Possible Undiagnosed Glaucoma Detected by MultiColor Imaging of Retinal Diseases

Abstract

To evaluate for the presence of visible retinal nerve fiber layer (RNFL) defects consistent with undiagnosed glaucoma in MultiColor images (Heidelberg Engineering, Heidelberg, Germany) obtained at clinicians' discretion for the diagnosis and management of retinal diseases. Retrospective chart review of MultiColor images obtained as part of routine clinical care between December 25, 2013 and June 24, 2014. Images were reviewed by 2 fellowship-trained glaucoma specialists (S.H.V.T., S.G.A.) for the presence of RNFL defects in the superotemporal or inferotemporal quadrants. No attention was given to the optic nerve head when identifying candidate images. Retinal nerve fiber layer defects were not considered glaucomatous if they traced to regions of retinal atrophy. A total of 157 retina clinic patients aged 18 years or older who carried at least 1 retinal diagnosis; patients were subsequently excluded if medical records review revealed a history of glaucoma or glaucoma suspect diagnoses at the time of imaging. MultiColor confocal scanning laser ophthalmoscopy images were obtained using the Heidelberg Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany). The primary end point was the presence of at least 1 RNFL defect tracking toward the optic nerve. Among 157 reviewed charts, 134 eyes of 80 patients met inclusion criteria, of whom 13 eyes of 10 patients had visible RNFL defects consistent with possible undiagnosed glaucoma. The average age of patients with presumed glaucomatous eyes was 67 years (range, 35-88 years; standard deviation, 15.7 years). The retinal diagnoses in the glaucomatous eyes included branch retinal vein occlusion (3 eyes and 1 fellow eye), neovascular age-related macular degeneration (2 eyes), non-neovascular age-related macular degeneration (both eyes of 1 patient), proliferative diabetic retinopathy (2 eyes), nonproliferative diabetic retinopathy (both eyes of 1 patient), and epiretinal membrane (1 eye). Retinal nerve fiber layer defects consistent with glaucoma may be visible on MultiColor images obtained for the diagnosis and management of retinal diseases and may represent an underused opportunity to prevent additional visual dysfunction in patients already undergoing retinal disease management.