A decision-making schema for the detection of glaucoma.

Area of Science:

• Ophthalmology and Optometry
• Public Health and Epidemiology

Background:

• Glaucoma is a leading cause of irreversible blindness.
• Early detection of glaucoma, particularly angle-closure glaucoma, is crucial to prevent optic nerve damage and vision loss.
• Current optometrical practices may not consistently identify early-stage or asymptomatic glaucoma.

Purpose of the Study:

• To propose a comprehensive management schema for optometrical patients at risk of glaucoma.
• To facilitate the early diagnosis of asymptomatic angle-closure glaucoma.
• To integrate established clinical procedures into a structured risk-based assessment pathway.

Main Methods:

• Development of a patient management schema based on 22 identified glaucoma risk factors.
• Establishment of decision points and management pathways utilizing current optometrical clinical procedures.
• Recommendation for routine inclusion of the Van Herick test and consideration of gonioscopy, with an alternative pathway if gonioscopy is omitted.

Main Results:

• The proposed schema allows for the identification of patients with glaucoma or its risk factors.
• It enables the diagnosis of early angle-closure glaucoma during its asymptomatic phase.
• The system incorporates clinical procedures suitable for routine optometrical practice.

Conclusions:

• The proposed optometrical management schema provides a structured approach for early glaucoma detection.
• Implementing this schema can lead to timely intervention, preventing advanced optic disc and visual field damage.
• Routine use of the Van Herick test is recommended within this framework for enhanced patient assessment.