青光眼诊断与治疗规范——2017年英国专家共识解读

青光眼是一组会损害视神经甚至可能导致不可逆失明的眼病。近年眼科学者对青光眼的诊断和治疗有了新的认识,本文将对2017年版英国国家卫生与临床优化研究所的青光眼诊断和管理指南进行解读。     

规范斜视的诊断和治疗:解读美国眼科学会内斜视和外斜视2017年版临床指南

美国眼科学会发布的眼科临床指南(Preferred Practice Pattern,PPP)是目前国际上公认的眼科权威诊断和治疗指南。2017年9月,内斜视和外斜视2017年版PPP正式发布。该版PPP采用最新的证据质量和推荐强度分级,基于最可靠的临床试验结果或专家委员会对现有依据的集体判断和评估,对2012年版PPP进行了更新。本文从斜视的定义、流行病学调查、诊断和治疗几个方面对内斜视和外斜视2017年版PPP进行解读,并与2012年版PPP进行比较,希望帮助眼科临床医师深入领会2017年版PPP的更新要点,进一步促进我国斜视诊断和治疗的规范化。     

青光眼住院手术患者的构成及变化趋势分析

目的分析青光眼住院手术患者的内部构成比及其性别、年龄分布,为青光眼的防治研究提供流行病学参考。方法回顾分析浙江大学医学院附属第二医院眼科2001年1月至2008年12月期间青光眼住院手术患者资料,统计住院手术患者的年龄、性别分布及各种类型青光眼的构成比,分析其内部构成比及变化趋势。结果原发性青光眼、继发性青光眼和先天性青光眼患者数各占青光眼总数的61.82%、31.01%和7.16%。住院手术患者中,原发性闭角型青光眼（PACG）患者男：女=1：2.05;原发性开角型青光眼（POAG）患者男：女=2.41：1;继发性青光眼（SG）患者男：女=1.94：1;先天性青光眼（CG）患者男：女=1.45：1。40岁以下原发性青光眼手术患者以POAG患者多于PACG,而40岁以上则相反。结论 PACG是青光眼住院手术患者的主要类型。40岁以上人群中,PACG可能是青光眼防治的重点,而40岁以下人群的防治重点则可能是POAG。     

EYESI双目间接检眼镜模拟训练系统作为眼底检查技能培训和考核平台的有效性

目的 评价EYESI双目间接检眼镜模拟训练系统（简称EYESI系统）作为眼科住院医师眼底检查技能培训方法和考核手段的有效性。设计 比较性教学研究。研究对象 眼科在岗住院医师20人。方法 根据学习间接检眼镜的时间，将20名住院医师分为0组、1月组、3月组和6月组，利用EYESI系统对各组进行间接检眼镜操作技巧、眼底绘图技巧的考核，比较组间得分差异，评价EYESI系统作为考核手段的有效性。选10名住院医师随机分2组，分别利用EYESI系统、传统实践方法进行培训，比较两组在操作、眼底绘图方面的提高情况，评价EYESI系统作为培训方法的有效性。主要指标 操作技巧指标：检查时长，光暴露时长，总分；眼底绘图技巧指标：绘图时长、光暴露时长、绘图精确性、总分。结果 0组住院医师检查时长最长（1359.25±729.82）s，其他组随使用经验增加检查时长逐渐缩短，3月组（553.67±87.37）s、6月组（489.40±107.16）s与0组差异显著（P=0.026，0.009）。0组光暴露时长最长（442.00±188.79）s，其他三组均与0组有显著差异（P=0.018，0.011，0.006），但总分差异不明显；绘制眼底图时长随间接检眼镜使用经验的增加而逐渐递减，0组最长（1860.50±188.80）s，6月组最短（968.75±336.58）s，差异显著（P=0.026）；绘图光暴露时长、精确度和总分组间差异不显著。经EYESI系统培训后，住院医师的检查时长由（1226.67±832.76）s降低为（761.00±307.32）s，缩短幅度为（30.58%±19.22%）；绘图时长由（1001.00±507.72）s降为（667.00±333.75）s，缩短幅度为（33.90%±1.46%）；精确度由81.28%±3.50%提升为88.88%±1.45%；增长幅度为9.41%±2.93%。经传统实践培训后，住院医师的检查时长由（765.00±306.92）s降低为（595.67±158.71）s，缩短幅度为（19.09%±12.87%）；绘图时长由（1810.00±424.08）s降低为（1429.67±180.47）s，缩短幅度（19.40%±10.40%）；绘图精确度由75.13%±11.29%提升为81.62%±10.31%，增长幅度为（15.59%±12.26%）。结论 EYESI系统作为眼科住院医师学习间接检眼镜的考核和培训平台具有高效、精确的特点。     

