The method of observation for quantitative evaluation of disc pattern in early diagnosis of simple glaucoma was discussed in view of necessity of quantitative analysis of disc pattern, outline of quantitative disc pattern, judgement of quantitative disc pattern, type of glaucomatous cupping and classification of grade for glaucoma etc. At this attempt, authors observed vertical cup and disc ratio of physiologic cupping, prior to the investigation of variations of glaucomatous changes of optic disc. The associated factors with this study were briefly mentioned for further study.
Classification ; Early Diagnosis* ; Evaluation Studies as Topic* ; Glaucoma ; Glaucoma, Open-Angle*

The Humphrey Visual Field Analyzer and The Octopus Visual Field Analyzer in Early Primary Open Angle Glaucoma Visual field measurements are useful tool not only for diagnosis but also for management ealuation of early glaucoma. To know the relationship between the results of visual field which were performed by the Humphrey and the Octopus, the 25 disc data which have shown the general reduction of sensitivity on two continuous separate sessions in Humphrey viual field analyzer were transmitted into the Peridata Standard Printout Mode of GIX program on the Octopus 1-2-3. We compared the aspect of Bebie curve of Octopus 1-2-3 and the difference of the global indices between Humphrey and Octopus in the basically input data of age related standard sensitivity of visual field. The general reduction of sensitivity in Humphrey visual field analyzer showed the sensitivity loss in Bebie curve of Octopus 1-2-3(p<5%). In the statistical analysis of Global indices between the two field analyzers there were no differences in the MD and PSD(p>0.05) but were difference the CPSD and SF(p<0.05). In the comparison of the correlation on global indices between the two field analysis. MD and PSD were closely correlated r=0.657, PSD r=0.697, p<0.001), CPSD and SF were statistically correlated(p<0.001) but had lower correlation coefficients(CPSD r=0.478, SF r=0.389). Thus we conclude that there are little differences between the results of two field analyzers.
Diagnosis ; Glaucoma ; Glaucoma, Open-Angle* ; Octopodiformes* ; Visual Fields*

OBJECTIVE: In order to study the mechanism of the aqueous humor circulation and its relationship to the glaucoma macroscopically with engineering methods. METHODS: A dynamistic model was presented, which can be used to simulate the situation and the treatment of the primary open angle glaucoma (POAG). The frame of the model was built based on the ophthalmically accepted feedback mechanism between the aqueous humor circulation and the intraocular pressure (IOP). The transfer functions and the parameters were educed from the analysis of physiological theories, the basic elements of hydrodynamics, and the clinical parameters. The relation between the parameters of the system and the episode mechanism of POAG was discussed. A digital method was used to simulate the Challenge test and some medicines' treatment of POAG, and the results were consistent with clinical observations. RESULTS: The results of simulation illuminate that the model can simulate the mechanism of the aqueous humor circulation and the curative mechanism of some medicines under the physiological condition and the pathological condition of the POAG. CONCLUSION: A few parameters which can hardly be captured with clinical method could be obtained from the model. These parameters can be helpful for the diagnosis and prediction of the curative effect.
Aqueous Humor* ; Diagnosis ; Glaucoma ; Glaucoma, Open-Angle* ; Hydrodynamics ; Intraocular Pressure

PURPOSE: To evaluate and compare the characteristics of patients whose nerve fiber layer (NFL) photographs showing diffuse or focal nerve fiber layer defects. METHODS: Patients with diffuse NFL defect were selected by comparing upper and lower half of a NFL photo, and we included the patients only when one part of it showed NFL defect. Patients with focal NFL defect were selected only when one eye had a wedge-shape NFL defect. RESULTS: There were no significant differences between the two groups in visual field index, nor in the results of glaucoma hemifield test. However, patients with diffuse NFL defect (13 eyes, 13 patients) mostly had primary open-angle glaucoma (POAG) (62%), and patients with focal NFL defect (13 eyes, 13 patients) mostly had normal- tension glaucoma (NTG) (62%) (p=0.048, chi-square test). CONCLUSIONS: We found significant differences in the diagnosis of glaucoma between the diffuse and focal NFL loss groups. Our results suggest that the characteristics of NFL loss in POAG and NTG may be different.
Diagnosis ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Nerve Fibers* ; Visual Fields

