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D. Raja, D.A. John, U. Rao, B. Barahimi, C. Recchia, L.M. Merin, K. Guentri, A. Chomsky; Photographic Screening for Detection of Glaucoma in Diabetic Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3420.
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The use of telemedicine for screening for diabetic retinopathy has been widely reported. The purpose of this study was to determine the incidence of glaucoma among diabetic patients with an enlarged cup–to–disc (C/D) ratio detected through photographic screening.
Retrospective clinical chart review of 100 randomly selected patients (June 2003 to March 2005) referred for a clinical eye evaluation based on suspicion for glaucoma. The photographic criterion for glaucoma included a C/D ratio ≥ 0.6 detected through monoscopic 45 degree photograph centered on the nerve. On the referral visit, the C/D ratio and the IOP (mm Hg) were evaluated, the latter by applanation, tonopen, or digipen. Based on the clinical findings, the need for Humphrey visual fields (HVF), treatment and follow–up were determined. A paired t–test was used to compare the clinical to the screening C/D ratio.
Of the 100 charts reviewed, 76 patients presented for follow–up. Eleven of those patients (14%) were established patients with known optic neuropathy; 10 related to glaucoma and 1 due to trauma. Among the remaining 65 patients, the mean screening and clinical C/D ratio in both eyes was 0.60 and 0.62, respectively. There was no statistically significant difference between the screening and clinical C/D ratios of the right (p<0.14) or left (p<0.72) eye. The mean IOP for both eyes was 16.9 mmHg. A total of 52 patients (68.4%) were newly diagnosed with glaucoma (n=12) or were found to be glaucoma suspects (n=40). Treatment was initiated in 22 patients or continued in 10 patients: 100% of the glaucoma patients and 25% of the glaucoma suspects. Follow–up was recommended for 62 patients.
In our study population, there seemed to be a significant correlation between an enlarged C/D ratio detected by photographic screening and a clinical diagnosis of glaucoma. These findings suggest that photographic screening may be useful for identifying patients with glaucoma.
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