合并视网膜色素变性的青光眼临床特征

目的 分析合并视网膜色素变性（RP）的青光眼患者的临床特征。设计 回顾性病例系列。研究对象 2008年8月至2012年9月北京同仁眼科中心RP合并青光眼患者37例（62眼）及未合并青光眼的RP患者109例（215眼）。方法 对上述患者的门诊电子病历结合门诊病案资料进行回顾分析。主要指标 青光眼类型,矫正视力及眼压。结果 37例（62眼）RP合并青光眼者中急性闭角型青光眼9例（18眼,29.0%）,慢性闭角型青光眼21例（34眼,54.8%）,原发性开角型青光眼7例（10眼,16.1%）。RP合并青光眼及未合并青光眼者盲眼（视力<0.05）比例分别为58.9%和33.6%（P=0.000）。RP合并青光眼者的平均眼压（23.1±14.0）mm Hg。结论 此回顾性研究中RP合并的青光眼多为原发性闭角型,且视力损害加重。（眼科,2013, 22：42-44）     

微导管引导的内路小梁切开术治疗原发性先天性青光眼六个月的疗效

目的 评估微导管引导的内路小梁切开术治疗原发性先天性青光眼的效果。设计 回顾性病例系列。研究对象 2018年8月至2019年2月北京同仁眼科中心原发性先天性青光眼患者27例（30眼）。方法 患者接受微导管引导的内路小梁切开术，根据术中全周切开和次全周切开，以及是否有既往手术史分组。术后随访6个月。主要指标 眼压、降眼压药物及术后并发症。结果 术前平均眼压（31.5±6.1）mmHg，用药中位数3种（1~4种）；术后末次随访眼压（15.7±3.6）mmHg，用药中位数0种（0~3种）（P均<0.001）。全周切开组（17眼）及次全周切开组（13眼）的术前眼压及术后末次眼压均无统计学差异（P均＞0.05），但全周切开组的降眼压幅度为（54.7%±10.1%），明显大于次全周切开组（37.5%±16.8%，P=0.002）。初次手术组（16眼）与多次手术组（14眼）术前眼压、术后末次眼压及降眼压幅度的差异均无统计学意义（P均＞0.05）。术后早期均有前房积血, 6眼（20%）术后一过性眼压升高。结论 短期随访结果显示， 微导管引导的内路小梁切开术治疗角膜透明的原发性先天性青光眼是可行的。     

2006-2013年河北省眼科医院住院继发性青光眼患者的类型及治疗方法

 目的  回顾2006-2013年河北省眼科医院住院继发性青光眼患病人群的类型及治疗方法。设计 回顾性病例系列。研究对象 2006年6月-2013年3月河北省眼科医院青光眼科住院的继发性青光眼1178例1361眼。方法 回顾患者病历资料,分析患病年龄、病因、治疗方法等。病因构成比按例数计算。主要指标  继发性青光眼的病因及构成比。结果 1178例继发性青光眼患者中新生血管性青光眼436例522眼（37.0%）,外伤性青光眼166例166眼（12.2%）,晶状体源性青光眼185例201眼（15.7%）,
葡萄膜炎继发青光眼160例176眼（13.6%）,角膜炎所致青光眼63例71眼（5.4%）,其他病因者168例225眼（14.3%）。新生血管性青光眼中以糖尿病视网膜病变（46.2%）和视网膜静脉阻塞（32.8%）为多。外伤性青光眼以眼球钝挫伤晶状体脱位（27.7%）、前房玻璃体出血（25.9%）比例较大。晶状体源性青光眼以晶状体膨胀因素（36.8%）居多。手术治疗1204眼（88.5%）,其中小梁切除术351眼（29.2%）,Ahmed阀植入术257眼（21.3%）,睫状体冷冻术131眼（10.9%）,白内障摘除联合滤过性手术127例（10.5%）,睫状体光凝术122眼（10.1%）,晶状体摘除术84眼（7.0%）,其他手术132眼（11.0%）。结论 2006-2013年河北省眼科医院住院继发性青光眼以新生血管性青光眼为首位病因。其次为外伤性青光眼、晶状体源性青光眼和葡萄膜炎继发青光眼。依据继发性青光眼的病因不同,采用多种不同的治疗方式。（眼科,2015,24： 40-43）     

