Glaucoma In Screening Of Diabetic Retinopathy Programme

Purpose To assess the proportion of new glaucoma suspects among diabetic patients aged 18 years or older attending photographic screening for diabetic retinopathy arranged by the City of Helsinki. Methods Two 60 degree monochromatic digital fundus images, one macula and the other disc centered were taken with Canon DF-60 DSi Digital Fundus Camera using a green filter by trained nurses after instillation of mydriatic drops (tropicamide and if needed, cyclopentolate). All images with abnormalities were analyzed by one ophthalmologist. Patients screened during the year 2012 were included in the analysis. Glaucoma suspicion was based on disc hemorrhage and/or glaucomatous cupping and nerve fiber defects. Results Of 6937 patients attending fundus photography for screening of diabetic retinopathy, 24 (0,3%) had glaucoma diagnosed earlier and two were currently under examination for glaucoma suspicion. Altogether 520 patients were referred to further examination (7.5%, 95% confidence interval (CI) 6.9-8.1), and of them the cause for referral was glaucoma suspicion in 50 (9.6, CI 7.3-12.5). Excluding the known glaucoma patients or those currently under examination, the suspicion of new glaucoma, 50 out of 6911, was 0.72% (95% CI 0.55-0.95). Ten patients had disc hemorrhage, one advanced nerve fiber defect and the rest suspiciou disc cupping. The majority, 44 patients with glaucoma suspicion had type 2 diabetes, 5 had type 1 diabetes and one had secondary diabetes. Conclusions Diabetes is a risk factor of glaucoma and changes related to it are thus not unusual in diabetic population, especially in elderly patients with type 2 diabets. Glaucoma suspicion constituted ca. 10% of all referrals. Graders of fundus images need to be aware of these changes. Known glaucoma patients in ophthalmologist's follow-up are, however, not expected to attend screening programme.