Common Mis-steps in Glaucoma Diagnosis:
Most clinicians don’t perform gonioscopy routinely thereby missing this diagnosis until it has already caused either chronic glaucoma or acute angle closure. Those at greatest risk are female hyperopes. Screening at least this subclass of patients will result in diagnosing the majority of cases.
- Perform Gonioscopy or Anterior Segment imaging in Female Hyperopes
Normal Tension Glaucoma
Frequently, in an otherwise healthy patient, clinicians quickly glance over the optic nerve or perform a photograph and do not clearly make out the optic nerve features. It is important to carefully assess the features of optic nerves to look for subtle findings of sloping, rim thinning, notching, Drance hemes, and asymmetry. This becomes especially important in higher risk patients (middle-aged women and patients with a history of Migraines, Raynaud’s phenomenon, low blood pressure, and anemia).
- Assess the optic nerve in all patients, especially those at risk
Many clinicians fail to look at the anterior segment of the eye once a patient is dilated. This is only natural since we have already examined the anterior segment by slit lamp and after dilation is focused on the fundus exam. This leads a good portion of patients with Pseudoexfoliation being missed. Since 30-50% of eyes with Pseudoexfoliation go on to develop glaucoma which can be volatile and rapidly progressive in these patients, early diagnosis allows for more close monitoring with every six month IOP checks.
- Examine lens capsule after dilation in all patients
Since this condition tends to happen in young myopic patients, it is easily overlooked. I suggest all patients get a thorough anterior segment exam on the first visit to your clinic so you can be sure to rule out this relatively common condition that could lead to glaucoma in over 30% of patients. Use a thin beam to examine the corneal endothelium (Krukenberg spindle) and a small maximum brightness beam of light through the pupil to look for Iris Transillumination Defects.
- Look for changes in the corneal endothelium and TIDs in myopic patients before dilation.
Learn more about Glaucoma Treatment & Management
With so much to consider and keep track of, you’ll be glad to have the expert experience found at Dougherty Laser Vision in your corner. Call or schedule a free consultation online today in order to learn more about your options for Glaucoma Treatment & Management.
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