PURPOSE: To evaluate the ability of qualitative signs for glaucoma diagnosis, both alone and in combination, to discriminate between eyes with and without glaucomatous visual field damage. Furthermore, we investigated whether the characteristic optic disc changes in primary angle-closure glaucoma (PACG) differ from those in primary open-angle glaucoma (POAG). METHODS: Using color polaroid optic disc photographs, we examined 10 qualitative signs in 177 patients with PACG, 184 patients with POAG, and 181 normal subjects. RESULTS: Rim notches and rim shape alteration were found more frequently in patients with POAG than in those with PACG (p<0.05). Disc hemorrhage was not found in any eye in the PACG group. In the early stage (mean deviation >-6 dB) of the PACG and POAG groups, the best qualitative sign was rim shape alteration, and area under the receiver operating characteristic (ROC) curve was 0.696 and 0.768, respectively. The area under the ROC curve for the combination of qualitative signs was 0.802 and 0.918, respectively. CONCLUSIONS: These results suggest that glaucomatous disc damage was less pronounced in the PACG eyes than in the POAG eyes with similar visual field damage. A combination of the qualitative signs of optic disc using multiple logistic regression modelling improved the diagnostic ability.
Diagnosis ; Glaucoma ; Glaucoma, Angle-Closure* ; Glaucoma, Open-Angle* ; Hemorrhage ; Humans ; Logistic Models ; ROC Curve ; Visual Fields

PURPOSE: To evaluate the pressure-lowering effects of selective trabeculoplasty versus these of Argon laser trabeculoplasty. METHODS: Fifteen eyes of 15 patients with primary open-angle glaucoma and ocular hypertension, all with IOPs over 30 mm Hg received SLT and 30 eyes of 30 patients with the same diagnosis were treated with ALT. Patients were evaluated after laser treatments at 1 hour, 1 day, 1 week, 1 month, and 3 months using slit lamp examinations and Goldmann applanation tonometry. RESULTS: At 3 months postoperative, the SLT group had a mean IOP of 16.9+/-4.2 mmHg with a mean reduction of 31.2+/-20.1%, while the ALT group had a mean IOP of 17.9+/-5.4 mmHg with a mean reduction of 26.3+/-23.3%. CONCLUSIONS: Selective trabeculoplasty and Argon laser trabeculoplasty are equally effective statistically in lowering IOP over a 3-month period (p=0.47). SLT has been shown to be safe and effective in lowering IOP.
Argon* ; Diagnosis ; Glaucoma, Open-Angle* ; Humans ; Manometry ; Ocular Hypertension ; Trabeculectomy*

In the diagnosis of primary open angle glaucoma, it is very important to evaluate the outflow facility and intraocular pressure. Although tonography affords one of the most convenient methods for the estimating the outflow facility, there have been many efforts to overcome its inhernt inaccuracy. Honan introcular pressure reducer(HIPR) is widely used prior to cataract surgery because it is believed to be clinically safe and effective in reducing intraocular pressure, vitreous volume and the risk of vitreous loss. For the evaluation of the effects of HIPR in relation to outflow facility, the intraocular pressures were measured with applanation tonometer in 30 nonglaucomatous and 30 glaucomatous patients before and immediately after the application of HIPR at a pressure 30mmHg for 30 minutes, and then repeatedly at 5-minute intervals for 30 minutes thereafter. The results were as follows; 1. Mean initial IOPs were 15.6 +/- 2.71mmHg in nonglaucomatous patients and 20.7 +/- 2.71mmHg in glaucomatous patients. 2. Mean IOPs immediately after commpression were 4.3 +/- 1.38mmHg in nonglauco matous patients and 10.3 +/- 0.95mmHg in glaucomatous patients. 3. Mean IOP reductions were 11.20 +/- 1.89mmHg in nonglaucomatous patients and 10.45 +/- 1.69mmHg in glaucomatous patients. 4. Mean IOP reduction rates were 72.8% in nonglaucomatous patients and 50.3% in glaucomatous patients. 5. Mean IOP recovery times were 24.5 minutes in nonglaucomatous patients and more than 30 minutes in glaucomatous patients. 6. Rates of IOP recovery after 25 minutes elapsed were 76.6% in nonglaucomatous patients and 10% in glaucomatous patients. On the basis of the results HIPR may be considered to be beneficial in clinical diagnosis of open angle glaucoma.
Cataract ; Diagnosis ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure*

OBJECTIVETo investigate the clinical significance of the Octopus 101 GKP kinetic and static automated perimetry in the diagnosis of the primary open angle glaucoma (POAG).

