Diagnostic Tests for Glaucoma

Diagnostic Test list for Glaucoma:

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Glaucoma includes:

• Visual acuity test
• Visual field test
• Dilated pupil exam
• Tonometry
• Air puff test
• Glaucoma test - Check pressure in eye, done by opthamologist, painless, simple.
• Gonioscopy - examine eye's drainage angle
• Test peripheral vision - look at a central light, tested by light on the periphery
• Dye tests - These tests examine choroidal circulation within the eye.
• Indocyanine green (ICG) eye dye test, IUP eye dye test

Home Diagnostic Testing

These home medical tests may be relevant to Glaucoma:

• Vision & Eye Health: Home Testing:
  • Home Eye Tests
  • Home Vision Tests

Diagnostic Tests for Glaucoma: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the diagnostic tests for Glaucoma.

HYPERTENSION: DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)

Routine diagnostic tests include a CBC, sedimentation rate, chemistry panel, total and high-density lipoprotein (HDL) cholesterol, a VDRL test, urinalysis including microscopic, a urine culture with colony count and sensitivity, and an EKG, chest x-ray, and flat plate of the abdomen for kidney size.

If these are normal, a nephrologist should be consulted before undertaking expensive diagnostic tests. It may be wise to observe the results of treatment before further testing also.

Additional tests that may be ordered are an intravenous pyelogram, a 24-hr urine catecholamine, a serum cortisol, a plasma renin level, a 24-hr urine aldosterone determination, a cystoscopy, and retrograde pyelography. A 24-hr free cortisol may be more useful in diagnosing Cushing's syndrome than serum free cortisone. Renal angiography used to be done more frequently, but should be considered in sudden onset of hypertension in the elderly and in hypertension that is resistant to treatment.

Twenty-four-hr blood pressure monitoring can be useful both in diagnosis and in evaluating the results of therapy. Magnetic resonance angiography is a good noninvasive alternative to renal angiography.

 

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Halo vision: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

First, ask the patient how long he has been seeing halos around lights and when he usually sees them. The patient with glaucoma usually sees halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.

Next, examine the patient’s eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.

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Blood pressure increase [Hypertension]: History and physical examination

(Handbook of Signs & Symptoms (Third Edition))

If you detect sharply elevated blood pressure, quickly rule out possible life-threatening causes. (See Managing elevated blood pressure.)

After ruling out life-threatening causes, complete a more leisurely history and physical examination. Determine if the patient has a history of cardiovascular or cerebrovascular disease, diabetes, or renal disease. Ask about a family history of high blood pressure — a likely finding with essential hypertension, pheochromocytoma, or polycystic kidney disease. Then ask about its onset. Did high blood pressure appear abruptly? Ask the patient's age. The sudden onset of high blood pressure in middle-aged or elderly patients suggests renovascular stenosis. Although essential hypertension may begin in childhood, it typically isn't diagnosed until near age 35. Pheochromocytoma and primary aldosteronism usually occur between ages 40 and 60. If you suspect either, check for orthostatic hypotension. Take the patient's blood pressure with him lying down, sitting, and then standing. Normally, systolic pressure falls and diastolic pressure rises on standing. With orthostatic hypotension, both pressures fall.

Note headache, palpitations, blurred vision, and sweating. Ask about wine-colored urine and decreased urine output; these signs suggest glomerulonephritis, which can cause elevated blood pressure.

Obtain a drug history, including past and present prescriptions, herbal preparations, and over-the-counter drugs (especially decongestants). If the patient is already taking an antihypertensive, determine how well he complies with the regimen. Ask about his perception of elevated blood pressure. How serious does he believe it is? Does he expect drug therapy to help? Explore psychosocial or environmental factors that may impact blood pressure control.

Follow up the history with a thorough physical examination. Using a funduscope, check for intraocular hemorrhage, exudate, and papilledema, which characterize severe hypertension. Perform a thorough cardiovascular assessment. Check for carotid bruits and jugular vein distention. Assess skin color, temperature, and turgor. Palpate peripheral pulses. Auscultate for abnormal heart sounds (gallops, louder second sound, murmurs), rate (bradycardia, tachycardia), or rhythm. Then auscultate for abnormal breath sounds (crackles, wheezing), rate (bradypnea, tachypnea), or rhythm.

Palpate the abdomen for tenderness, masses, or liver enlargement. Auscultate for abdominal bruits. Renal artery stenosis produces bruits over the upper abdomen or in the costovertebral angles. Easily palpable, enlarged kidneys and a large, tender liver suggest polycystic kidney disease. Obtain a urine sample to check for microscopic hematuria.

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Halo vision: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

First, ask the patient how long he has been seeing halos around lights and when he usually sees them. Patients with glaucoma usually see halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.

