Scientific Online Resource System

Bulgarian Review of Ophthalmology

Skills and habits of young ophthalmologists in the diagnostics of glaucoma

Mladena Radeva, Christina Grupcheva



Globally, glaucoma is the second leading cause of blindness. The diagnosis of the disease, especially at an early stage, is often an occupational challenge for young ophthalmologists. Adequate diagnostics requires a comprehensive ophthalmologic examination that is related to a broad range of knowledge, skills and various high-tech devices. Bulgarian scientific literature does not offer information about the currently used methods for treatment and diagnosis by residents and young ophthalmologists; there is also no detailed information about the difficulties that ophthalmologists experience in the management of the disease.


The main goal of this study is to provide information about the methods used for the management of glaucoma by residents and young ophthalmologists in Bulgaria, as well as data on the potential difficulties and problems that may reduce the quality of health care.


Detailed anonymous questionnaires about workplace, used equipment, methods of investigation, potential weaknesses in the diagnosis and management of the disease, as well as personal attitude towards the problems in the field, were sent to residents and young ophthalmologists with experience of up to 5 years by e-mail and with the help of social networks.


One hundred and twenty questionnaires were sent but only 45 individuals responded to the survey. Of these, 30 were classified as residents (66.7%) and 15 as specialists with up to 5 years of experience (33.3%). Regarding the number of glaucoma patients examined, 27 of the participants (60.0%) indicated that they have examined under 5 patients who suffer from glaucoma or are suspected of glaucoma, 14 (31.1%) under 10 and only four (8.9%) managed less than 20 glaucoma patients per day. Thirty-four of the participants (75.6%) mentioned air tonometry as the main method in their practice. Eleven percent of the participants never performed gonioscopy, and 4.4% had tried but failed. Only 11 (24.4%) of the participants said they had no difficulty performing gonioscopy. A preferred method of determining the depth of the anterior chamber was Van Herick's method (51.1%). Regarding perimetry, 43 (95.6%) of the participants always required the presence of a glaucoma diagnosis, and 39 (86.7%) reported that they always performed a visual examination to evaluate the optic nerve and the neurofibrillary layer. Fifteen respondents (33.3%) (of them 12 residents) never assisted in an anti-glaucoma operation. Thirty-eight (84.4%) of the participants found a need for more trainings and seminars on glaucoma.


Diagnosis of glaucoma is a challenge for doctors as well as for patients. Identifying potential weak spots among ophthalmology residents and young professionals and obtaining sufficient feedback is essential to improve the proper management of the disease nationwide.


glaucoma, residents in ophthalmology, skills, young ophthalmologists, IOP measurement, gonioscopy

Full Text


Kingman S. Glaucoma is second leading cause of blindness globally. Bull World Health Organ. 2004;82(11):887-8. doi:/S0042-96862004001100019.

International Council of Ophthalmology. ICO Guidelines for Glaucoma Eye Care. In: Guidelines for Glaucoma Eye Care; 2016. doi:10.1103/PhysRevE.68.041109.

Robinson R, Deutsch J, Jones HS, Youngson-Reilly S, Hamlin DM, Dhurjon L, et al. Unrecognised and unregistered visual impairment. Br J Ophthalmol. 1994;78(10):736-40. doi:10.1136/bjo.78.10.736.

Shaikh Y, Yu F, Coleman AL. Burden of undetected and untreated glaucoma in the United States. Am J Ophthalmol. 2014;158(6):1121-9.e1. doi:10.1016/j.ajo.2014.08.023.

King AJW, Reddy A, Thompson JR, Rosenthal AR. The rates of blindness and of partial sight registration in glaucoma patients. Eye (Lond). 2000;14 ( Pt 4):613-9. doi:10.1038/eye.2000.152

Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081-90. doi:10.1016/j.ophtha.2014.05.013.

McMenemy MG. Primary open angle glaucoma. In: Samples JR, Schaknow PR, editors. Clinical Glaucoma Care: The Essentials. New York: Springer-Verlag; 2014. pp. 215-41. doi:10.1007/978-1-4614-4172-4_12.

Harris R. Screening for glaucoma. BMJ. 2005; 331(7517):E376-7. doi:10.1136/bmj.331.7517.E376

Manolova Y, Boyadgieva M, Boyadgiev D, Marinov M, Zlatarova Z, Grupcheva C. Results of Scrееning Program for Detection of Patients with Glaucoma on the Territory of North – Eastern Bulgaria for 2016. The Glaucomas. 2017; 6(1):6–11.

Stein DM, Wollstein G, Schuman JS. Imaging in glaucoma. Ophthalmol Clin North Am. 2004;17(1):33-52. doi:10.1016/S0896-1549(03)00102-0.

Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: A review. JAMA. 2014; 311(18):1901-11. doi:10.1001/jama.2014.3192.

Robert YCA. What do we measure with various techniques when assessing IOP? Surv Ophthalmol. 2007; 52(Suppl 2):S105-8. doi:10.1016/j.survophthal.2007.08.003.

Zlatarova Z, Toshev R, Grupcheva C. Glaucoma screening - goals, results and social significance. The Glaucomas. 2013;2(1):10–14.

Zlatarova Z, Decheva D. Comparison of the values of intraocular pressure and central corneal thickness measured by Goldmann's applanation tonometry, ultrasound tachymetry and Tonopachy NT-530P. Bulg Rev Ophthalmol. 2013; 18–22. (in Bulgarian)

Sakata LM, Lavanya R, Friedman DS, Aung HT, Gao H, Kumar RS, et al. Comparison of gonioscopy and anterior segment ocular coherence tomography in detecting angle closure in different quadrants of the anterior chamber angle. Ophthalmology. 2008; 115(5):769-74. doi:10.1016/j.ophtha.2007.06.030

Farhood QK. Comparative evaluation of intraocular pressure with an air-puff tonometer versus a Goldmann applanation tonometer. Clin Ophthalmol. 2013;7:23-7. doi:10.2147/OPTH.S38418

Atanassov MA, Konareva MI. Reproducibility and agreement between three methods of intraocular pressure measurement. Folia Med (Plovdiv). 2002;44(4):19-22.

Prokopich CL, Flanagan JG. Evaluation of the anterior chamber angle. In: Glaucoma Identification & Co-management. Butterworth-Heinemann; 2007. pp. 37-53. doi:10.1016/B978-0-7506-3782-4.50007-7



Font Size

About The Authors

Mladena Radeva
Medical University of Varna

Department of Ophthalmology and Visual Sciences, Faculty of Medicine

Christina Grupcheva
Medical University of Varna

Scientific coordinator

Department of Ophthalmology and Visual Sciences, Faculty of Medicine