Monitoring Glaucoma in the Developing World

V Gulati, HC Agarwal, R Sihota
Dr Rajendra Prasad Centre for Ophthalmic Sciences,
All India Institute of Medical Sciences, New Delhi, India

Purpose: To evaluate the efficacy of random tonometry, optic disc evaluation, and visual field assessment in the follow-up of patients with primary open angle glaucoma using long-term antiglaucoma treatment.

Patients and Methods: Seventy four eyes of 37 patients with open angle glaucoma, who had intraocular pressures <21 mm Hg with topical antiglaucoma medications and glaucomatous optic disc cupping were included in the study. All patients were followed up for 9 months with 3-monthly automated perimetry using the Humphrey visual field analyser, monthly random applanation tonometry during office hours (9 am to 8 pm), and stereoscopic optic disc evaluation. If the visual field defects or glaucomatous optic disc cupping progressed or the intraocular pressure was >21 mm Hg, diurnal IOP was performed and antiglaucoma medications were increased to lower the intraocular pressure to <21 mm Hg.

Results: Five percent of the patients with previously normal visual fields developed visual field defects despite maintenance of intraocular pressure <21 mm Hg. Twenty percent of eyes showed progression of visual field defects. The average mean deviation worsened by 19% and the average corrected pattern standard deviation worsened by 24%. No clinically detectable changes in optic disc cupping were observed during 9 months of follow-up.

Conclusions: Random tonometry alone or in combination with ophthalmoscopic optic disc evaluation, as practised by many ophthalmologists in the developing world, is inadequate for the follow-up of patients with open angle glaucoma. It is preferable to perform routine automated perimetry along with applanation tonometry for follow-up of patients with glaucoma receiving long-term medical treatment.