Next, examine the patient’s eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.

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Blood pressure increase [Hypertension]: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If you detect sharply elevated blood pressure, quickly rule out possible life-threatening causes. (See Managing elevated blood pressure.)

After ruling out life-threatening causes, complete a more leisurely history and physical examination. Determine if the patient has a history of cardiovascular or cerebrovascular disease, diabetes, or renal disease. Ask about a family history of high blood pressure—a likely finding in patients with essential hypertension, pheochromocytoma, or polycystic kidney disease. Then ask about its onset. Did high blood pressure appear abruptly? Ask the patient’s age. Sudden onset of high blood pressure in middle-aged or elderly patients suggests renovascular stenosis. Although essential hypertension may begin in childhood, it typically isn’t diagnosed until near age 35. Pheochromocytoma and primary aldosteronism usually occur between ages 40 and 60. If you suspect either, check for orthostatic hypotension. Take the patient’s blood pressure with him supine, sitting, and then standing. Normally, systolic pressure falls and diastolic pressure rises on standing; in orthostatic hypotension, both pressures fall.

Note headache, palpitations, blurred vision, and sweating. Ask about wine-colored urine and decreased urine output; these signs suggest glomerulonephritis, which can cause elevated blood pressure.

Obtain a drug history, including past and present prescription and over-the-counter drugs (especially decongestants) as well as herbal preparations. If the patient is already taking an antihypertensive, determine how well he complies with the regimen. Ask about his perception of elevated blood pressure. How serious does he believe it is? Does he expect drug therapy to help? Explore psychosocial or environmental factors that may impact blood pressure control.

Follow up the history with a thorough physical examination. Using a funduscope, check for intraocular hemorrhage, exudate, and papilledema, which characterize severe hypertension. Perform a thorough cardiovascular assessment. Check for carotid bruits and jugular vein distention. Assess skin color, temperature, and turgor. Palpate peripheral pulses. Auscultate for abnormal heart sounds (gallops, louder second sound, murmurs), rate (bradycardia, tachycardia), or rhythm. Then auscultate for abnormal breath sounds (crackles, wheezing), rate (bradypnea, tachypnea), or rhythm.

Palpate the abdomen for tenderness, masses, or liver enlargement. Auscultate for abdominal bruits. Renal artery stenosis produces bruits over the upper abdomen or in the costovertebral angles. Easily palpable, enlarged kidneys and a large, tender liver suggest polycystic kidney disease. Obtain a urine specimen to check for microscopic hematuria.

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Hypertension: Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

 A. Blood pressure measurement. Use a standardized technique (2,3) when measuring blood pressure to avoid spuriously high or low values. Patients should be seated in a chair, upright with back support, feet flat on the floor, arms bared, and supported at heart level. The patient should be resting at least 5 minutes before blood pressure measurements are taken. Stimulants such as nicotine and caffeine should be avoided at least 30 minutes prior to measurement. Appropriate cuff size is very important; the bladder within the cuff should circle at least 80% of the arm. Initial blood pressure measurements should include both arms; the arm with the higher reading should be used thereafter. It is recommended that two or more readings, separated by 2 minutes, be averaged. If the first two readings differ by more than 5 mm Hg, then additional readings should be obtained and averaged.

 B. Additional physical examination. Height and weight should be measured. In a focused physical examination, pay particular attention to the fundi (for hemorrhages or vascular changes), the carotid arteries (for bruits), the heart (for murmurs), the abdomen (for bruits), and the extremities (for pulses, bruits, edema).

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Hypertension: Diagnostic Approach
(Field Guide to Bedside Diagnosis)

The level of blood pressure associated with 50% increase in cardiovascular mortality: men younger than 45 years old, 130/90; men older than 45 years, 140/95; women, 160/95. An ankle-brachial systolic blood pressure ratio of less than 0.9 predicts a fourfold increase in cardiovascular mortality.

Clues to secondary hypertension include onset at a young age (,35), abrupt onset of hypertension, blood pressure difficult to control requiring high dosages of two or more drugs, and very high or labile blood pressure. Hypertension with relative tachycardia may be a clue to sympathetic effect or diastolic dysfunction. Headaches with severe hypertension are occipital and worse in the morning.

Hypertensive end organ damage must be searched for when the diastolic BP is greater than 130 mm Hg and the patient exhibits confusion, dyspnea, restlessness, or blurred vision. Perform fundoscopy looking for papilledema or retinal hemorrhages, and cardiopulmonary exam for third heart sound or bibasilar rales. Clues to hypertension-associated left ventricular hypertrophy include a fourth heart sound, an apical impulse greater than two intercostal spaces, a holosystolic sustained apical impulse diameter, and a hypertensive response to exercise ( .210 systolic). Cotton wool spots, which are caused by anoxic edema with axon degeneration, are seen in advanced hypertension (also in diabetes, dysproteinemia, and fat emboli).