METHODSThirty POAG patients (POAG group) and 34 normal individuals (control group) were detected with Octopus 101 GKP static and kinetic perimetry with GKP and TOP program from October 2006 to March 2007. The visual acuity, intraocular pressure (IOP), cupping/disc (C/D) ratio, mean defect (MD), loss variance (LV), areas of isopter, and testing time were analyzed.

RESULTSThe mean visual acuity, mean IOP and mean C/D ratio were significantly different between POAG group and control group (P = 0.000), and so was the testing time (P = 0.001). The mean test time was (307.78 +/- 134.50) s in the POAG group and was (228.12 +/- 75.33) s in the normal group. No linear correlation was found between the IOP and the areas of isopter or MD between these two group. The visual parameters (I 2e and III 4e) as to the areas of isopter of POAG were significantly different (P = 0.000), and so were the MD, LV and areas of isopter (P = 0.000). Static perimetry had a sensitivity of 80% and a specificity of 45%, and kinetic perimetry had a sensitivity of 86% and a specificity of 63%. The combined method of static and kinetic approaches had a sensitivity of 90%.

CONCLUSIONSThe Octopus 101 GKP static and kinetic perimetry can perform an automated test that combines the advantages of both kinetic and static perimetry, resulting in a decreased subjectivity and individual difference by adjusting the response time and improved accuracy of test results. By changing stimulus size, background illumination, and stimulus angular velocity, the combination of the kinetic and static test may provide a higher sensitivity in the diagnosis of the early stage of POAG, particularly in patients with early peripheral visual field defect.

Objective: In previous decades, glaucoma has been primarily attributed to elevated intraocular pressure (IOP), but this has gradually been replaced by the development of optic neuropathy as the central concept of glaucoma in developed countries. However, there still remain strong controversies in the definition of glaucoma in China. In this current review, we are going to discuss these controversies and elaborate on the historical transitions of the definition of glaucoma both in China and developed countries. Furthermore, we will briefly describe the "ocular-cranial pressure gradient" theory and discuss the relationship between glaucoma and degenerative diseases of the central nervous system (CNS) in order to show the complex pathogenesis of glaucoma and the importance for the modification to the definition of glaucoma. Data Sources: We performed a comprehensive search in both PubMed and SinoMed using the following keywords: (a) "primary glaucoma" and "guideline," (b) "ocular-cranial pressure gradient," and (c) "glaucoma," "Alzheimer's disease," and "Parkinson's disease." The literature search included the related articles with no restrictions on publication date. Study Selection: The primary references were Chinese and English articles including (a) original guidelines and expert consensuses of primary glaucoma, (b) reviews focusing on the differences between various versions of these guidelines and consensuses, and (c) papers about ocular-cranial pressure gradient theory and the relationship between glaucoma and CNS degenerative diseases. Results: The definitions and classifications of both primary open-angle glaucoma and primary angle-closure glaucoma differ between Chinese glaucoma consensuses and international primary glaucoma guidelines. Chinese definitions and classifications put more emphasis on the IOP, while international guidelines put more emphasis on the presence of optic neuropathy. The ocular-cranial pressure gradient theory and the research on the relationship between glaucoma and CNS degenerative diseases have provided new directions for exploring the pathogenesis of glaucoma. Conclusions As regards the definition and classification of primary glaucoma, we find that there are still some discrepancies between Chinese expert consensuses and international guidelines. Glaucoma is a disease with complex etiologies, while its common characteristic is a specific optic neuropathy. The current definition and understanding of glaucoma is an ongoing and evolving process, reflecting our latest available evidence on its pathogenesis. Chinese ophthalmology community may need to update our guidelines, accommodating these latest developments.
China ; Glaucoma ; diagnosis ; physiopathology ; Glaucoma, Angle-Closure ; diagnosis ; physiopathology ; Glaucoma, Open-Angle ; diagnosis ; physiopathology ; Humans ; Intraocular Pressure ; physiology ; Ophthalmology ; methods

Diagnosis of glaucema in its earliest stage with the accurate estimation of functional disturbances of the eye is constant goal of the important part of clinical ophthalmology. Diagnostic measures for glaucoma especially in the early detection are reviewed. They include the tonometric techniques, ophthalmoscopy (observation of optic disc), visual field examinations and goniscopy., etc. in various methods. The more concerns are on the diagnostic evaluation of primary open angle glaucoma, and the practical value of mass screening of the glaucoma is described additionally.
Diagnosis* ; Glaucoma* ; Glaucoma, Open-Angle ; Mass Screening ; Ophthalmology ; Ophthalmoscopy ; Visual Fields