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PubMed2003

Diagnostic effectiveness of noncontact slitlamp examination in the identification of retinal tears.

PURPOSE: To compare the diagnostic accuracy of noncontact slitlamp examination with indirect ophthalmoscopy and scleral depression, in the identification of retinal tears. METHODS: A prospective study was performed using 17 patients who were referred with retinal tears. All were initially examined at the slitlamp with a hand-held Volk (noncontact) lens. The same observer then carried out indirect ophthalmoscopy with scleral indentation. RESULTS: In 17 eyes a total of 18 acute retinal u-tears were found. A total of 16 tears were picked up at the initial examination at the slitlamp (89%), while two were missed (11%). CONCLUSIONS: Indirect ophthalmoscopy with scleral depression is the 'gold standard' for the identification of peripheral retinal tears. This small study has shown that although the majority of these can be picked up by the use of a noncontact lens at the slitlamp, 11% were missed using this technique.

Adult↗

PubMed2000

Preservation of sight in diabetes: developing a national risk reduction programme.

BACKGROUND: Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre-symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera-based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk-reduction programme. OPHTHALMOSCOPY: Evidence indicates that direct ophthalmoscopy using a hand-held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill. PHOTOGRAPHIC SCHEMES: The principal advantage of camera-based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions. COST ISSUES: Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late-presenting advanced retinopathy. CONCLUSION: A systematic national programme based on digital photography is proposed.

Blindness↗

PubMed1999

The clinical efficacy of paremyd with and without dapiprazole in subjects with light and dark brown irides.

BACKGROUND: Paremyd, a mydriatic formulation of 0.25% tropicamide and 1.0% hydroxyamphetamine hydrobromide provides adequate dilation for binocular indirect ophthalmoscopy in young Caucasians. We studied the clinical effectiveness of Paremyd in dilating heavily pigmented eyes by comparing its mydriatic efficacy in Blacks, Asians and Caucasians with light and dark brown irides. We also evaluated the efficacy of one drop of dapiprazole (Rev-Eyes) in reversing Paremyd-induced mydriasis in our subject sample. METHODS: In a masked, randomized, controlled experimental design, several visual functions which included pupillary dilation, near visual acuity, amplitude of accommodation, ocular hyperemia, and discomfort glare were measured at 30-min intervals, for a total of 300 min, in subjects dilated with a single drop of Paremyd in each eye. Ease of binocular indirect ophthalmoscopy was also assessed. A 3-way analysis of variance was used to assess changes in these measures as function of irides color/pigmentation (designated as light or dark brown iris color), presence or absence of dapiprazole, and test time interval. RESULTS: We found that subjects in our light brown irides group (mainly Caucasians) dilated faster than subjects in our dark brown irides group (mainly Blacks). Dapiprazole increased the speed of recovery from pupillary dilation for all subjects, but more so for those with light rather than dark brown irides. Similarly, subjects with light rather than dark brown irides recovered accommodative function more quickly. Although neither the use of dapiprazole nor the degree of iris color/pigmentation was significantly related to visual acuity or glare discomfort, there was a clear trend that these visual measures were affected to a greater degree in subjects with dark brown (primarily Blacks) rather than light brown irides. Overall, Paremyd provided adequate dilation for binocular indirect ophthalmoscopy in all subjects irrespective of iris color/pigmentation. CONCLUSIONS: Our data indicate that a single drop of Paremyd provides adequate mydriasis, without significant side effects, for routine fundus examination of all subjects, independent of iris color/pigmentation. Furthermore, a single drop of dapiprazole was effective in speeding the return of pupillary dilation in most subjects, but had no significant effect on accommodation, near visual acuity or glare discomfort. Side effects such as stinging upon instillation, conjunctival hyperemia, and a few instances of ptosis, with possible additional cost to patients, appear to lessen its overall clinical benefit.

Accommodation, Ocular↗

PubMed2006

Intravitreal toxicity of garenoxacin.

