Glaucoma Background

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European Glaucoma Society significant abnormalities

Abnormal glaucoma hemifield test
Three abnormal points p<5% level (one of which being <1% level) and none contiguous with the blind spot
Corrected PSD <5% if the VF is otherwise normal (confirmed on two consecutive tests with no other retinal/neurological disease)

Goldmann applanation tonometry
- Calibrated for subjects with average CCT of 520 so greatly affected by deviation in CCT
Reichart Ocular Response Analyser: automated, non-contact device
Pascal dynamic contours tonometer: less affected by CCT than GAT
Tono-Pen: affected by CCT but less by corneal curvature
Icare: affected by CCT but less by corneal curvature (only device that does not need topical anaesthesia)

Type 1 focal ischaemic: focal notch in NRR with localised field defect
- Females
- Migraine
- Vasospasm
Type 2 myopic glaucomatous: temporal crescent without degenerative myopia
- Dense superior/inferior field loss
- Younger males
Type 3 senile sclerotic: shallow saucerised cup with sloping rim
- Elderly
- Hypertensives
- Cardiovascular disease
Type 4 concentrically enlarging: thinning of the entire rim without a notch, diffuse field loss
- High IOP at presentation
- Younger patients
Type 5 mixed

Grade 1: minimal cupping, nasal step or paracentral scotoma, MD <-6bD
Grade 2: NRR thinning, arcuate scotoma, MD <-12dB
Grade 3: marked cupping, extensive field loss, including central 5 degrees, MD >-12dB
Grade 4: gross cupping, small residual field

Alpha zone: outer of the two
- Variable hyper- and hypopigmentation of the RPE.
- Occurs with same frequency in normal subjects as in POAG but is larger in POAG
Beta zone: inner of the two
- Represents loss of RPE and choriocapillaris
- Occurs with greater frequency in POAG

More complex and includes notation for iris configuration and response to indentation