Detection of glaucoma by the primary care optometrist

1 May 2009
Volume 10, Issue 2

The classification, risk factors and detection of glaucoma.

Introduction

As with most western countries, the UK has an increasing elderly population. In 2003, there were 20 million individuals over the age of 50 years and this number is predicted to increase by 36% by 2031 (National Statistics online: Population Predictions, accessed April 2009). With increased longevity comes an increase in the prevalence of age-related morbidities, including ophthalmic disease. In the UK, the three most common causes of irreversible visual impairment in the elderly are age-related macular degeneration, diabetic retinopathy and glaucoma (Bunce & Wormald 2006). 

It has been predicted that, with our ageing population, the number of people suffering from glaucoma will increase by at least a third over the next two decades (Tuck & Crick 2003), although the disease remains significantly underdetected in the population (Tuck & Crick 1997). General population glaucoma screening programs have not been implemented as they are not effective at detecting the disease; therefore it has been suggested that screening should be targeted at ‘at-risk’ groups (Burr et al. 2007). At present, in the UK most cases of glaucoma are detected through opportunistic case-finding by community optometrists. Optometrists’ undergraduate training provides them with the necessary clinical skills to detect the presence of glaucoma, but reports suggest that there are still a large number of false-positive referrals to the Hospital Eye Service (HES) (Bowling et al. 2005). 

This paper is a brief review of the signs the optometrist should look for when determining the presence, and progression, of the disease.

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