Joshi Pratibha Lama, Jha Bhaskar, Paudyal Indira, Thapa Suman Shamsher
Tilganga Institute of Ophthalmology, Kathmandu.
Nepal J Ophthalmol. 2019 Jan;11(21):33-39. doi: 10.3126/nepjoph.v11i1.25415.
To find out the most common referral parameter among the glaucoma suspects patients from general eye clinic and to establish glaucoma diagnosis.
This study is a retrospective cohort hospital based study. Two hundred patients from January to February 2017 sent to glaucoma clinic as glaucoma suspects were re-evaluated meticulously by glaucoma specialist and were diagnosed as glaucoma, non glaucoma, suspects and ocular hypertension.
Out of the 200 patients referred to glaucoma clinic as glaucoma suspects only19% were diagnosed to have glaucoma. The mean age at which glaucoma diagnosed was 55.29(14.4) compared to 41.6(15.1) in normal group. One hundred and sixty five patients were referred on the basis of suspicious optic nerve head, among them 14.5% (24/165) had glaucoma. This study showed that, open angle glaucoma (OAG) 28.9% was the most common type of total glaucoma diagnosed. The mean vertical cup discratio in the OAG group was 0.69±0.1 (0.4 -0.9) compared to 0.56 ± 0.11((0.2-0.8)(p=0.00) normal. The mean intra ocular pressure (IOP) in OAG group was 19.73 ±4.95(11-32) mmHg compared to 16.74± 3.36(10-30) mmHg (p=0.00) in normal group. The mean central corneal thickness (CCT) in OAG group was 533.05 ± 31.24μm (467-606) compared to normal was 534.9±33.6 μm (432-696) (p=0.670).
Suspicious optic nerve head is the most common referral parameter between the general ophthalmologist and residents, but this study shows only few of them were diagnosed with glaucoma. This gives us a clue that the ophthalmologists and residents are to be trained better to help them identify the signs of glaucoma on the optic nerve head beside its size, which will reduce unnecessary burden to the resources of patients and hospital.
找出综合眼科门诊青光眼疑似患者中最常见的转诊参数，并确立青光眼诊断。
本研究是一项基于医院的回顾性队列研究。对2017年1月至2月转诊至青光眼门诊的200例青光眼疑似患者由青光眼专科医生进行细致的重新评估，并诊断为青光眼、非青光眼、疑似青光眼和高眼压症。
在转诊至青光眼门诊的200例青光眼疑似患者中，仅19%被诊断为青光眼。青光眼诊断时的平均年龄为55.29（14.4）岁，而正常组为41.6（15.1）岁。165例患者因视神经乳头可疑被转诊，其中14.5%（24/165）患有青光眼。本研究表明，开角型青光眼（OAG）占确诊青光眼总数的28.9%，是最常见的类型。OAG组的平均垂直杯盘比为0.69±0.1（0.4 - 0.9），而正常组为0.56 ± 0.11（0.2 - 0.8）（p = 0.00）。OAG组的平均眼压（IOP）为19.73 ± 4.95（11 - 32）mmHg，而正常组为16.74 ± 3.36（10 - 30）mmHg（p = 0.00）。OAG组的平均中央角膜厚度（CCT）为533.05 ± 31.24μm（467 - 606），而正常组为534.9 ± 33.6μm（432 - 696）（p = 0.670）。
视神经乳头可疑是普通眼科医生和住院医生之间最常见的转诊参数，但本研究显示其中只有少数被诊断为青光眼。这为我们提供了一个线索，即眼科医生和住院医生需要接受更好的培训，以帮助他们除了视神经乳头大小之外，还能识别青光眼的体征，这将减少患者和医院资源的不必要负担。