急性闭角型青光眼高眼压状态下行白内障摘除对角膜内皮细胞的影响

目的：观察急性闭角型青光眼高眼压状态下行白内障摘除联合人工晶状体植入对角膜内皮细胞的 影响。方法：回顾性系列病例研究。选择2018年1月至2021年8月在同济大学附属同济医院眼科就 诊的急性闭角型青光眼发作且药物保守治疗及前房穿刺不能稳定控制眼压患者41例（55眼），眼压 （47.3±4.8）mmHg（1 mmHg=0.133 kPa），同时伴不同程度晶状体混浊。所有患者行白内障摘除联合 人工晶状体植入及房角分离术。术前及术后3个月内行常规眼科检查，并获取角膜内皮相关指标， 包括角膜内皮细胞密度（ECD）、中央角膜厚度（CCT）及变异系数（CV）等。手术前后各指标差值比 较采用配对t检验或Wilcoxon符号秩和检验。结果：术后第1天眼压为（16.7±3.7）mmHg，其中4眼 眼压仍高（[ 24.9±2.2）mmHg]需药物控制，其余患眼眼压在正常范围内；术后3个月眼压为（15.7±3.1） mmHg，与术前相比差异有统计学意义（t=36.48, P<0.001）。术后ECD[（1 023±344）个/mm2]明显 较术前 [（2 062±300）个/mm2]下降（t=-22.75, P<0.001）。术后CV（33.5%±6.8%）明显较术前CV （22.7%±2.6%）增大（t=13.62, P<0.001）。手术前后患眼最佳矫正视力明显改善（Z=-4.94, P<0.001）。 所有患者均未发生术中或术后并发症。结论：急性闭角型青光眼高眼压状态下行白内障摘除联合人 工晶状体植入可快速有效控制眼压，但角膜内皮细胞损伤明显。     

Ahmed FP-7青光眼引流阀治疗难治性青光眼的18个月效果

目的 评估Ahmed FP-7青光眼阀植入治疗难治性青光眼的效果。设计 回顾性病例系列。研究对象 哈尔滨医科大学附属第二医院难治性青光眼患者45例46眼。方法 对以上患者行Ahmed FP-7青光眼阀植入,术后平均随访（10.7±7.3）个月。不用降眼压药眼压≤21 mm Hg定义为成功。主要指标 眼压、视力、手术后并发症。结果 术后18个月成功率为74.1 %;术前平均眼压（45.8±12.1）mm Hg,术后18个月为（17.6±5.3）mm Hg （P<0 .001）。视力提高 9眼,无改变35眼。手术并发症包括引流盘纤维包裹9眼（19.6%）、脉络膜脱离6眼（13.0%）、前房出血5眼（10.9%）、引流管暴露2眼（4.3%）。结论 18个月的随访显示,Ahmed FP-7青光眼阀植入术可控制3/4的难治性青光眼患者的眼压。（眼科,2013,22：253-256）     

《中国青光眼临床工作指南》(2005)公布

近几年，美国、欧洲及亚太地区眼科学会均相继制定了本地区的青光眼临床工作指南，我国多年来一直沿用1987年制定的《原发性青光眼早期诊断的初步建议》，该建议已不能满足指导国内青光眼临床工作的要求，我国迫切需要适合国情的现代青光眼临床工作指南。有鉴于此，中华医学会眼科学分会青光眼学组于2005年7月29～30日在广东省东莞市召开学组全体委员工作会议，经过开放、民主、自由、严谨及认真地讨论，取得共识，一致同意参照美国青光眼建议工作模式（prefered practice pattern，PPP）（2005）制定我国青光眼临床工作指南。现将中华医学会眼科分会青光眼学组一致通过的《中国青光眼临床工作指南》（简称指南）公布如下。     

121697人健康体检中青光眼的筛查结果分析

目的探讨健康体检中青光眼筛查方法及结果分析。方法采用同顾分析方法对我院健康体检数据库资料进行分析。结果在121697人健康体检中，发现青光眼1381例，患病率为1.14％，原发性闭角型青光眼（PACG）810例，患病率为0.67％，原发性开角型青光眼（POAG）476例，患病率为0.39％，正常眼压性青光眼（NTG）44例，患病率为0.04％，继发性青光眼（SG）51例、患病率为0。04％。正常大陷门者112例，术发现先天性青光眼。结论青光眼筛查方法应简易、快捷、价廉及有效的。对健康体检作青光眼筛查足必要的并且足可行的，而且在健康体检数据中为所有受检建立健康档案，这对青光眼患者诊断、治疗及评估有十分重要意义，特别对可疑青光眼受检者有一个长期跟踪观察及对比机会。     

