的视野进展[（0.7±0.7）dB/年] 快于无回退组[（0.1±0.1）dB/年]（t=-2.899,P=0.011）。结论：准分子术后的青光眼患者确诊时大多 处于病情早中期,4/5患者眼压在21 mmHg以下,通过眼底照相能明确视网膜神经纤维层缺损的只 占一半病例。随访中约2/3患者视野恶化,可能与屈光回退有关。     

A prospective longterm study of primary chronic angle closure glaucoma

PURPOSE: To prospectively evaluate the longterm outcome of therapy for chronic primary angle closure glaucoma (PACG) and to assess the efficacy of medical and surgical treatment in terms of intraocular pressure (IOP) and visual field stabilization. METHODS: Seventy consecutive patients with chronic PACG, whose IOP remained > 21 mmHg despite a patent iridotomy, had their IOP controlled by medications or trabeculectomy performed without antimetabolites. They were followed over a 6-year period. Best corrected visual acuity, IOP (mean of annual diurnal variation readings), cup : disc ratio and visual fields were recorded. A trabeculectomy was performed if the IOP was not adequately controlled on maximal tolerable medical therapy or if there was a progression of the glaucomatous defect. Data from one eye of each patient were analysed; if both eyes met the inclusion criteria, one was randomly selected for the analysis. The baseline parameters were compared with those at the end of 6 years. RESULTS: A total of 46 eyes (65%) were controlled medically throughout the 6-year follow-up period, while 24 eyes (35%) required surgery. The mean IOP was 25.4 +/- 4.9 mmHg at baseline and 15.6 +/- 4.6 mmHg at 6 years follow-up (p < 0.001). Stereoscopic evaluation of the cup : disc ratio did not show a significant change from a mean of 0.6 +/- 0.18 at baseline to a mean of 0.64 +/- 0.2 at 6 years (p = 0.12). Progression of visual field defects was seen in seven eyes (10%), which had statistically larger cup : disc ratios (p = 0.04) and more extensive visual field deficits at the initial assessment (p = 0.04), and which also maintained higher levels of IOP (p = 0.03) over the 6 years of follow-up. CONCLUSIONS: Stable visual fields and good longterm IOP control were seen in 90% of chronic primary angle closure glaucoma eyes on medical/surgical therapy over 6 years.     

原发性闭角型青光眼易患者六年随访研究

目的了解原发性闭角型青光眼的自然发展史和危险因素,为原发性闭角型青光眼的筛检提供有益的经验。方法对４０岁以上人群（６５４８人）中筛选出的原发性闭角型青光眼易患者４８５例进行６年随访,随访检查包括视力、前房轴深、周边前房深度、眼压测定和视乳头杯／盘比。高度可疑者再进一步检查。结果４８５例易患者中,发生闭角型青光眼者２０例（４．１％）,其中自然发病者１４例（急性发作期６例,慢性期８例）,早期发现者６例,２８．０％的易患者前房进行性变浅。结论前房深度是闭角型青光眼筛检的一个重要指标,对于闭角型青光眼易患者的筛检及定期随访十分有意义。     

