Pseudoexfoliation Syndrome (Pseudoexfoliation Glaucoma) Workup

Updated: Oct 23, 2018
  • Author: Mauricio E Pons, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Workup

Imaging Studies

Various imaging technologies are being used to document and monitor changes due to glaucomatous damage in the optic disc and the retinal nerve fiber layer.

Optical coherence tomography (OCT) is a valuable tool in the evaluation of glaucoma. OCT provides a cross-sectional view of the scanned retinal area that allows differentiation between the retinal layers. The thickness of the retinal nerve fiber layer can be measured using this technique.

The confocal scanning laser ophthalmoscope (Heidelberg retina tomograph [HRT]) provides topographical measures of the optic disc as well as indirect measurements of the retinal nerve fiber layer thickness.

OCT and HRT have been used to help in the diagnosis and follow-up of patients with glaucoma. Both OCT and HRT have shown a high correlation between the retinal nerve fiber layer thickness and the visual field mean defect during achromatic perimetry.

The GDx Nerve Fiber Analyzer has been reported to be a valuable tool in helping the clinician to discriminate between healthy eyes and glaucomatous eyes.

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Other Tests

Gonioscopy and visual field testing

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Histologic Findings

Gottanka et al found marked differences in the optic nerve between primary open-angle glaucoma and pseudoexfoliation glaucoma. [45] Eyes with primary open-angle glaucoma were found to have axon loss associated with more connective tissue in the septa and surrounding the central retinal vessels and a decrease in the density of capillaries as compared with eyes with pseudoexfoliation glaucoma where the capillary density did not change with axon loss.

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