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Lee, Kim, Kim, Ahn, and Hwang: The Path to Glaucoma Diagnosis
Original Article

J Korean Ophthalmol Soc 2015;57(5):794-799.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2016.57.5.794

The Path to Glaucoma Diagnosis

Kwan Bok Lee, MD1, Min Kyung Kim, MD1, Mi Jin Kim, MD1, Sang Il Ahn, MD2, Young Hoon Hwang, MD1

1Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim‘s Eye Hospital, Konyang University College of Medicine, Seoul, Korea

2Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea

Address reprint requests to Young Hoon Hwang, MD Department of Ophthalmology, Kim’s Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 07301, Korea Tel: 82-2-2639-7777, Fax: 82-2-2633-3976 E-mail: brainh@hanmail.net

Received 17 December 201526 February 2016       Accepted 27 March 2016

© 2016 The Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/ which perm its unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the events leading to a diagnosis of glaucoma.

Methods

Medical records of 484 subjects (223 women, 261 men; mean age, 55.3 years) who visited a glaucoma clinic without previous glaucoma diagnosis were reviewed. Events were classified into: 1) glaucoma-related symptoms, such as ocular pain accompanied by intraocular pressure elevation or visual disturbance without other ocular abnormalities except glaucoma, 2) ocular examination by an ophthalmologist for other symptoms, 3) routine health examination, or 4) patient request due to family history of glaucoma. Ocular findings that suggested glaucoma and led to detailed glaucoma assessment were classified as: 1) an optic disc abnormality, 2) high intraocular pressure, or 3) both.

Results

Events that led to the diagnosis of glaucoma were glaucoma-related symptoms in 11.8%, examination by an ophthalmologist in 74.2%, routine health examination in 12.4%, and family history in 1.7% of subjects. Findings that suggested glaucoma in ocular and routine health examinations were an optic disc abnormality in 84.2% and high intraocular pressure in 15.8%; both of these findings were found in 7.4% of subjects.

Conclusions

The most common path to glaucoma diagnosis was optic disc assessment by an ophthalmologist and routine health examination. To facilitate early detection of glaucoma, regular detailed optic disc evaluation by an ophthalmologist should be emphasized.

Keywords: Diagnosis, Glaucoma, Visual field

References

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2. MacKean JM. Elkington AR. Referral routes to hospital of patients with chronic open-angle glaucoma. Br Med J (Clin Res Ed). 1982; 285:1093–5.
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3. Kwak HW. Joo MJ. Yoo JH. The significance of fundus photography without mydriasis during health mass screening. J Korean Ophthalmol Soc. 1997; 38:1585–9.
4. Chung YS. Kim JM. Sohn YH. Diagnostic outcomes of patients suspicious for glaucoma referred from the company health screening. J Korean Ophthalmol Soc. 2006; 47:1444–8.
5. Park KH. Lee SY. Hong YJ. Outpatient distribution for glaucoma evaluation. J Korean Ophthalmol Soc. 2015; 56:388–95.
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6. Kim CS. Seong GJ. Lee NH, et al. Prevalence of primary open-angle glaucoma in central South Korea the Namil study. Ophthalmology. 2011; 118:1024–30.
7. Boodhna T. Crabb DP. Disease severity in newly diagnosed glaucoma patients with visual field loss: trends from more than a decade of data. Ophthalmic Physiol Opt. 2015; 35:225–30.
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Table 1.
Distribution of events that lead to the diagnosis of glaucoma according to age
  ≤39 years (n = 79) 40’s (n = 91) 50’s (n = 105) 60’s (n = 116) ≥ 70 years (n = 93) Total (n = 484)
Ocular examination (n, %) 59 (74.7) 57 (62.6) 81 (77.1) 88 (75.9) 74 (79.6) 359 (74.2)
Routine health examination (n, %) 19 (24.1) 20 (22.0) 13 (12.4) 6 (5.2) 2 (2.2) 60 (12.4)
Glaucoma-related symptoms (n, %) 1 (1.3) 8 (8.8) 10 (9.5) 21 (18.1) 17 (18.3) 57 (11.8)
Patients’ own request (n, %) 0 (0) 6 (6.6) 1 (1.0) 1 (09) 0 (0) 8 (1.7)
Table 2.
Comparison of clinical characteristics of eyes suspected to have glaucoma during ocular examinations for refractive surgery (study group) and other eyes (control group)
  Study group (n = 27) Control group (n = 457) p-value
Age (years) 29.0 ± 5.4 (18~38) 56.9 ± 13.7 (17~89) <0.001
Refractive error (diopter) -5.82 ± 3.47 (-13.00-0.0) -1.42 ± 3.24 (-20.00~3.50) <0.001
Visual acuity (decimal) 0.94 ± 0.12 (0.6-1.0) 0.82 ± 0.25 (0-1.0)  0.014
Intraocular pressure (mm Hg) 19.7 ± 5.5 (12-35) 20.7 ± 9.5 (10-70)  0.594
Mean deviation of visual field (dB) -6.21 ± 5.66 (-23.22~-(.48) -8.07 ± 7.70 (-32.56~2.51) 0.219

