First-visit diagnosis of preperimetric glaucoma

Area of Science:

• Ophthalmology
• Optometry
• Neuroscience

Background:

• Glaucoma diagnosis often relies on visual field defects, which appear late in the disease.
• Preperimetric glaucoma (PPG) presents a diagnostic challenge due to the absence of detectable visual field loss.
• Early detection of glaucoma is crucial to prevent irreversible vision loss.

Purpose of the Study:

• To propose a revised interpretation of diagnostic data for identifying preperimetric glaucoma (PPG) during the initial patient examination.
• To establish objective criteria for the early detection of glaucoma.
• To refine the diagnostic approach for glaucoma suspects.

Main Methods:

• Analysis of existing literature on preperimetric glaucoma (PPG).
• Longitudinal follow-up (6 years) of a patient with glaucoma suspect findings.
• Evaluation of retinal nerve fiber layer (RNFL) thickness using imaging techniques.

Main Results:

• Asymptomatic, localized retinal nerve fiber layer (RNFL) thinning in specific quadrants (inferior and superior) was identified as a potential early sign of glaucoma.
• Imaging-derived RNFL thickness was proposed as a reference standard for glaucoma diagnosis.
• A case study demonstrated successful retrospective diagnosis of low-tension PPG based on these criteria, later confirmed by the development of cecocentral scotoma and further RNFL thinning.

Conclusions:

• A revised diagnostic approach, focusing on objective RNFL thinning, enables earlier detection of preperimetric glaucoma (PPG).
• This method facilitates the diagnosis of PPG at the first patient visit.
• The findings support the use of RNFL imaging as a primary tool in early glaucoma detection.