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June 1994

Screening for Glaucoma in a Medical Clinic With Photographs of the Nerve Fiber Layer

Author Affiliations

From the Dana Center for Preventive Ophthalmology and the Glaucoma Service, The Wilmer Ophthalmological Institute, The Johns Hopkins University, and The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.

Arch Ophthalmol. 1994;112(6):796-800. doi:10.1001/archopht.1994.01090180094042

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.

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