开角型青光眼与正常大陷凹眼中视乳头旁萎缩区的比较研究

目的研究原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)与正常大陷凹眼的视乳头旁脉络膜萎缩区(PPA)的差异及其与视野的关系。方法利用计算机图像分析系统对拍摄的视乳头立体图像进行测量,比较42例(42只眼)POAG、40例(40只眼)NTG与45例(45只眼)正常大陷凹眼之间PPA的发生率及大小差异,分析PPA的有关参数与视乳头结构指标、视野分级之间的相关性。所有入选患者的屈光度(等效球镜度数)均在+3.00~-3.00D之间。结果正常大陷凹组、POAG组及NTG组α区的出现率分别为85.4%、100.0%、95.0%,β区的出现率分别为19.1%、48.9%、37.5%,POAG组和NTG组的α区和β区的出现率均大于正常大陷凹组,差异均有统计学意义(P<0.05)。正常大陷凹组、POAG组及NTG组β区面积分别为(0.08±0.25)、(0.24±0.36)、(0.14±0.21)mm2,POAG组的β区面积大于正常大陷凹组,差异有统计学意义(P<0.05)。三组的α区面积差异无统计学意义(Chi-Square=4.534,P=0.104)。而POAG组与NTG组间上述各指标及α区和β区出现率的差异均无统计学意义(P>0.05)。青光眼患者视乳头结构指标与视野相关分析结果表明,杯/盘比值与视野受损分级之间有较强相关性(r=0.5624,P<0.01)。而α区面积、β区面积与视野受损分级之间均为低相关性(α区:r=0.246,P<0.01;β区:r=0.2302,P<0.01)。有无青光眼性视野缺损相关因素的Logistic回归分析结果显示,在包括年龄、性别、屈光度、杯/盘比值分级指标及α区面积和β区有无的多个因素中,仅年龄和杯/盘比值分级指标被证实为两个可能的影响因素。结论排除了-3.00D以上的中高度近视人群后,POAG和NTG患者的α区和β区出现率及β区面积虽与正常大陷凹者有所不同,但其与视野缺损程度的相关性较传统的视乳头结构指标低,在两组青光眼患者间也未见明显差异。由此认为PPA不能作为诊断POAG的独立指标,也不能作为POAG与NTG的鉴别诊断指标。     

Open-angle glaucoma in an urban population in southern India: the Andhra Pradesh eye disease study

OBJECTIVE: To assess the prevalence and features of open-angle glaucoma in an urban population in southern India. DESIGN: A population-based cross-sectional study. PARTICIPANTS: A total of 2522 persons (85.4% of those eligible) of all ages, including 1399 persons 30 years of age or older, from 24 clusters representative of the population of Hyderabad city. TESTING: The participants underwent an interview and detailed eye examination that included logarithm of minimum angle of resolution visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, dilatation, cataract grading, and stereoscopic fundus evaluation. Automated Humphrey threshold 24-2 visual fields (Humphrey Instruments Inc., San Leandro, CA) and optic disc photography were performed when indicated by standardized criteria for disc damage or if intraocular pressure (IOP) was 22 mmHg or more. MAIN OUTCOME MEASURES: Definite primary open-angle glaucoma (POAG) was defined as obvious glaucomatous optic disc damage and visual field loss in the presence of an open-angle, and suspected POAG was defined as suspected glaucomatous optic disc damage without definite visual field loss. Ocular hypertension (OHT) was defined as IOP of 22 mmHg or more without glaucomatous optic disc damage or visual field loss in the presence of an open-angle. Glaucomatous optic disc damage or IOP of 22 mmHg or more secondary to an obvious cause and with an open-angle was defined as secondary open-angle glaucoma. RESULTS: Definite POAG, suspected POAG, and OHT were present in 27, 14, and 7 participants, respectively, with age- and gender-adjusted prevalence (95% confidence interval) of 1.62% (0.77%-2.48%), 0.79% (0.39%-1.41%), and 0.32% (0.10%-0.78%) in those 30 years of age or older, and 2.56% (1.22%-3.91%), 1.11% (0.43%-1.78%), and 0.42% (0.11%-1.12%) in those 40 years of age or older, respectively. The prevalence of POAG increased significantly with age using multivariate analysis (P < 0.001). Only two of 27 participants (7.4%) with definite POAG had been previously diagnosed and treated, and 66.7% of the previously undiagnosed had IOP less than 22 mmHg. Fourteen of 27 participants (51.9%) with definite POAG had severe glaucomatous damage based on optic disc and visual field criteria, of which five participants (18.5%) had at least one blind eye as a result of POAG (all with best-corrected distance visual acuity less than 20/400 or central visual field less than 10 degrees); the other 13 participants (48.1%) had moderate glaucomatous damage. Because visual fields and optic disc photography were not performed on all participants, the prevalence of POAG may have been underestimated. Secondary open-angle glaucoma was present in one participant as a result of angle recession. CONCLUSIONS: The prevalence of open-angle glaucoma in this urban population in southern India is at least as much as that reported recently from white populations in developed countries. However, the vast majority of persons with glaucoma were undiagnosed in this population, and a large proportion of those having definite POAG already had severe glaucomatous damage.     

