title: Detection of Glaucoma and Its Association With Diabetic Retinopathy in a Diabetic Retinopathy Screening Program.
abstract: OBJECTIVE
  To determine the type of glaucoma in subjects with diabetes mellitus detected during a diabetic retinopathy screening program and to determine any association between diabetic retinopathy (DR) and glaucoma.
  
  
  METHODS
  This is a population-based prospective cross-sectional study, in which subjects with diabetes mellitus underwent screening for DR in a primary care outpatient clinic. Digital fundus photographs were taken and graded for presence/absence and severity of DR. During this grading, those fundus photographs showing increased cup-to-disc ratio (CDR) (≥0.6) were identified and these patients were referred to the specialist ophthalmology clinic for detailed examination. The presence of glaucoma was established based on CDR and abnormal visual field (VF) defects according to Hodapp-Parrish-Anderson's criteria. An elevation of intraocular pressure was not required for the diagnosis of glaucoma. The patients said to have definite glaucoma were those with vertical CDR>/=0.6, glaucomatous defects on VF examination, or retinal nerve fiber thinning if VF was unreliable.
  
  
  RESULTS
  Of the 2182 subjects who underwent screening, 81 subjects (3.7%) had increased CDR and 40 subjects (1.8%) had confirmed glaucoma. Normal-tension variant of primary open-angle glaucoma was the most prevalent type (1.2%) We did not find any evidence that DR is a risk factor for glaucoma [odds ratio for DR vs. no DR=1.22 (95% confidence interval, 0.59-2.51)].
  
  
  CONCLUSIONS
  The overall prevalence of glaucoma in this diabetic population, based on finding increased cupping of optic disc in a teleretinal screening program was 1.8% (95% confidence interval, 1.0-3.0).
authors.affiliation: *Department of Ophthalmology ‡School of Public Health, The University of Hong Kong †Department of Ophthalmology, Queen Mary Hospital, Hong Kong SAR, China.
authors.forename: Rita A
authors.initials: RA
authors.lastname: Gangwani
authors.forename: Sarah M
authors.initials: SM
authors.lastname: McGhee
authors.forename: Jimmy S M
authors.initials: JS
authors.lastname: Lai
authors.forename: Christina K W
authors.initials: CK
authors.lastname: Chan
authors.forename: David
authors.initials: D
authors.lastname: Wong
mesh_terms: D000368:Aged; D063171:Corneal Pachymetry; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis* / Q000453:epidemiology; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D057066:Low Tension Glaucoma / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D010781:Photography; D015995:Prevalence; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular