RESEARCH ARTICLE

First-Visit Diagnosis of Preperimetric Glaucoma

Avinoam Ophir, * Open Modal Authors Info & Affiliations
The Open Ophthalmology Journal 31 May 2010 RESEARCH ARTICLE DOI: 10.2174/1874364101004010022

Abstract

Purpose:

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

Methods:

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

Results:

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.

Conclusions:

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.
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