Early Detection of Glaucomatous Optic Nerve Abnormality by Nonmydriatic Digital Fundus Camera in a Routine Health Check-up

ABSTRACT

PURPOSE: To investigate the usefulness of the non-mydriatic digital fundus camera for detection of normal-tension glaucoma in routine health check-ups. METHODS: Among 1986 persons who received a routine health check-up in the Kangnam Health Care Center of Seoul National University Hospital (SNUH) from October to December 2003, 60 patients were referred to the Glaucoma Clinic of SNUH due to a suspicious optic nerve head or a retinal nerve fiber layer (RNFL) defect detected by a non-mydriatic digital fundus camera. The glaucoma work-up was performed, including Goldmann applanation tonometry, red free RNFL photography, Humphrey visual field (HVF), Stratus OCT and HRT II. RESULTS: Among 60 patients with a suspicious optic nerve head or suspected RNFL defect, 23 patients showed a retinal nerve fiber layer defect on red free RNFL photography. Those 23 patients had already demonstrated possible RNFL defects on photographs taken by a non-mydriatic digital fundus camera at their routine health check-up. In comparison with the normal, high PSD value of HVF (p=0.002), the narrow neuroretinal rim area shown by OCT (p=0.05) and HRT (p=0.02) were significantly different statistically. CONCLUSIONS: The non-mydriatic digital fundus camera can serve as a useful tool to screen normal-tension glaucoma in routine health check-up systems. However, the final diagnosis of glaucoma should be confirmed by red free RNFL photography and standard automated perimetry.