重视《中国青光眼指南(2020年)》发布后的推广和评价

青光眼是全球首位不可逆性致盲眼病。《中国青光眼指南(2020年)》(以下简称《指南》)基于我国基本国情,结合了国内外最新研究进展,可为我国青光眼临床诊疗工作提供重要参考和建议。眼科界应对《指南》加大宣传和推广力度,拓展其传播渠道和覆盖范围,以期充分发挥《指南》对临床工作的指导作用;还应注重对《指南》进行质量评价和后效评价,在临床工作中检验《指南》的可靠性和适用性,推动青光眼循证实践;同时应不断积累和反馈证据,以促进《指南》更新和完善,从而构建良好的证据生态系统,以期不断有效助力我国青光眼临床诊疗水平提高。(中华眼科杂志,2021,57:161-165)     

Reproducibilidad de la densidad vascular peripapilar,cabeza del nervio óptico y área macular por OCT-A de acuerdo con la severidad del glaucoma

ObjectiveTo assess the reproducibility of peripapillary, optic nerve head (ONH-PP) and macular vessel density (VD) by spectral domain optical coherence tomography angiography (SD OCT-A) in glaucoma patients and healthy subjects.MethodsCross-sectional study assessing 63 eyes of 63 subjects, including 33 glaucoma patients and 30 healthy subjects. Glaucoma was classified in mild, moderate, or advanced. Two consecutive scans were acquired by spectralis module OCT-A (Heidelberg, Germany), and provided images of the superficial vascular complex (SVC), nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP), deep vascular complex (DVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). VD (%) was calculated by AngioTool. Intraclass correlation coefficients (ICCs) and coefficients of variation (CV) were calculated.ResultsAmong ONH-PP VD, better ICC presented advanced (0.86-0.96) and moderate glaucoma (0.83-0.97) compared with mild glaucoma (0.64-0.86). For the macular VD reproducibility, ICC results for superficial retinal layers were better for mild glaucoma (0.94-0.96) followed by moderated (0.88-0.93) and advanced glaucoma (0.85-0.91), and for deeper retinal layers ICC was better for moderate glaucoma (0,95-0,96) followed by advanced (0.80-0.86) and mild glaucoma (0.74-0.91). CVs ranged from 2.2%% to 10.94%. Among healthy subjects, ICCs for the ONH-PP VD measurements (0.91-0.99) and for the macular VD measurements (0.93-0.97) were excellent in all layers, with CVs from 1.65% to 10.33%.ConclusionsSD OCT-A used to quantify macular and ONH-PP VD showed excellent and good reproducibility in most layers of the retina, both in healthy subjects and in glaucoma patients regardless of the severity of the disease.     

Temba glaucoma study: a population-based cross-sectional survey in urban South Africa

OBJECTIVE: To determine the prevalence and features of glaucoma in an urban South African black population. DESIGN: Random sampling cross-sectional population survey. PARTICIPANTS: Black residents of Temba, North West Province, South Africa, age > or =40 years. MAIN OUTCOME MEASURES: Automated visual field testing and detailed, standardized slit-lamp examination were attempted on all subjects. Glaucoma was diagnosed by use of the scheme proposed by the Working Group for Defining Glaucoma of the International Society of Geographical and Epidemiologic Ophthalmology on the basis of evidence of end-organ damage. RESULTS: Of 1120 subjects, 839 (74.9%) were examined. The age- and gender-adjusted prevalence of glaucoma of all types was 5.3% (95% confidence interval [CI], 3.9%-7.1%). Primary open-angle glaucoma (POAG) was the most common glaucoma diagnosis, with an adjusted prevalence of 2.9% (95% CI, 1.9%-4.3%). Secondary glaucoma occurred with an adjusted prevalence of 2.0% (95% CI, 1.2%-3.3%). Exfoliative glaucoma was responsible for 16% of all glaucoma cases. The prevalence of primary angle-closure glaucoma was 0.5% (95% CI, 0.13%-1.2%). Of all subjects with glaucoma, 58% were blind in at least one eye. The prevalence of all types of glaucoma increased with age. Of subjects with POAG, 87% had not been previously diagnosed. CONCLUSIONS: The prevalence of glaucoma in this South African population was higher than that found in white populations, and most cases were undiagnosed and untreated. Glaucoma is a major cause of blindness in this population.     

