At Press Time

Misdiagnosis in Chinese Men
They Appeared to Have Glaucoma — But Did Not.

• Many young and middle-aged people of Chinese ancestry who believe they are at risk of going blind from glaucoma may have been misdiagnosed, say researchers at the Stanford University School of Medicine.
After following 16 such patients for 7 years and observing more than 100 others, the researchers concluded that there is a new syndrome occurring in the Chinese population, and it may be less likely to lead to severe vision loss or blindness than typical glaucoma. Their results were published in the March issue of Ophthalmology.
Almost all of the patients were nearsighted and many had normal IOP. To see so many similar patients, including many with normal pressure, was unusual, report the researchers. The combination of similarities among the patients led Kuldev Singh, M.D., M.P.H., professor of ophthalmology at the Stanford University School of Medicine, to question whether these individuals, including some as young as 25, had glaucoma rather than another syndrome. So instead of the normal, aggressive course of treatment for young glaucoma patients — including surgery — Dr. Singh kept most of the patients on low doses of IOP-lowering eye drops as a precaution.
As he suspected, none of the patients progressed toward blindness during the course of the study. Dr. Singh relayed his findings to doctors around the world and found he was not the only one with patients with these symptoms. Frequently, he said, a doctor in an online forum would describe a puzzling case of a young man with unexplained glaucoma. Dr. Singh would respond, “Is he nearsighted and is he Chinese?” and the doctor would respond, “How did you know?” Dr. Singh said he thinks that optic nerve damage in these patients is caused by their nearsightedness, and that others have reported that nearsightedness is increasing in the Chinese population.
Dr. Singh and his fellow researchers suggested in their paper that stretching the eye can damage the optic nerve. Because nearsightedness rarely gets worse in people after their 30s, the optic nerve damage may ultimately slow or stabilize in such patients. “Some might say that by classic definitions, all of these patients have glaucoma,” said Dr. Singh, because they meet the optic nerve damage criteria for the disease.
But a second criterion for glaucoma is that it leads to progressive vision loss, especially if not adequately treated.” The cluster of patients did not appear to be headed for blindness over the 7 years they were followed. But Dr. Singh calls the findings preliminary and said further studies are needed. “If they don’t appear to be progressing toward blindness right now,” he said, “they shouldn’t be treated as if they have a blinding condition, especially since surgery is associated with significant risks.”