PURPOSE: To assess the retinal toxicity of varying concentrations of intravitreally injected garenoxacin. METHODS: Twenty eyes of 20 New Zealand albino rabbits were used for this study. The animals were anesthetized with ketamine (35-50 mg/kg) and xylazine (3-5 mg/kg). Garenoxacin was titrated using distilled water to the following concentrations: 4,000, 2,000, 1,000, 400, 200, and 100 microg/0.1 mL. Each concentration was injected intravitreally (0.1 mL) into three rabbit eyes. Three control eyes were injected with 0.1 mL of balanced saline solution. All animals were examined before and after injection by indirect ophthalmoscopy and slit-lamp biomicroscopy. Electroretinography was performed on all animals before intravitreal injection and 14 days after injection. The animals were examined by indirect ophthalmoscopy and slit-lamp biomicroscopy before they were killed; the eyes were enucleated and examined with light microscopy. RESULTS: No electroretinographic changes or signs of retinal toxicity by slit-lamp examination, indirect ophthalmoscopy, or light microscopy were seen in any eyes 14 days after intravitreal injection of garenoxacin (< or =4,000 microg/0.1 mL). CONCLUSIONS: Garenoxacin injected intravitreally appeared safe at concentrations of < or =4,000 microg/0.1 mL.

Animals↗

PubMed2006

The Photographic Screening for Retinopathy of Prematurity Study (Photo-ROP): study design and baseline characteristics of enrolled patients.

OBJECTIVE: The Photographic Screening for Retinopathy of Prematurity Study (Photo-ROP) sought to evaluate the utility of digital wide-angle photographic fundus screening for retinopathy of prematurity (ROP) as compared to bedside indirect ophthalmoscopy. This article describes the study design and presents baseline characteristics of the subjects. DESIGN: Prospective, multicenter, masked, Internet-based clinical trial. PARTICIPANTS: Premature infants <31 weeks postmenstrual age at birth and <1000 g birthweight. INTERVENTIONS: Examinations began at 31 weeks postmenstrual age or 4 weeks postnatal age, whichever was later. Both eyes of all infants were imaged with a panoramic fundus imaging system followed by indirect ophthalmoscopic fundus examination. Images were transmitted via Internet to the Reading Center for interpretation by masked graders. Clinical interpretations based on indirect ophthalmoscopy were recorded for comparison with the Reading Center determinations. Examinations were performed weekly for 10 weeks or until an infant was discharged from the hospital. MAIN OUTCOME MEASURE: Sensitivity, specificity, and positive and negative predictive values of Reading Center image interpretations were compared to clinical impressions based on bedside indirect ophthalmoscopy. RESULTS: Enrollment began in February 2001 and was completed in February 2002. The target number of infants was 50, and 62 were enrolled. Of those enrolled, 51 infants (102 eyes) were considered eligible, and are the subject of this article. Mean postmenstrual age (+/- SD) at time of delivery was 26.80 +/- 1.73 weeks (median = 26.86 weeks, interquartile range [IQR] = 2.43 weeks). Mean postmenstrual age at first examination (+/- SD) was 32.19 +/- 2.86 weeks (median = 31.71 weeks, IQR = 2.29 weeks). Mean birthweight (+/- SD) was 830.51 +/- 219.57 g (median = 817 g, IQR = 225 g). Female infants comprised 49.02% of the patients. Race distribution was as follows: white 45.10%, African or black 39.22%, Hispanic 3.92%, Asian 9.80%, and other races 1.96%. Mean follow-up (+/- SD) was 5.73 +/- 3.22 weeks (median = 6 weeks, IQR = 5, range = [1, 15]). CONCLUSIONS: The Photo-ROP Study Cooperative Group successfully recruited and enrolled at-risk premature infants into a longitudinal, prospective clinical trial comparing two different diagnostic approaches. Technology employed in this study is comparable to that currently available. Design issues for this trial included establishing the information technology infrastructure for an ROP study based on digital imaging, defining the study endpoints, estimating event rates, defining a standardized imaging protocol, and defining standards for interpretation of image quality and clinical findings.

Canada↗

PubMed1993

The scanning laser ophthalmoscope and retinal assessment in diabetes.