青光眼住院病人5年构成及视力损害分析

目的 对邯郸市眼科医院青光眼的住院病人5年构成和视力损害情况进行分析.方法 对2001～2005年邯郸市眼科医院住院患者中不同类型青光眼进行回顾性分析.结果 962例患者中,男性320例,女642例,平均年龄(61.2±13.6)岁.其中,原发性青光眼794例(82.5%),继发性青光眼127例(13.30%),先天性青光眼13例(1.4%).原发性青光眼中,急性闭角型青光眼424例(53.4%),慢性闭角型青光眼313例(37.4%),开角型青光眼57例(7.1%).原发性青光眼中双眼盲发生率7.9%(63/794),其中急性闭角型青光眼致盲、慢性闭角型青光眼、原发性开角型青光眼所致分别占36.5%(23/63)、52.3%(33/63)、11.1%(7/63);低视力发生率16.8%(134/794),其中急性闭角型青光眼、慢性闭角型青光眼致盲和原发性开角型青光眼所致分别占46.2%(62/134)、30.6%(41/134)和8.9%(12/134).结论 原发性闭角型青光眼是邯郸地区住院青光眼患者中的主要类型,而住院闭角型青光眼中,急性闭角型青光眼居多且视力损害重,如能加强和规范急性闭角型青光眼的早期防治和急诊处理,可大幅度降低青光眼的致盲率.     

A deep dive into the latest European Glaucoma Society and Asia-Pacific Glaucoma Society guidelines and their relevance to India

Glaucoma is the second leading cause of blindness in India. Despite advances in diagnosing and managing glaucoma, there is a lack of India-specific clinical guidelines on glaucoma. Ophthalmologists often refer to the European Glaucoma Society (EGS) and Asia-Pacific Glaucoma Society (APGS) guidelines. A group of glaucoma experts was convened to review the recently released EGS guideline (fifth edition) and the APGS guideline and explore their relevance to the Indian context. This review provides the salient features of EGS and APGS guidelines and their utility in Indian scenario. Glaucoma diagnosis should be based on visual acuity and refractive errors, slit-lamp examination, gonioscopy, tonometry, visual field (VF) testing, and clinical assessment of optic nerve head, retinal nerve fiber layer (RNFL), and macula. The intraocular pressure target must be individualized to the eye and revised at every visit. Prostaglandin analogues are the most effective medications and are recommended as the first choice in open-angle glaucoma (OAG). In patients with cataract and primary angle-closure glaucoma (PACG), phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Trabeculectomy augmented with antifibrotic agents is recommended as the initial surgical treatment for OAG. Laser peripheral iridotomy and surgery in combination with medical treatment should be considered in high-risk individuals aged <50 years. In patients with phakic and PACG, phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Visual acuity, VF testing, clinical assessment of the optic disc and RNFL, and tonometry are strongly recommended for monitoring glaucoma progression.     

Glaucoma in oman: a review

PURPOSE: Glaucoma is one of the priority eye diseases in Oman in its VISION 2020 Plan. A review of available data is presented on the basis of situation analysis carried out in 2002. METHODS: The General demography, morbidity and management of eye diseases reported by different eye institutions. Predefined parameters and definitions were used to calculate incidence and coverage of glaucoma. RESULTS: The rate of glaucoma cases reported by ophthalmologists was 1.14/1000. 11.5% of estimated blindness in Oman in 1997 was due to glaucoma. Primary Open angle glaucoma constituted 63.5% of the total glaucoma cases. In spite of free and easy access to the eye treatment, coverage of glaucoma surgery was 25% of the reported cases. Evidence based information on glaucoma in the community is needed in Oman. The health facilities for eye care of glaucoma cases are available in different health regions of Oman. CONCLUSIONS: Glaucoma should be addressed through a program approach both to reduce/delay visual disabilities and improve quality of life of glaucoma patients.     

