Product information and disease description Place of product in therapy Disease description

Diagnosis

7 evidence topics · 5 sources

Guideline: comprehensive initial glaucoma evaluation

“The comprehensive initial glaucoma evaluation (history and physical examination) includes all components of the comprehensive adult medical eye evaluation” (opens the source at this quote in a new tab)
“The evaluation may require more than one visit. For instance, an individual might be suspected of having glaucoma on one visit but may return for further evaluation to confirm the diagnosis, including additional IOP measurements; gonioscopy; CCT determination; visual field assessment; and ONH, circumpapillary RNFL, and macular ganglion cell layer imaging.” (opens the source at this quote in a new tab)

Guideline: diagnostic tests

Diagnostic test	Quoted record
Corneal thickness	“CCT measurement”
Corneal biomechanics	“Corneal hysteresis measurement”
Visual function	“Visual field evaluation”
Structural imaging	“ONH, circumpapillary RNFL, and macular ganglion cell layer imaging”

Structural and functional criteria and limits of early detection

“With retinal ganglion cell death and optic nerve fiber loss in glaucoma, characteristic changes in the appearance of the optic nerve head and retinal nerve fiber layer occur.” (opens the source at this quote in a new tab)
“Because there is no single perfect reference standard for establishing the diagnosis of glaucoma, early diagnosis can be challenging.” (opens the source at this quote in a new tab)
“Presence of characteristic visual field defects can confirm the diagnosis, but as many as 30% to 50% of retinal ganglion cells may be lost before defects are detectable by standard visual field testing.” (opens the source at this quote in a new tab)
“These techniques, including confocal scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography, have improved the identification of early disease and also enhanced the observation of progressive optic nerve fiber loss over time” (opens the source at this quote in a new tab)

Intraocular pressure alone does not establish the diagnosis

“Although elevated intraocular pressure is a very consistent risk factor for the presence of glaucoma, several population-based studies found intraocular pressure was lower than 22 mm Hg in 25% to 50% of individuals with glaucoma.” (opens the source at this quote in a new tab)

Diagnostic and monitoring tests in clinical practice

“Diagnostic testing to assess for glaucoma and to monitor for disease progression includes measurement of intraocular pressure, perimetry, and optical coherence tomography.” (opens the source at this quote in a new tab)

“Glaucoma is diagnosed using ophthalmoscopy, tonometry, and perimetry.” (opens the source at this quote in a new tab)

“Eye doctors can check for glaucoma as part of a comprehensive dilated eye exam.” (opens the source at this quote in a new tab)
“The exam includes a visual field test to check your side vision.” (opens the source at this quote in a new tab)
“If you’re at higher risk, you need to get a comprehensive dilated eye exam every 1 to 2 years.” (opens the source at this quote in a new tab)

Test variability and the number of examinations needed to detect deterioration

“Perimetry describes the subjective psychophysical defect as experienced by the patient, but it has fairly high intervisit variability, so at least three perimetric examinations could be necessary to detect visual-field deterioration reliably.” (opens the source at this quote in a new tab)
“One measurement of intraocular pressure has a low sensitivity to detect glaucoma under screening conditions.” (opens the source at this quote in a new tab)

Proportion of cases undiagnosed and the case against population-wide screening

“A large proportion (50–90%) of patients with glaucoma remain undiagnosed in developed, developing, and underdeveloped regions of the world.” (opens the source at this quote in a new tab)
“Because of the fairly low prevalence of glaucoma (about 3·5% in individuals aged 40 years or older), and since diagnostic measures with sufficient precision are not yet available, general screening for glaucoma would result in an unacceptably high number of false-positive diagnoses.” (opens the source at this quote in a new tab)