In order to evaluate the Scanning Laser Ophthalmoscope as a method of assessing diabetic retinopathy, 57 consecutive patients with diabetes were examined through undilated pupils using laser ophthalmoscopy followed by pupillary dilatation and direct ophthalmoscopy. Results of laser scanning were recorded on videotape and analysed independently. Scanning (both eyes) took under 5 minutes per patient. For the 113 eyes studied, the two techniques gave concordant results in 73/113 (65%). Where there was discordance, laser ophthalmoscopic severity was greater than direct ophthalmoscopy in 36/40 (90% of discordant results). In 4/40 eyes conventional ophthalmoscopic appearances were judged more severe than those seen with the laser. The laser ophthalmoscope may have value as a method of assessing diabetic retinopathy, but further work is required to evaluate its efficacy as a screening tool in patients with moderate to severe retinopathy.

Diabetic Retinopathy↗

PubMed2004

Retinal toxicity of intravitreal tenecteplase in the rabbit.

AIM: To investigate the retinal toxicity of intravitreal injection of a novel fibrinolytic tenecteplase in rabbit eyes. METHODS: Tenecteplase (25-350 micro g in 0.1 ml BSS) was injected into the vitreous cavity of normal rabbit eyes. Control (fellow) eyes received 0.1 ml of BSS. One day, 1 week, and 2 months post-injection, the eyes were examined by slit lamp biomicroscopy, indirect ophthalmoscopy, and electroretinography, and then harvested for histopathological examination. RESULTS: No evidence of retinal toxicity was seen with tenecteplase doses up to and including 50 micro g. At a dose of 150 micro g ophthalmoscopy was normal, but histology showed mild retinal damage in the inner nuclear layer and electroretinography showed a temporary reduction in B-wave amplitude. At doses of 200 micro g and above, there was evidence of retinal toxicity on electroretinography, ophthalmoscopy, and histology. Ophthalmoscopic findings included vitreal fibrosis, retinal necrosis and tractional retinal detachment and light microscopy revealed necrosis of retinal pigment epithelium and other retinal layers. Damage was centred around the injection site but was more widespread with the higher doses. CONCLUSION: A dose of 50 micro g tenecteplase appears safe for intravitreal injection in the rabbit. Tenecteplase could have potential applications in the treatment of submacular haemorrhage and retinal vein occlusion.

Animals↗

PubMed1996

Adding retinal photography to screening for diabetic retinopathy: a prospective study in primary care.

OBJECTIVE: To evaluate whether adding retinal photography improved community screening for diabetic retinopathy. SETTING: Mobile screening unit at rural and urban general practices in south west England. SUBJECTS: 1010 diabetic patients from primary care. DESIGN: Prospective study; patients were examined by ophthalmoscopy by general practitioners or opticians without fundal photographs and again with photographs, and assessments were compared to those of an ophthalmologist. MAIN OUTCOME MEASURES: Whether fundal photography improved the sensitivity of detection of retinopathy and referrable diabetic retinopathy, and whether this sensitivity could be improved by including a review of the films by the specialist. RESULTS: Diabetic retinopathy was detected by the ophthalmologist in 205 patients (20.5%) and referrable retinopathy in 49 (4.9%). The sensitivity of the general practitioners and opticians for referrable retinopathy with ophthalmoscopy was 65%, and improved to 84% with retinal photographs. General practitioners' sensitivity in detecting background retinopathy improved with photographs from 22% to 65%; opticians' sensitivity in detecting background retinopathy improved from 43% to 71%. The sensitivity of detecting referrable retinopathy by general practitioners improved from 56% to 80% with photographs; for opticians it improved from 75% to 88%. CONCLUSIONS: Combining modalities of screening by providing photography with specialist review of all films in addition to direct ophthalmoscopy through dilated pupils improves assessment and referral for diabetic retinopathy by general practitioners and opticians. With further training and experience, primary care screeners should be able to achieve a sensitivity that will achieve an effective, acceptable, and economical community based screening programme for this condition.

Ambulatory Care↗

PubMedDate not supplied

Can non-ophthalmologists screen for retinopathy of prematurity?