Grading hypertensive retinopathy provides a marker of end-organ damage, which is tied to prognosis:

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Halo vision: Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Examine the patient’s eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.

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Hypertension: Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

BP can bemeasured at any age, but it should be measured in any child ≥3yrs of age each year. Any infant or child with unexplained heartmurmur, cardiomegaly, decreased femoral pulses, abdominal mass,seizures, any suspicion of cardiovascular or renal disease, or anyacute severe illness should have BP measured.

Arm BP should be measured with childsitting or supine with the cubital fossa at heart level. Width ofbladder cuff should cover two-thirds of distance between shoulderand elbow. Phase 1 and 5 Korotkoff sounds should be recorded. Ithas now been determined that phase 5 Korotkoff sound (disappearanceof Korotkoff sound) is reliable measure of diastolic BP in childrenof all ages. In child suspected of having hypertension, BP shouldbe measured in both arms and in at least 1 leg initially.

Complete history and physical examshould be performed in any child with hypertension. Extent of evaluationdepends on child's age, clinical presentation and findings,family history, level of BP, and whether increase in BP is transientor sustained.

Age

At any age, stress in form of anxiety, pain,or trauma is common cause of transient hypertension.Common and uncommon causes of sustained hypertensionby age are listed previously.In pediatric population, renal parenchymaldisease and renal artery stenosis are most common causes of severehypertension.Generally, the younger the child and higherthe BP, the more likely it is that an identifiable cause will befound.

Clinical Presentation

Childrenwith mild increase in BP are usually asymptomatic.

Infants <1 yr of age withsevere hypertension may have feeding problems, vomiting, irritability,failure to thrive, respiratory distress, cardiac failure, and seizures.

Older children with severe hypertensionmay have severe headache, blurred vision, funduscopic changes, focalor generalized seizures, or cardiac failure.

Family History

Many children and adolescents with primaryhypertension often have positive family history of hypertension.Polycystic kidney disease and glucocorticoid-remediable aldosteronismare genetic diseases associated with hypertension.

Level of Blood Pressure

When singleBP measurement indicative of increased BP has been recorded in asymptomaticchild, several BP measurements should be made subsequently to determinewhether hypertension truly exists.

If BP is in ninety-fifth percentilefor age, gender, and height, and especially if family history ispositive for primary hypertension and child is overweight, diagnosisis most likely primary hypertension.

Several tests should be performed initially:CBC, UA, blood urea nitrogen, serum electrolytes and creatinine,and renal U/S.

If results of these tests are normal,recommendations for decreasing salt intake and weight, and increasingexercise, should be made.

If BP becomes normal, no other investigationsare necessary, but the BP should be measured periodically.

If primary hypertension seems unlikelybased on negative family history, lack of obesity, and young age,the same tests should be performed.

Cortical imaging may be useful in child withhistory of significant vesicoureteral reflux to look for focal scarring.

Urinary tract obstruction may needto be investigated by combination of studies, including voidingcystourethrography, intravenous urography, and diuretic renography.

If diagnosis remains uncertain, plasmarenin activity (PRA) should be measured because low PRA is usefulscreening test for mineralocorticoid excess. Plasma aldosteronealso should be measured. Finally, renal angiography should be considered.

Cardiac organ damage can be evaluatedby echocardiography.

In all individuals with severe hypertension,investigations should search for underlying cause.

Several testsshould be performed: CBC with differential and platelet counts,UA, urine culture, serum electrolytes and creatinine, blood ureanitrogen, abdominal U/S, chest radiography, and echocardiography.

Other useful tests include plasma reninactivity, plasma aldosterone, morning and evening serum cortisol,urine timed collection for catecholamines, measurement of specificplasma steroids to diagnose 17-alpha-hydroxylase and 11-beta-hydroxylasedeficiencies, and captopril renography.

Renal angiography also should be considered.

Transient vs Sustained Hypertension

In somecases, whether hypertension is transient or sustained can only bedetermined with passage of time. If hypertension is severe, whetherit is transient or sustained, immediate therapy for BP control isnecessary to prevent severe complications (e.g., cerebral hemorrhageand infarction). Investigations to determine underlying cause canbe performed once BP is under control.

With sustained hypertension, repeatBP measurements must be made to assess its severity. Presence ofcardiomegaly, facial nerve palsy, and funduscopic changes of arteriolarnarrowing and arteriovenous nicking indicate long-standing severehypertension. These children must be investigated to determine causeof hypertension.

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Halo vision: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

First, ask the patient how long he has been seeing halos around lights and when he usually sees them. The patient with glaucoma usually sees halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.

