The technique of retinal nerve fibre photography has been developed and tested in specialized centres and glaucoma clinics. The usefullness of a modifed technique in clinical practice is the subject of this prospective study. Retinal nerve fibre photos from 41 patients with open-angle glaucoma and 40 normal patients were examined in a blind study, a total of 161 eyes. Photos from 5 eyes were of insufficient quality to allow evaluation. Nerve fibre loss was found in 36% of the normal eyes, 42% of glaucomatous eyes without visual field defects, and 87% of eyes with glaucomatous visual field defects. Sensitivity was 86% and specificity was 62% totally. In the younger patients aged less than 65 years both values were 82%. Photographic nerve fibre loss was found in 69% of normal eyes from patients aged more than 65 years, leading to a low specificity of 31% in this age group.Age related nerve fibre loss and clinically insignificant cataracts were the most obvious causes of non-glaucomatous nerve fibre loss.Primary open-angle glaucoma affects the optic nerve head leading to enlargement of the optic disc cup and visual field defects. Following the description by Hoyt et al. (1973) several investigations have shown retinal nerve fibre loss and reduced sensitivity of the retina as early features of glaucoma.Thorough photographic studies of the retinal nerve fibre layer have been carried out in specialized centres and glaucoma clinics where the technique and evaluation have been improved. This knowledge and skill generally is not immediately available and the general clinical usefulness cannot be deduced from the above-mentioned studies.To clarify this, we have tried to adapt the technique and evaluate some basic results. Material and MethodsThe ophthalmological practitioners from our district were asked to refer patients with primary open-angle glaucoma (POAG) non treated with miotics and without clinically significant cataract. A total of 41 patients (81 eyes, mean age 63.5 years, range 38-82) were included. None had low-tension glaucoma. All eyes had open-angles without visible pathological changes and all had evidence of optic nerve damage in at least one eye.A control group aged 50 years or more was included, in total 40 persons (80 eyes, mean age 63.2, range 50-83). All were in good general health, and without known organic nerve disease, or pathological affection of the eyeball.After informed consent, all subjects completed two examinations. The first examination included measurement of the corrected visual acuity, Goldmann applanation tonometry, gonioscopy, and computerized perimetry using Octopus program 32 without mydriasis. This was followed by mydriatic ophthalmoscopy, slit-lamp examination, repeated tonometry, and Goldman 3-mirror glasses. When either open-angle glaucoma or normality had been confiied the subjects were included in 441

The clinical syndromes central serous retinopathy (RCS) and presenile exudative disciform macular degeneration (PEDMD) are well known, but the causes of the pathophysiological and pathoanatomical changes in the choriocapillaris, Bruch's membrane and pigment epithelium as predisposing factors are unknown. Apparently these two degenerative macular conditions are different. However, they possibly represent two manifestations of the same nosological entity, which is initially dominated by a subretinal exudation in the macular region. It is therefore also reasonable to consider that RCS can be part of, or an initial stage of PEDMD. In the present study these possibilities have been demonstrated by a follow-up examination, using among other things fluorescein angiography of a selective material of 20 patients with RCS. In addition, it is shown that RCS can be a more serious condition with regard to the central vision than is generally accepted.

The development of fluorescein angiography and the introduction of laser technology into the treatment of macular diseases has considerably widened our knowledge of the pathological processes in the macular region. A number of clinicopathological reports have confirmed the angiographic findings and interpretations. T h e aetiological factors that lay behind the clinical lesions are, however, still unknown. The clinical pictures have, as a result of the above, more relation to the histological than to the aetiological classifications. Clinical classification includes an analysis and categorization of the individual diseases. This process takes place daily in the surgery of every ophthalmologist by means of the ophthalmoscope. T h e ophthalmoscopical examination is enhanced by knowledge of the angiographic picture of the lesion. This means that in the great majority of cases it is possible using the ophthalmoscope alone, to evaluate the type and anatomical localization of the pathological lesions. Fluorescein angiography is the most important single supplementary examination, both with regard to the diagnosis, indication for treatment and the The present work describes 9 clinically and histopathologically welldefined lesions, which isolated or in combination are seen in the majority of adult macular diseases. follow-up.