First-Visit Diagnosis of Preperimetric Glaucoma
Identifiers and Pagination:Year: 2010
First Page: 22
Last Page: 27
Publisher ID: TOOPHTJ-4-22
Article History:Received Date: 25/1/2010
Revision Received Date: 18/3/2010
Acceptance Date: 20/3/2010
Electronic publication date: 31/5/2010
Collection year: 2010
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http: //creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
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.