BACKGROUND: Dilation and tortuosity of the posterior pole vessels ("plus disease") is a poor prognostic sign and may indicate the presence of threshold or pre-threshold retinopathy of prematurity (ROP). Because stage 3 ROP appears rarely in the absence of posterior pole vascular abnormalities, we prospectively evaluated the ability of non-ophthalmologists (4th-year medical students, pediatric residents, and nurse practitioners) to identify abnormalities in the retinal blood vessels of infants undergoing examinations for ROP. METHODS: Fifty infants weighting less than 1600 g at birth were examined between 32 and 40 weeks after conception. Prior to ophthalmological examination, non-ophthalmologist examiners graded posterior pole vessels as normal or abnormal based on ophthalmoscopic appearance. One hundred twenty-one ocular examinations were performed using the teaching mirror of the indirect ophthalmoscope, 179 using the direct ophthalmoscope. The indirect ophthalmoscopy was performed simultaneously by an ophthalmologist who evaluated the posterior pole vessels for abnormalities prior to conducting a peripheral fundus examination on either eye. RESULTS: Testing sensitivity for the non-ophthalmologist examiners using direct and indirect ophthalmoscopy was 96% and 92%, respectively. Combining the results from direct and indirect ophthalmoscopy, the Clopper-Pearson 95% sensitivity confidence interval for identifying abnormal arterioles and venules was 82% to 99%, with a point estimate of 95%. CONCLUSION: These data suggest that non-ophthalmologist examiners can detect posterior pole vascular abnormalities in premature infants. If properly trained, they could possibly play a role in screening or follow-up examinations for ROP.

Humans↗

PubMedDate not supplied

Comparison of ultrasonic and ophthalmoscopic evaluation of retinopathy of prematurity.

PURPOSE: Screening for detection of retinopathy of prematurity (ROP) currently is limited to indirect ophthalmoscopy, which requires considerable examiner skill and experience. We investigated whether conventional 10 MHz B-scan ultrasonography could document the clinical stages of ROP as accurately as indirect ophthalmoscopy. METHODS: Thirty-four eyes of 18 neonates were examined by masked, independent observers with indirect ophthalmoscopy and digitally recorded 10-MHz B-scan ultrasonography. After pupil dilation and lid speculum placement, the retinologist recorded the stage of retinopathy with a retinal drawing. The ultrasonographer, without use of papillary mydriatics or lid speculum, determined the presence or absence of a ridge or tractional elements, if present on the ridge. RESULTS: Ultrasound grade correlated with clinical grade (R = .79, P < .001). However, nine eyes were overdiagnosed by one stage, and one eye, in which a peripheral detachment was mistaken for an artifact, was underdiagnosed. CONCLUSIONS: Ten-megahertz ultrasonography offers the potential of imaging and detecting the clinical stages of ROP; the use of higher ultrasound frequencies, now becoming commercially available, is likely to enhance diagnostic accuracy. Care must be taken to distinguish between artifact and true anatomical structures in noncontact ultrasound examinations. Neonates with suspected ROP could be screened with B-scan ultrasonography by neonatal personnel without pupillary dilatation or lid speculum, thus eliminating potential morbidity, and clinically significant cases of ROP then could be referred to the retinologist.

Fundus Oculi↗

PubMed1988

Proposed criteria for referring diabetic retinopathy.

Diabetic retinopathy is a leading preventable cause of blindness in the United States. The primary care nurse practitioner is often confronted with the decision of whether to refer a person with diabetes to an ophthalmologist. Because ophthalmoscopy may be technically difficult with a particular patient, current recommendations are to refer all diabetics. Unfortunately, many studies reveal that this approach is not working. This article defines criteria for the nurse practitioner to determine who is most in need of referral. The tested criteria have a sensitivity of 77 percent and a specificity of 81 percent when compared with ophthalmoscopy. The criteria are based on the results of ophthalmoscopy, duration of diabetes, status of glycemic control, status of achilles tendon reflex, status of serum creatinine, amount of alcohol consumption and the presence of hypertension. Using the criteria is feasible in a clinic or hospital setting. Use of this tool may improve appropriate ophthalmological referral of persons with diabetes.

