Glaucoma

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GLAucOMA
the diagnosis of glaucoma is usually made after a comprehensive clinical eye examination that includes biomicroscopy, applanation tonometry, gonioscopy and dilated stereoscopic evaluation of the optic disc and fundus. Further testing including automated perimetery is performed on those suspected to have glaucoma after such an examination. automated perimetry confirms functional damage and provides a baseline for follow-up. Imaging techniques are not essential for the diagnosis but may have a role to play in follow-up. A comprehensive eye examination for every clinic patient can achieve the objective of detecting all potentially sight threatening disease including glaucoma.

An approach to of a glaucoma
The eye-care practitioner should aim to detect all potentially serious ophthalmic pathology, including glaucoma. Screening for glaucoma using imaging or visual fields prior to a clinical examination can have too many false positives and negatives and is not recommended.
the diagnosis is possible, yet intervention can still alter the course of the disease and change the prognosis. Diagnosis at an even earlier stage (pre-perimetric glaucoma) is ideal but far more difficult than and not as critical as in established disease. As early diagnosis comes with implications of ‘labelling’ and life-long treatment,3,9 it is best confirmed by an experienced ophthalmic examiner using the experience and tools at their disposal. The diagnostic importance of concepts such as pretest probability, sensitivity, specificity and likelihood ratios of symptoms, signs and tests and how they can be used to confirm a diagnosis are basic to any test and are dealt with elsewhere.10,11 already on a systemic beta-blocker. As another example topical alpha-2 agonists are contraindicated in a patient on monoamine oxidase inhibitors.

Introduction
Glaucoma affects around three per cent of the Australian population over the age of 50 years; of those affected, 50 per cent do not...