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Editors Selection IGR 9-2

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Comment by Esther Hoffmann on:

53737 Do findings on routine examination identify patients at risk for primary open-angle glaucoma? The rational clinical examination systematic review, Hollands H; Johnson D; Hollands S et al., JAMA (Journal of the American Medical Association), 2013; 309: 2035-2042

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Hollands and colleagues have performed a systematic review on the question whether findings on routine examination identify patients at risk for open-angle glaucoma. They included 57 publications from 41 studies and tried to include only high-quality studies with random samples of the population. The method they used was a structured medline search from 1950-today. Studies from 1971-2011 were finally included in the review.

The authors found a summary prevalence of glaucoma of 2.6%. Overall, this review supports the findings that increased cup-to-disc ratio (CDR), CDR asymmetry, disc hemorrhage, and elevated IOP are associated with an increased risk of developing glaucoma. Furthermore, this review highlights that demographic risk factors of family history, black race, and advanced age are also associated with a higher risk for glaucoma. One has to bear in mind that the absence of these parameters does not effectively rule out glaucoma.

In conclusion, Hollands and colleagues found that detection of glaucoma requires a specialized ophthalmologist and ‐ beside IOP measurement ‐ specific devices for glaucoma diagnostics. Several risk factors for glaucoma exist. Patients with these risk factors should be referred to a glaucoma specialist.

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