Scholarly Article
STRUCTURED MULTIMODAL OPHTHALMIC EXAMINATION WITH STANDARD AUTOMATED PERIMETRY FOR THE DETECTION, STAGING AND MANAGEMENT OF GLAUCOMA
Tejasree Jakka, Pallavi P, Shreya Reddy
2026-09-02 · International Journal of Clinical and Biomedical Research · Sumathi Publications
Abstract
Background: Glaucoma is the leading cause of irreversible blindness and typically remains symptomless until substantial optic-nerve damage has occurred. Because no single test is sufficient for diagnosis, a structured examination combining tonometry, gonioscopy, optic-disc assessment, optical coherence tomography (OCT) and standard automated perimetry (SAP) is recommended. This study describes the diagnostic yield, severity distribution and treatment outcomes of such a pathway in an Indian tertiary care setting. Methods: In this prospective observational study, 196 consecutive patients with suspected or established glaucoma underwent a standardized evaluation comprising best-corrected visual acuity, slit-lamp examination, Goldmann applanation tonometry, gonioscopy, pachymetry where available, dilated stereoscopic optic-disc assessment, OCT of the retinal nerve fibre layer (RNFL) and macular ganglion-cell complex, and SAP. Patients were classified by mechanism and staged by the Hodapp-Parrish-Anderson criteria, managed individually with medical, laser or surgical treatment, and followed with repeat tonometry, OCT and perimetry. Results: Mean age was 58.4 ± 11.7 years and 124 patients (63.3%) were men. Established glaucoma was present in 144 (73.5%) primary open-angle in 91 (46.4%), primary angle-closure in 31 (15.8%), secondary in 14 (7.1%) and normal-tension in 8 (4.1%) while 36 (18.4%) were glaucoma suspects and 16 (8.2%) had ocular hypertension. OCT detected RNFL abnormality in 151 (77.0%), against reproducible field defects in 144 (73.5%); structure-function correspondence was present in 132 (67.3%). Of the established cases, 54 (37.5%) were early, 48 (33.3%) moderate and 42 (29.2%) severe; RNFL thickness correlated with mean deviation (r = 0.68) and visual field index (r = 0.64; both p < 0.001). Initial management was medical in 103 (71.5%), laser in 21 (14.6%) and surgical in 20 (13.9%). Mean IOP fell from 23.8 ± 6.4 to 15.9 ± 3.1 mmHg (33.2%; p < 0.001); at final assessment 132 (91.7%) had IOP ≤ 18 mmHg, 126 (87.5%) had stable or improved fields and 18 (12.5%) showed progression. Conclusion: A structured multimodal pathway detected structural damage somewhat more often than functional loss, staged disease reliably, and achieved target pressure in over 90% of treated patients. Nearly a third of patients nonetheless presented with severe disease, underlining the need for earlier case-finding in the Indian population.
Keywords
Glaucoma, Standard automated perimetry, Optical coherence tomography, Retinal nerve fibre layer, Gonioscopy, Intraocular pressure, Hodapp-Parrish-Anderson
Citation Details
International Journal of Clinical and Biomedical Research, Vol. 11, No. 3, pp. 338-346