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E.Y. Wong, J.E. Keeffe, L. Weih, J.L. Rait, A. Le, H.R. Taylor; Detection of Glaucoma by Eye Health Professionals . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3411.
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Purpose: To determine the possible reasons for undiagnosed glaucoma in people who have attended an eye care provider within the previous 12 months and to suggest strategies to assist in early detection of glaucoma. Methods: A cluster random sample of 4744 participants from two cohorts, urban and rural, was studied. Structured standardized interviews were conducted in all eligible participants. Questions were asked regarding each person’s demographic characteristics, lifestyle, medical history, medication use, prior knowledge of eye disease, current visual symptoms and use of eye care services. In addition, trained clinicians performed dilated ocular examinations on all individuals. Data on intraocular pressures, cup-to-disc ratios, visual fields, and photography of optic discs were obtained. Suspected glaucoma cases were submitted to a panel of six ophthalmologists and were classified into definite, probable or possible open angle glaucoma. Results: The overall prevalence of open angle glaucoma was 4%. Of the 187 participants with open angle glaucoma, 73 had previously undiagnosed definite and probable glaucoma. Of these undiagnosed definite and probable glaucoma cases, 36 had visited an optometrist, ophthalmologist or both in the previous 12 months. Within this group, the mean age was 71 years compared to the overall cohort mean of 59 years. Of those with undiagnosed glaucoma and had been seen by an eye care provider in the previous 12 months, the mean IOP was 19mmHg, significantly higher than persons with previous diagnosis of the disease (17mmHg, p<0.05) and to the rest of the population (14mmHg, p<0.0001). In all, 97% of those with undiagnosed glaucoma had visual field defects, whereas only 64% had a vertical cup-disc ratio equal or more than 0.7 and only 11% had a cup-disc ratio asymmetry of more than 0.3. Conclusions: Eye care professionals should include visual field testing as part of their routine eye examination of people in whom glaucoma could be suspected, especially those who are 50 years or older, have abnormal optic disc or a positive family history of open angle glaucoma.
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