title: Opportunistic detection of glaucomatous optic discs within a diabetic retinopathy screening service.
abstract: OBJECTIVE
  To determine the prevalence of glaucoma among patients referred to a glaucoma service with suspicious disc photographs from the diabetic retinopathy (DR) screening program.
  
  
  METHODS
  A clinical audit of all patients attending a single-center DR screening program in the Mater Misericordiae University Hospital, Dublin, between July 2010 and October 2011 was conducted with a minimum follow-up of 30 months. The DR screening service uses trained technician graders to assess 2-field color retinal photographs for the features of DR. Recently, the service was enhanced so that optic discs are also assessed for signs of glaucoma.
  
  
  RESULTS
  In the 16-month study period, 3,697 diabetic patients were photographed. Following photograph grading, 91 (2.46%) were judged to require referral for assessment at the glaucoma clinic. Of these, 63 (69.23%) presented for assessment. Thirteen patients (20.63%) were diagnosed with glaucoma, comprising 7 cases of low-tension glaucoma and 6 cases of primary open-angle glaucoma. Thirty-six patients (57.14%) were classified as glaucoma suspects and 14 patients (22.22%) were discharged back to the DR screening program following normal ocular examination. Only 6 (9.52%) of the 63 patients examined had an intraocular pressure greater than 21 mm Hg.
  
  
  CONCLUSIONS
  The assessment of DR screening photographs for signs of glaucomatous optic nerve damage should be considered as part of a strategy to improve glaucoma case detection and to reduce the burden of this disease on society.
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin - Ireland.
authors.forename: Maxwell P
authors.initials: MP
authors.lastname: Treacy
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin - Ireland.
authors.forename: Evelyn C
authors.initials: EC
authors.lastname: O'Neill
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin - Ireland.
authors.forename: Melissa
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Department of Ophthalmology, Mater Private Hospital, Dublin - Ireland.
authors.forename: Louise
authors.initials: L
authors.lastname: O'Toole
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin - Ireland.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Delaney
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin - Ireland.
authors.forename: Colm
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin - Ireland.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Connell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D057066:Low Tension Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D015995:Prevalence; D014065:Tonometry, Ocular; D014794:Visual Fields