First-Visit Diagnosis of Preperimetric Glaucoma

Avinoam Ophir*
Division of Ophthalmology, Hillel-Yaffe Medical Centre, Hadera and The Ruth and Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel

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© Avinoam Ophir; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http: // which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Division of Ophthalmology, Hillel-Yaffe Medical Centre, Hadera, Israel; Tel: 04-6304458, Mobile: 0547222688; Fax: 03-5409222; E-mail:



To present a revised interpretation of the work-up data that enabled diagnosis of preperimetric glaucoma (PPG) at the first examination.


a) Literature analysis on PPG; b) 6-year follow-up of a glaucoma-suspect patient.


Two new concepts may be adapted: (a) the objective finding of retinal nerve fiber layer (RNFL) thinning below the normal border in the opposing typical glaucoma locations, the inferior and superior quadrants, and in a non-diffuse pattern, appears asymptomatically and simultaneously only in glaucoma; and (b) the imaging-related RNFL thickness may be considered the reference glaucoma standard, whereas the suspicious early glaucomatous optic neuropathy, having a potential diagnostic inaccuracy, would serve as a complementary revealing finding. That approach enabled, in retrospect, a first-visit diagnosis of low-tension PPG in the patient. Diagnosis was confirmed after 6 years, when cecocentral scotoma and further RNFL thinning emerged despite treatment.


A revised approach enabled PPG diagnosis during the first visit.

Keywords: Preperimetric glaucoma, early glaucoma, low-tension glaucoma, optical coherence tomography, retinal nerve fiber layer.