Next, examine the patient's eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.

READ BOOK EXCERPT ONLINE »

Blood pressure, increased [Hypertension]: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

If you detect sharply elevated blood pressure, quickly rule out possible life-threatening causes. (See Managing elevated blood pressure, page 84.)

After ruling out life-threatening causes, complete a history and physical examination. Determine if the patient has a history of cardiovascular or cerebrovascular disease, diabetes, or renal disease. Ask about a family history of high blood pressure—a likely finding with essential hypertension, pheochromocytoma, or polycystic kidney disease. Then ask about its onset. Did high blood pressure appear abruptly? Ask the patient's age. The sudden onset of high blood pressure in middle-aged or elderly patients suggests renovascular stenosis. Although essential hypertension may begin in childhood, it typically isn't diagnosed until near age 35. Pheochromocytoma and primary aldosteronism usually occur between ages 40 and 60. If you suspect either, check for orthostatic hypotension. Take the patient's blood pressure with him lying down, sitting, and then standing. Normally, systolic pressure falls and diastolic pressure rises on standing. With orthostatic hypotension, both pressures fall.

Note headache, palpitations, blurred vision, and sweating. Ask about wine-colored urine and decreased urine output; these signs suggest glomerulonephritis, which can cause elevated blood pressure.

Obtain a drug history, including past and present prescriptions, herbal medicines, and over-the-counter drugs (especially decongestants). If the patient is already taking an antihypertensive, determine how well he complies with the regimen. Ask about his perception of elevated blood pressure. How serious does he believe it is? Does he expect drug therapy to help? Explore psychosocial or environmental factors that may impact blood pressure control.

Follow up the history with a thorough physical examination. Using a funduscope, check for intraocular hemorrhage, exudate, and papilledema, which characterize severe hypertension. Perform a thorough cardiovascular assessment. Check for carotid bruits and jugular vein distention. Assess skin color, temperature, and turgor. Palpate peripheral pulses. Auscultate for abnormal heart sounds (such as gallops, louder second sound, or murmurs), rate (for example, bradycardia or tachycardia), or rhythm. Then auscultate for abnormal breath sounds (such as crackles or wheezing), rate (for example, bradypnea or tachypnea), or rhythm.

Palpate the abdomen for tenderness, masses, or liver enlargement. Auscultate for abdominal bruits. Renal artery stenosis produces bruits over the upper abdomen or in the costovertebral angles. Easily palpable, enlarged kidneys and a large, tender liver suggest polycystic kidney disease. Obtain a urine sample to check for microscopic hematuria.

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Tests and diagnosis discussion for Glaucoma:

Are You at Risk for Glaucoma: NEI (Excerpt)

Many people may know of the "air puff" test or other tests used to measure eye pressure in an eye examination. But, this test alone cannot detect glaucoma. Glaucoma is found most often during an eye examination through dilated pupils. This means drops are put into the eyes during the exam to enlarge the pupils. This allows the eye care professional to see more of the inside of the eye to check for signs of glaucoma. (Source: excerpt from Are You at Risk for Glaucoma: NEI)

Facts About Glaucoma: NEI (Excerpt)

Most people think that they have glaucoma if the pressure in their eye is increased. This is not always true. High pressure puts you at risk for glaucoma. It may not mean that you have the disease.

Whether or not you get glaucoma depends on the level of pressure that your optic nerve can tolerate without being damaged. This level is different for each person. (Source: excerpt from Facts About Glaucoma: NEI)

Facts About Glaucoma: NEI (Excerpt)

Although normal pressure is usually between 12-21 mm Hg, a person might have glaucoma even if the pressure is in this range. That is why an eye examination is very important.

To detect glaucoma, your eye care professional will do the following tests:

Visual acuity: This eye chart test measures how well you see at various distances.

Visual Field: This test measures your side (peripheral) vision. It helps your eye care professional find out if you have lost side vision, a sign of glaucoma.

Pupil dilation: This examination provides your eye care professional with a better view of the optic nerve to check for signs of damage. To do this, your eye care professional places drops into the eye to dilate (widen) the pupil. After the examination, your close-up vision may remain blurred for several hours.

Tonometry: This standard test determines the fluid pressure inside the eye. There are many types of tonometry. One type uses a purple light to measure pressure. Another type is the "air puff," test, which measures the resistance of the eye to a puff of air. (Source: excerpt from Facts About Glaucoma: NEI)

Diagnosis of Glaucoma: medical news summaries:

The following medical news items are relevant to diagnosis of Glaucoma:

• Eye doctors can pick up a variety of diseases from an eye examination
• Lupus can be difficult to diagnose because of it’s multitude of symptoms
• New eye disease detection equipment receives FDA approval

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