How can we improve the detection of glaucoma?

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6979.546 (Published 04 March 1995) Cite this as: BMJ 1995;310:546
  1. Ronald Pitts Crick,
  2. Maurice W Tuck
  1. Honorary chairman Honorary consultant economist International Glaucoma Association, King's College Hospital, London SE5 9RS

    Thorough testing and better targeting

    Primary open angle glaucoma is an insidious disease that affects 1-2% of people over 40. In Britain it accounts for about one in eight new registrations for blindness, although early detection can prevent much damage to sight.1 Over 90% of new confirmed cases result from the seven to eight million sight tests for those aged over 40 conducted at opticians' premises each year.2 Available data suggest, however, that only about half of all cases of primary open angle glaucoma are detected3; and one in five people with newly confirmed disease already have advanced visual field loss.2

    Although a high proportion of the relevant population attends opticians fairly regularly, the standard of testing for glaucoma is uneven.4 5 6 7 A recent large survey has shown that optometrists who routinely used tonometry detected over twice as many glaucomas as did optometrists who relied mainly on ophthalmoscopy.7 8 Those who, in addition, used perimetry in most patients at high risk of glaucoma detected over three times as many glaucomas, while routine perimetry yielded …

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