Glaucoma probability score vs Moorfields classification in normal, ocular hypertensive, and glaucomatous eyes

PURPOSE: To evaluate the Heidelberg Retina Tomograph III (HRT III) glaucoma probability score in differentiating normal from pathologic eyes and to compare the glaucoma probability score with Moorfields regression analysis (MRA). DESIGN: Prospective cross-sectional study. METHODS: Fifty-nine normal, 40 hypertensive, and 83 glaucomatous eyes were examined with Swedish interactive threshold algorithm standard 24-2 visual fields and HRT III. Sensitivity and specificity were evaluated using global and sectorial glaucoma probability score and MRA compared with damage in visual fields. Areas under receiver operating characteristic (ROC) curves were evaluated. Agreement between MRA and glaucoma probability score was calculated using the kappa coefficient. Glaucoma probability score was considered to be displaced when a symbol was outside and the opposite symbol was inside the optic disk. RESULTS: MRA sensitivity and specificity were 39.8% and 93.2% (most specific criteria) and 68.7% and 83.1% (least specific criteria), respectively. Glaucoma probability score sensitivity and specificity were 71.1% and 69.5% (most specific criteria) and 85.5% and 54.2% (least specific criteria), respectively. Visual field parameters were related to the global (P = .001) and sectorial (P < .05) glaucoma probability score. A displaced glaucoma probability score was found in 35 eyes, but with unchanged glaucoma probability score sensitivity and specificity. Areas under the ROC curves of glaucoma probability score was 0.77. The kappa coefficient was 0.34. CONCLUSIONS: Glaucoma probability score analysis tends to be more sensitive but less specific than MRA. Glaucoma probability score did not differentiate normal and hypertensives eyes. When displaced, glaucoma probability score sensitivity and specificity were unchanged. MRA and glaucoma probability score agreement was low. Glaucoma probability score is advantageous over MRA in early-stage glaucoma.     

Ocular hypertension and glaucoma: the contribution of large studies to daily practice

Official guidelines to manage and treat various clinical presentations of glaucoma and ocular hypertension are not currently in wide use. Several well-designed clinical trials have been published recently which can provide ophthalmologists with therapeutic recommendations. In the field of ocular hypertension, three major and historic studies are reported and discussed in this review. A more recent study undertaken in Sweden and the design of the Ocular Hypertension Treatment Study (OHTS) are reviewed as well, although the final results of this important trial have not yet been published. The conclusions of the Collaborative Normal Tension Study Group (CNTSG) have been expected for a long time since this disease is difficult to manage; a 30% reduction in baseline intraocular pressure avoids further deterioration of the visual field in most patients. Other studies have dealt with different strategies in open angle glaucoma. The Advanced Glaucoma Intervention Study (AGIS) has investigated different therapeutic sequences in advanced glaucoma while the Collaborative Initial Glaucoma Treatment Study (CIGTS) and the Early Manifest Glaucoma Trial (EMGT), still in progress, have evaluated the efficacy and safety of surgery versus medical treatment and treatment versus no treatment, respectively, in new and low-grade glaucoma. These long-term studies have led to a better approach to ocular hypertension, normal tension glaucoma, initial glaucoma, and advanced glaucoma. This review presents the characteristics of these clinical studies, points out the problems linked to giving a fair and practical interpretation, and attempts to draw useful guidelines for daily clinical practice.     

The Heidelberg Retina Tomograph vs clinical impression in the diagnosis of glaucoma

PURPOSE: To compare the sensitivity and the specificity of the Heidelberg Retina Tomograph (HRT) classification of "Glaucoma" or "Normal" with that derived from clinical impression (CI) based on several parameters. DESIGN: Consecutive observational case series. METHODS: In a retrospective chart review of 200 left eyes of 200 consecutive patients referred to the Glaucoma Service Diagnostic Laboratory of the Wills Eye Hospital, we compared the HRT-based classification of "Glaucoma" or "Normal" with a CI classification of "Definite glaucoma," "Probably glaucoma," "Probably no glaucoma," and "No glaucoma." RESULTS: The HRT-based diagnosis of "Glaucoma" or "Normal" had an 86% sensitivity and 68% specificity when compared with a clinical impression (CI) of "Definite glaucoma," used as a strict gold standard definition of glaucoma; an 83% sensitivity and 57% specificity when the CI "Definite glaucoma" and "Probably glaucoma" were combined as a more liberal definition of glaucoma; a 76% sensitivity and 69% specificity when the CI "Definite glaucoma," "Probably glaucoma," and "Probably no glaucoma" were combined as the most liberal definition of glaucoma. The HRT diagnosis had an 86% sensitivity and 51% specificity when compared with the groups "Probably glaucoma," "Probably no glaucoma," and "No glaucoma" combined and considered as no glaucoma. CONCLUSIONS: In this study, HRT-based classification of "Glaucoma" or "Normal" was moderately sensitive, but not very specific when compared with the clinical impression as the gold standard. Clinicians should not rely on the HRT diagnosis alone, but should use it to supplement the impression based on an eye examination and other ancillary tests.