Mandatory medical device diagnostics.
- Slit-lamp examination (slit-lamp microscope; viewing of the eyeball under appropriate illumination and high magnification) of the anterior and middle segments of the eye (if not performed within the past year)
- Stereoscopic findings of optic disc (area of retina where retinal nerve fibers gather and form optic nerve after leaving eyeball) and peripapillary nerve fiber layer [characteristic findings:
- Increase in optic disc excavation/hollowing (excavation) of the optic disc (optic disc) (corresponding to atrophy of the nerve fibers).
- Fading of the optic disc
- Optic disc rim hemorrhages (as a sign of vascular dysfunction (vascular dysfunction); indicator of progressive glaucoma damage)
- Nerve fiber bundle defects (nerve fiber layer thickness is nowadays measured by optic disc OCT (see below))]
- Tonometry (intraocular pressure measurement) – should be done several times, since intraocular pressure varies during the day (normal range: 15.5 ± 5.5 mmHg); the upper normal value is 21 mmHgNote: a “normal” reading does not exclude glaucomatous damage to the optic nerve, since not every glaucoma is accompanied by increased intraocular pressure!
- Perimetry* (visual field measurement) – required as basic diagnostics in all patients.
* Functional deficits in perimetry are usually only visible when the morphological damage of the neuroretinal rim tissue (> 40%) is already significantly advanced.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification.
- Gonioscopy (examination of the chamber angle) – The ophthalmologist places the gonioscope directly on the eye so that it can see the angle between the cornea (cornea of the eye) and iris (iris). The chamber angle (angulus iridocornealis) is an anatomical structure of the eye located between the cornea and iris.
- Optic disc photomorphometry and morphometry for follow-up.
- Corneal pachymetry (corneal thickness measurement).
- Ultrabiomicroscope (UBM) – special high-resolution ultrasound device for the diagnosis of, for example, tumors inside the eye.
- Measurement of ocular blood flow (OBF) – in glaucoma patients, the ocular blood flow in the entire eye is reduced on average.
For follow-up diagnosis:
- Laser scanning tomography with the Heidelberg Retina Tomograph* (HRT) – three-dimensional image of the optic disc (optic nerve head) with computer evaluation).
- Optical coherence tomography (OCT)* or the polarization method (GDx)* – measurement of nerve fiber thickness around the optic disc (optic disc).
* These examinations can indicate deterioration, especially in the early stages of glaucoma, which then have important consequences for therapy.