A PRACTICAL METHOD TO SCREEN FOR GLAUCOMA IN THE PRIMARY CARE PHYSICIAN'S OFFICE

R. Zeimer

JHU Wilmer Eye Institute, Department of Ophthalmology,

Baltimore, USA

There is a growing awareness that the identification of individuals with glaucomatous damage, not seen by an ophthalmologist, is an essential step to reduce the incidence of blindness. This, along with market pressures on health care organizations to provide preventive care, sets the stage for screening. Efforts to screen for diabetic retinopathy have shown that the targeted population is most effectively reached during routine visits to primary care physicians. We have developed, in collaboration with EyeTel-Imaging (Centerville, VA, USA), the DigiScope, a new dedicated, automated digital fundus camera that can be operated by non-technical personnel. The DigiScope provides digital images of the posterior pole, automatically sent via Internet to an expert reading center that determines if the patient needs referral to an ophthalmologist. The DigiScope is currently being implemented to screen for diabetic retinopathy. We will demonstrate that the Digiscope can be modified to obtain high quality images of the optic nervehead and the peripapillary nerve fiber layer. Moreover, the DigiScope is able to perform automated psychophysical testing. The results of its current use to assess visual acuity demonstrate the feasibility of such tests. Thus, tests such as frequency doubling perimetry could be incorporated. The quality of the DigiScope images will be shown in comparison to conventional photographs and assessment of the cup/disc ratio will be compared to data obtained with the Heidelberg Retina Tomograph. RZ and JHU are entitled to sales royalty from Eyetel Imaging, own stocks and receive research support.