Adult↗

PubMed1978

[Ophthalmocalibrometric assessment of the state of the microcirculation in the retinal vessels in transient disorders of cerebral circulation].

The report analyses some results of a neuro-ophthalmological study of 82 patients from 34--76 years (37 males and 45 females) with transient disorders of cerebral circulation. Besides clinical studies the authors applied EEG and REG registrations, studies of the lipid metabolism, coagulative and anticoagulative blood systems. Ophthalmological studies included the assessment of visual acuity with and without correction, quantitative perimetry, the determination of a genuine intra-ocular pressure, ophthalmodynamometry, biomicroscopy of the conjunctiva and episclera, biomicro-ophthalmoscopy, ophthalmoscopy with the use of electro-ophthalmoscopy, a large nonreflex ophthalmoscope, ophthalmocalibrometry. By means of ophthalmocalibtometrical studies the authors established an existence of expressed pathology of microcirculation in the form of a marked narrowing of arterioles and a dilatation of the venoules with a significant decrease of the arterio-venous correlations. The achieved data are analyzed with consideration of the etiology, development and topography of transient disorders of cerebral circulation.

Adult↗

PubMed1995

[Differential diagnosis of macular breaks by microperimetry with a scanning laser ophthalmoscope].

To improve differential diagnosis of macular breaks, microperimetry with a scanning laser ophthalmoscope (SLO) was performed. Fifty consecutive macular breaks were detected by biomicroscopy and indirect ophthalmoscopy, and SLO microperimetry was performed on each. Of the 50 eyes, 22 eyes were diagnosed with idiopathic macular breaks by biopmicroscopy and indirect ophthalmoscopy because of a cuff. SLO microperimetry also showed dense scotoma within the macular break and relative scotoma on the cuff in the 22 eyes. However, diagnosis was not done only by biomicroscopy and indirect ophthalmoscopy in the other 28 eyes because of the absence of a cuff. SLO microperimetry differentiated the full thickness macular breaks from pseudo-or lamellar breaks in these eyes. SLO microperimetry is useful for differentiating their prognosis, and determining the need for surgical treatment.

Aged↗

PubMed2005

No changes in anatomical and functional glaucoma evaluation after trabeculectomy.

PURPOSE: To assess the influence of glaucoma filtration surgery on anatomical and functional tests for glaucoma evaluation. METHODS: Twenty-five eyes (25 patients) with primary open-angle glaucoma were evaluated, prospectively. Data were collected on vision acuity, intraocular pressure, standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry (GDx) and confocal scanning laser ophthalmoscopy (HRT II) before and 3-6 months after surgery. RESULTS: Mean (+/-SD) pre- and postoperative visual acuities (logMAR) were 0.28 (+/-0.18) and 0.30 (+/-0.17), respectively (P=0.346). In a mean time of 4.5 (+/-1.1) months after surgery, the mean preoperative intraocular pressure of 20.7 (+/-5.4) mmHg decreased to 11.04 (+/-2.52) mmHg (P<0.001). The results of the standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy diagnostic methods revealed no significant difference (P>0.162) between pre and postoperative values and no significant correlation (P>0.296) between intraocular pressure reduction and value changes. CONCLUSION: No significant change on any test variable was detected after glaucoma filtration surgery. Trabeculectomy does not appear to influence standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy (HRT II) results after a 4.5-month period of surgery in early to moderate glaucoma.

Female↗

PubMedDate not supplied

Importance of fluorescein angiographic study in evaluating early retinal changes in Takayasu disease.

PURPOSE: To determine the usefulness of fluorescein angiography in studying Takayasu disease. METHODS: We examined 31 eyes in 16 patients with Takayasu disease using indirect ophthalmoscopy, color photography, and fluorescein angiography. Ophthalmoscopic and fluorescein angiographic findings were compared. RESULTS: Fluorescein angiography revealed no additional retinal changes in 10 eyes that had no retinal vein dilatation as seen by indirect ophthalmoscopy. Seven (33%) of 21 eyes that had dilated retinal veins also had additional abnormal findings, such as microaneurysms, arteriovenous shunts, retinal neovascularization, and avascular areas. Some differences in grading the stages of retinopathy were noted with these newly found retinal changes, as compared with the classifications determined by ophthalmoscopy alone. CONCLUSIONS: In Takayasu disease, studying the fundus of patients with fluorescein angiography is particularly important in correctly classifying the stages of retinopathy when the retinal vein appears dilated in ophthalmoscopic observation.

