A discussion on the diagnosis of glaucoma and detection of progression in the presence of concomitant diseases using visual field and disc assessments

Clinical Issues:

Diagnosis of glaucoma in the ageing eye

Author: Ananth Viswanathan FRCOphth MD PhD

Consultant Surgeon, Biomedical Research Centre at Moorfields Eye Hospital NHSFT, London and UCL Institute of Ophthalmology, London

Core concepts

• An examination of the neuroretinal rim and surrounding retinal nerve fibre layer is necessary to detect glaucomatous optic neuropathy.
• Glaucoma often affects the superior and inferior poles of the disc.
• Presence of disc haemorrhage and/or retinal nerve fibre layer defects is very suggestive of glaucoma.
• Reproducible visual field changes may be the first sign of glaucoma.
• Quantification of progressive disc/RNFL changes may be aided by analysis of serial confocal scanning laser ophthalmoscopy or OCT images.
• Pointwise analysis for VF progression is more helpful than use of global indices.
• Using glaucoma change software is more reliable than clinical judgement alone in estimating visual field progression.