STRUCTURED MULTIMODAL OPHTHALMIC EXAMINATION WITH STANDARD AUTOMATED PERIMETRY FOR THE DETECTION, STAGING AND MANAGEMENT OF GLAUCOMA

Background: Glaucoma is the leading cause of irreversible blindness and typically remains symptomless until substantial optic-nerve damage has occurred. Because no single test is sufficient for diagnosis, a structured examination combining tonometry, gonioscopy, optic-disc assessment, optical coherence tomography (OCT) and standard automated perimetry (SAP) is recommended. This study describes the diagnostic yield, severity distribution and treatment outcomes of such a pathway in an Indian tertiary care setting. Methods: In this prospective observational study, 196 consecutive patients with suspected or established glaucoma underwent a standardized evaluation comprising best-corrected visual acuity, slit-lamp examination, Goldmann applanation tonometry, gonioscopy, pachymetry where available, dilated stereoscopic optic-disc assessment, OCT of the retinal nerve fibre layer (RNFL) and macular ganglion-cell complex, and SAP. Patients were classified by mechanism and staged by the Hodapp–Parrish–Anderson criteria, managed individually with medical, laser or surgical treatment, and followed with repeat tonometry, OCT and perimetry. Results: Mean age was 58.4 ± 11.7 years and 124 patients (63.3%) were men. Established glaucoma was present in 144 (73.5%) primary open-angle in 91 (46.4%), primary angle-closure in 31 (15.8%), secondary in 14 (7.1%) and normal-tension in 8 (4.1%) while 36 (18.4%) were glaucoma suspects and 16 (8.2%) had ocular hypertension. OCT detected RNFL abnormality in 151 (77.0%), against reproducible field defects in 144 (73.5%); structure–function correspondence was present in 132 (67.3%). Of the established cases, 54 (37.5%) were early, 48 (33.3%) moderate and 42 (29.2%) severe; RNFL thickness correlated with mean deviation (r = 0.68) and visual field index (r = 0.64; both p < 0.001). Initial management was medical in 103 (71.5%), laser in 21 (14.6%) and surgical in 20 (13.9%). Mean IOP fell from 23.8 ± 6.4 to 15.9 ± 3.1 mmHg (33.2%; p < 0.001); at final assessment 132 (91.7%) had IOP ≤ 18 mmHg, 126 (87.5%) had stable or improved fields and 18 (12.5%) showed progression. Conclusion: A structured multimodal pathway detected structural damage somewhat more often than functional loss, staged disease reliably, and achieved target pressure in over 90% of treated patients. Nearly a third of patients nonetheless presented with severe disease, underlining the need for earlier case-finding in the Indian population.