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Federico Di Matteo, Paolo Bettin, Marina Fiori, Carlo Ciampi, Umberto De Benedetto, Francesco Bandello; How Was Glaucoma First Discovered? Risk Factors For Late Diagnosis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6389. doi: https://doi.org/.
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to identify the circumstances that lead to the diagnosis of glaucoma, and to determine the risk factors related to a late diagnosis.
124 consecutive patients coming for a visit in the Glaucoma Service of our Center with an established diagnosis of definite or suspect glaucoma were included in this study.Historical information about each patient's maximum intraocular pressure (IOP), perimetric indices, and first ophthalmological examination was collected from all available medical records. All patients were invited to fill a written questionnaire with five multiple-choice questions regarding the visit upon which their glaucoma or suspect glaucoma was first diagnosed (the aspects investigated were: approximate time elapsed from diagnosis, reason for the visit, person who first mentioned the possibile diagnosis, symptoms present at that moment and diagnostic signs, if any).According to the mean deviation (MD) value, visual fields (VF) defects were classified as: mild (MD -2 dB or better); moderate (MD between -2 and -12 dB); advanced (MD -12 dB or worse), and these cutoffs were used to stratify the patients into three groups according to the severity of the disease in the worse (or only seeing) eye.
patient age was 66.4 ± 13.3 years, whereas their age at the time of diagnosis was 57.4 ± 14.3 years (mean ± SD). 107 patients had a diagnosis of glaucoma (33 open-angle, 17 angle-closure, 16 pseudoexfoliative, 14 normal-tension, 11 pigmentary, 16 other secondary forms), while 17 were glaucoma suspects.Average IOP when diagnosis was made was 30.2 ± 10.9 mmHg and average MD on first VF examination was -9.0 ± 8.8 dB (mean ± SD).Fifty-nine percent of the cases were diagnosed during a routine ophthalmic examination requested for general check-up or spectacle prescription, however, 68% of the patients with advanced VF defects experienced some disease-related symptoms.High IOP, pseudoexfoliation, pigment dispersion, and complaint about "blurred" or "decreased" vision were associated with an advanced VF defect at the time of the diagnosis.
Among the outpatients accessing our Glaucoma Service with a diagnosis of definite or suspect glaucoma, first identification of the disease was strongly associated with incidental measurement of high IOP, as well as with detection of pigment dispersion or pseudoexfoliation during routine ophthalmological examinations. Particularly, patients with pseudoexfoliation and pigment dispersion were more likely affected by an advanced VF defect at the time of diagnosis.
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