Abstract
BackgroundTo assess the impact of knowing central corneal thickness (CCT) on glaucoma management in a United Kingdom district general hospital.MethodsA masked observational non-interventional study included 304 eyes of 152 consecutive glaucoma cases attending general clinic. CCT was measured using a hand-held pachymeter. IOP, as measured by the Goldmann applanation tonometer (GAT), was adjusted for CCT using a normogram. Two identical study sheets were retrospectively constructed from each subject's case notes: one included the CCT and adjusted IOP information, the other excluded. Study sheets were randomly presented to a single masked observer to decide glaucoma management. The difference in management decision was noted.ResultsThe mean ± standard deviation CCT was 561.5 ± 35.7 μm, 538.9 ± 41.4 μm, 538.3 ± 40.3 μm for ocular hypertension (OHT), primary open angle glaucoma (POAG) and normal pressure glaucoma (NPG) subjects respectively. IOP adjustment was greater than ±2 mmHg in 33.9%(103/304) of eyes. CCT and adjusted IOP information led to different treatment option in 37%(55/152). Of the most important changes 20.4%(31/152) cases would have been commenced on additional IOP-lowering medication, 2.0%(3/152) would have been counselled for trabeculectomy surgery and 3.3%(5/152) of the cohort would have been observed rather than treated.ConclusionCCT and adjusted IOP measurement can influence glaucoma management in a clinical context. It helps attribute risk and hence aids patient management decisions.
Highlights
To assess the impact of knowing central corneal thickness (CCT) on glaucoma management in a United Kingdom district general hospital
For the purpose of this study only cases with normal pressure glaucoma (NPG), primary open angle glaucoma (POAG) or ocular hypertension (OHT) were included. They were classified in the following way: POAG was defined as intraocular pressure (IOP) ≥22 mmHg, in presence of demonstrable visual field loss and/or significant optic disc cupping
OHT was defined as IOP ≥ 22 mmHg in the absence of visual field loss or significant optic disc cupping
Summary
To assess the impact of knowing central corneal thickness (CCT) on glaucoma management in a United Kingdom district general hospital. Measuring intraocular pressure (IOP) is well established, with the Goldmann Applanantion Tonometer (GAT) being the most widely used device. The influence of corneal thickness on IOP by conventional tonometers was acknowledged by Goldmann [1] and clarified later by other investigators [2,3,4,5,6]. It has been recommended by many that GAT readings should be complimented with CCT measurements [2,3]. Normograms, based on varying CCT, exist for adjusting GAT readings in normal eyes [4-. What is certain is CCT measurement can allow for a more accurate estimate of the true IOP [3,5] and as IOP is the main risk factor for the progression of glaucoma [9,10,11] using CCT in routine examinations seems mandatory
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