Adult↗

PubMed2002

Residents as teachers: outcomes of a brief training programme.

INTRODUCTION: Residents (RMOs) teach medical students in hospital wards, yet little evidence of efficacy is available for this activity. This study undertook to test the effectiveness of RMO teaching, and to delineate the principal barriers encountered. METHODS: Medical students in their fourth year were assessed at baseline for clinical examination skills in ophthalmoscopy, neurological examination of the legs, and rheumatological examination of the hands. One group of RMOs (n=6) taught ophthalmoscopy to the students attached to their unit, while the second group of RMOs (n=6) taught leg examination to their students. The third examination skill was not taught, but was used as a control intervention. The students were evaluated in all three skills by an observed, structured clinical examination at the beginning and end of their six-week attachments. RESULTS: There was a significant improvement in the skill of ophthalmoscopy in the intervention group (p<0.02), while the control group of students showed a decline in their abilities. The skill of examination of the legs improved after being taught, but not significantly. The RMOs universally reported that difficulty in finding time was a major barrier to their ability to teach medical students, and most set up additional teaching sessions rather than incorporate the teaching into their routine ward work. CONCLUSIONS: RMO teaching of medical students is effective, particularly for a skill which is novel. The difficulties arise in finding a suitable time for these important clinical teachers to transfer their skills.

Journal Article↗

PubMed2005

A modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy.

The objective of this study was to compare, using a 12-month time frame, the cost-effectiveness of a non-mydriatic digital tele-ophthalmology system (Joslin Vision Network) versus traditional clinic-based ophthalmoscopy examinations with pupil dilation to detect proliferative diabetic retinopathy and its consequences. Decision analysis techniques, including Monte Carlo simulation, were used to model the use of the Joslin Vision Network versus conventional clinic-based ophthalmoscopy among the entire diabetic populations served by the Indian Health Service, the Department of Veterans Affairs, and the active duty Department of Defense. The economic perspective analyzed was that of each federal agency. Data sources for costs and outcomes included the published literature, epidemiologic data, administrative data, market prices, and expert opinion. Outcome measures included the number of true positive cases of proliferative diabetic retinopathy detected, the number of patients treated with panretinal laser photocoagulation, and the number of cases of severe vision loss averted. In the base-case analyses, the Joslin Vision Network was the dominant strategy in all but two of the nine modeled scenarios, meaning that it was both less costly and more effective. In the active duty Department of Defense population, the Joslin Vision Network would be more effective but cost an extra 1,618 dollars per additional patient treated with panretinal laser photo-coagulation and an additional 13,748 dollars per severe vision loss event averted. Based on our economic model, the Joslin Vision Network has the potential to be more effective than clinic-based ophthalmoscopy for detecting proliferative diabetic retinopathy and averting cases of severe vision loss, and may do so at lower cost.

Cost-Benefit Analysis↗

PubMed1991

Glaucoma case detection.

In Dalby more than 1,000 residents have been followed for a decade (1977-1987) with periodic comprehensive eye examinations including family history, ophthalmoscopy, slit-lamp examination, applanation tonometry, and computerized perimetry. The large majority were followed at long intervals (2.75 and 5.65 years). Ophthalmoscopy and tonometry were used to select a minor part of the population to be followed at shorter intervals. In this way 16 out of 24 manifest glaucomas detected after the first survey were found among patients followed at shorter intervals. A closer look at the data suggested that the selection could have been further improved if the slit-lamp examination and the family history had been used in much the same way as ophthalmoscopy and tonometry. On this basis new criteria to select persons said to have 'presumptive glaucoma' are proposed.

Aged↗