Values are presented as mean ± standard deviation (range).

∗ Independent t-test.

Table 3.
Distribution of events that lead to the diagnosis of primary open-angle glaucoma (including normal-tension glaucoma) according to age
  ≤39 years (n = 77) 40’s (n = 81) 50’s (n = 95) 60’s (n = 93) ≥ 70 years (n = 76) Total (n = 422)
Ocular examination (n, %) 57 (74.0) 52 (64.2) 78 (82.1) 80 (86.0) 68 (89.5) 335 (79.4)
Routine health examination (n, %) 19 (24.7) 20 (24.7) 13 (13.7) 6 (6.5) 1 (1.3) 59 (14.0)
Glaucoma-related symptoms (n, %) 1 (1.3) 3 (3.7) 3 (3.2) 6 (6.5) 7 (9.2) 20 (4.7)
Patients’ own requirements (n, %) 0 (0) 6 (7.4) 1 (1.1) 1 (1.1) 0 (0) 8 (1.9)
Table 4.
Comparison of clinical characteristics and distribution of events according to type of glaucoma
  Primary open-angle glaucoma (n = 422) Other types of glaucoma (n = 62) p-value
Age (years) 54.4 ± 14.9 (18~89) 61.3 ± 11.8 (17~80) 0.001∗
Refractive error (diopter) -1.82 ± 3.46 (-20.00~3.50) -0.57 ± 2.63 (-12.00~3.00) 0.008∗
Visual acuity (decimal) 0.87 ± 0.19 (0~1.00) 0.58 ± 0.41 (0~1.00) <0.001∗
Intraocular pressure (mm Hg) 18.0 ± 4.9 (10~44) 38.5 ± 12.3 (12~70) <0.001∗
Mean deviation of visual field (dB) -7.25 ± 6.94 (-32.56~2.51) -13.86 ± 10.03 (-32.53~0.32) <0.001∗
Events     <0.001†
   Ocular examination (n, %) 335 (79.4) 24 (38.7)  
   Routine health examination (n, %) 59 (14.0) 1 (1.6)  
   Glaucoma-related symptoms (n, %) 20 (4.7) 37 (59.7)  
   Patients’ own requirements (n, %) 8 (1.9) 0 (0)

Values are presented as mean ± standard deviation (range) unless otherwise indicated.

∗ Independent t-test;

† Chi-squre test.

Table 5.
Comparison of clinical characteristics among eyes with different pathways of glaucoma diagnosis
  Glaucoma-related symptoms (group A, n = 57) Ocular examination (including patients’ own require, group B, n = 367) Routine health examination (group C, n = 60) p-value∗
Age (years) 62.2 ± 11.1 (33~80) 55.6 ± 15.2 (17~89) 46.8 ± 10.9 (27~73) <0.001
Refractive error (diopter) -0.40 ± 2.25 (-8.50~3.00) -1.71 ± 3.52 (-20.00~3.50) -2.59 ± 3.20 (-10.75~1.50) 0.003
Visual acuity (decimal) 0.6 ± 0.4 (0~1.0) 0.8 ± 0.2 (0~1.0) 0.9 ± 0.2 (0~1.0) <0.001
Intraocular pressure (mm Hg) 35.9 ± 14.8 (13~70) 18.9 ± 6.2 (10~49) 16.9 ± 3.4 (11~26) <0.001
Mean deviation of visual field (dB) -15.06 ± 9.43 (-32.56~-1.23) -7.51 ± 7.12 (-32.53~1.73) -4.75 ± 4.79 (-23.34~2.51) <0.001

Values are presented as mean ± standard deviation (range). Post hoc analysis: age, A > B > C; refractive error, A > B/C; visual acuity, A < B/C; intraocular pressure, A > B/C; mean deviation of visual field, A < B < C.

∗ Analysis of variance.

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