The pattern-evoked electroretinogram (PERG): Age-related alterations and changes in glaucoma

Pattern-onset electroretinograms (PERGs) were studied in 147 normal subjects of different ages (14-79 years) and in 110 eyes of 65 patients with glaucoma or ocular hypertension. The responses showed an increase (P less than 0.001) in peak latency with increasing age and a decrease (P less than 0.001) in amplitude which approximately parallels the loss of ganglion cells estimated by other authors. Many glaucoma eyes showed a loss of the normally present spatial tuning. In the age group above 50 years 50% of the onset responses were significantly diminished and the peak latencies were not significantly different. A negative correlation (P less than 0.001) was found between the size of the PERG and the cup/disc ratio and a positive correlation (P less than 0.001) with the area of the neuroretinal rim of the optic disc. The PERG decreased (P less than 0.01) with increasing visual field losses.     

Correlation between optic disc topography and retinal nerve fibre layer measurements in glaucoma

PURPOSE: To test the correlation between optic disc topography (as measured by confocal scanning laser ophthalmoscopy [CSLO]) and retinal nerve fibre layer (RNFL) measurements (as measured by scanning laser polarimetry [SLP]) in glaucoma. MATERIAL AND METHODS: A total of 112 patients with primary open-angle glaucoma and 88 normal individuals were enrolled in the study. All individuals underwent a thorough ophthalmic evaluation, a 24-2 full threshold Humphrey visual field, SLP with the GDx (Version 1.0.12) and CSLO with the TOPSS. Receiver operator characteristic curves were created for each individual CSLO and SLP parameter. Linear correlations between the four best parameters from each device were calculated. Finally, linear correlations between the same variables, controlled for the severity of visual field damage, were calculated. RESULTS: The best individual parameters in the diagnosis of glaucoma for each device were cup area, vertical cup : disc ratio, cup : disc area ratio and average cup depth for CSLO, and the Number, maximum modulation, ellipse modulation and superior nasal for SLP. Moderate to strong correlations were observed in 62% of the pairs. However, only 6% and 12% of the correlations remained moderate when we controlled for the visual field mean deviation and correct pattern standard deviation, respectively. CONCLUSIONS: The correlation between optic disc topography and RNFL measurements in glaucoma patients is moderate and highly dependent on the level of visual field loss.     

Comparison of disc damage likelihood scale, cup to disc ratio, and Heidelberg retina tomograph in the diagnosis of glaucoma

AIM: To evaluate the relative diagnostic strength of cup to disc (C/D) ratio, clinical disc damage likelihood scale (DDLS), a new clinical method of documenting glaucomatous optic disc changes, and Heidelberg retina tomograph (HRT-II) in patients with glaucoma, glaucoma suspects, and normal controls. METHOD: Consecutive observational case series. 110 eyes from 110 patients categorised as glaucoma, glaucoma suspect, or normal were examined clinically to grade the DDLS score. HRT-II examination was performed by an examiner masked to the clinical examination findings. Optic disc parameters and Moorfields regression analysis findings were recorded. Stereophotographs of the optic disc were examined independently by two glaucoma specialists in masked fashion to determine the C/D ratio. Zeiss SITA Standard 24-2 visual fields were obtained within 3 months of HRT-II and clinical examination. For each patient, the eye with the worse mean deviation of the visual field test was enrolled in the study, and each field was additionally graded by the four level Hodapp-Parrish-II-Anderson staging. Specificity and sensitivity were calculated by receiver operating characteristic (ROC) curves. RESULTS: Mean patient age was 58 years (SD 13.3) with 45 glaucoma patients, 23 glaucoma suspects, and 42 normals. The mean deviation on Humphrey visual field assessment using SITA-Standard was -4.95 D (SD 5 D) Clinical examination using DDLS had the best predictive power with an area under the ROC curve value of 0.95 when glaucoma patients and suspects were separated from borderline or normals. This was followed by clinical examination of C/D ratio (0.84), and HRT-II Moorfields analysis (0.68). The order of diagnostic strength did not change when definite glaucoma was compared to borderline and normals. CONCLUSIONS: The DDLS grading performs well compared to C/D ratio and HRT-II evaluation. Attention to disc diameter and to rim width may increase the value of clinical optic disc examination.