Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
In the UK, recommended guidelines for identifying individuals at risk of glaucoma, often referred to as case-finding, focus on specific tests performed by primary eye care professionals before referral for diagnosis of chronic open angle glaucoma (COAG) and related conditions NICE NG81. These guidelines do not outline specific screening programs for broadly defined 'high-risk populations' but rather detail the assessment and referral process for individuals where glaucoma is suspected NICE NG81.
- Recommended Tests for Case-Finding: Before referral, primary eye care professionals should offer the following tests:
- Central visual field assessment using standard automated perimetry (full threshold or supra-threshold) NICE NG81.
- Optic nerve assessment and fundus examination using stereoscopic slit lamp biomicroscopy (with pupil dilatation if necessary), and optical coherence tomography (OCT) or optic nerve head image if available NICE NG81.
- Intraocular pressure (IOP) measurement using Goldmann-type applanation tonometry NICE NG81.
- Peripheral anterior chamber configuration and depth assessments using gonioscopy or, if not available or preferred, the van Herick test or OCT NICE NG81.
- Important Considerations for Referral:
- A decision to refer should not be based solely on IOP measurement using non-contact tonometry NICE NG81.
- Consider repeating visual field assessment and IOP measurement on another occasion to confirm a visual field defect or an IOP of 24 mmHg or more, unless urgent referral is clinically indicated NICE NG81.
- For individuals with an IOP below 24 mmHg, advise them to continue regular visits to their primary eye care professional NICE NG81.
- Criteria for Referral: Referral for further investigation and diagnosis of COAG and related conditions is recommended if, after considering repeat measures, any of the following are present:
- Optic nerve head damage observed on stereoscopic slit lamp biomicroscopy NICE NG81.
- A visual field defect consistent with glaucoma NICE NG81.
- Intraocular pressure (IOP) of 24 mmHg or more using Goldmann-type applanation tonometry NICE NG81.
- Factors Influencing Referral: Referral criteria are largely based on the person's age, their intraocular pressure (IOP), their central corneal thickness, and if signs of glaucoma develop NICE CKS.