The fellow eye

Abstract

The result of a 10-year longitudinal study of the fellow eye at risk of developing closed-angle glaucoma (because the presenting eye had the disease) is described. 202 eyes were observed between 1 August 1970 and 31 July 1980. Each eye was provoked shortly after presentation using a pilocarpine phenylephrine provocative test. If the test produced a closed-angle glaucoma an iridectomy was done; if closed-angle glaucoma did not occur the eye was observed and it was reprovoked at yearly intervals. There were 3 possible outcomes for any one eye. Either the eye developed closed-angle glaucoma; or it was lost to follow-up; or at the end of the study the patient was alive, under observation, without having developed glaucoma. 90% of acute attacks occurred within 6 months of presentation. If an eye survived the first year without getting glaucoma the probability of its development in any one year period up to the fifth anniversary was 0.05; thereafter it was zero. The cumulative probability of an eye surviving to the fifth anniversary without glaucoma was 0.34, remaining constant thereafter; that is 34% of iridectomies are unnecessary. A high prevalence of ocular hypertension was seen in eyes that did not have an iridectomy (26%). It was concluded that a routine iridectomy is not necessary and that the fellow eye that will get glaucoma can usually be detected. The untreated fellow eye presents a naturally occurring model of one of the mechanisms involved in the production of ocular hypertension.