title: First-visit diagnosis of preperimetric glaucoma.
abstract: OBJECTIVE
  To present a revised interpretation of the work-up data that enabled diagnosis of preperimetric glaucoma (PPG) at the first examination.
  
  
  METHODS
  a) Literature analysis on PPG; b) 6-year follow-up of a glaucoma-suspect patient.
  
  
  RESULTS
  TWO NEW CONCEPTS MAY BE ADAPTED: (a) the objective finding of retinal nerve fiber layer (RNFL) thinning below the normal border in the opposing typical glaucoma locations, the inferior and superior quadrants, and in a non-diffuse pattern, appears asymptomatically and simultaneously only in glaucoma; and (b) the imaging-related RNFL thickness may be considered the reference glaucoma standard, whereas the suspicious early glaucomatous optic neuropathy, having a potential diagnostic inaccuracy, would serve as a complementary revealing finding. That approach enabled, in retrospect, a first-visit diagnosis of low-tension PPG in the patient. Diagnosis was confirmed after 6 years, when cecocentral scotoma and further RNFL thinning emerged despite treatment.
  
  
  CONCLUSIONS
  A revised approach enabled PPG diagnosis during the first visit.
authors.affiliation: Division of Ophthalmology, Hillel-Yaffe Medical Centre, Hadera and The Ruth and Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel.
authors.forename: Avinoam
authors.initials: A
authors.lastname: Ophir
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