Volume 19 ; Issue 1 ; in Month : 2026 (2026) Article No : 143
Kumari S, Kumar P, Fazal B, et al.

Abstract

Glaucoma is a group of progressive optic neuropathies characterized by retinal ganglion cell loss, optic nerve head damage and corresponding visual field impairment. Its early course is frequently asymptomatic, allowing structural injury to progress before patients recognize functional loss. The thesis underlying this review identifies glaucoma as a major cause of irreversible blindness and emphasizes the complementary roles of intraocular pressure (IOP) measurement, gonioscopy, fundus examination, visual-field testing and optical coherence tomography (OCT), while highlighting automated fundus-image analysis and artificial intelligence (AI) as emerging diagnostic tools. Current evidence supports a shift from single-test assessment toward integrated structural, functional and risk-based evaluation. Fundus photography enables scalable assessment of the optic disc, cup-to-disc ratio (CDR) and retinal nerve fiber layer (RNFL) changes; OCT provides reproducible quantitative measurements of RNFL, ganglion-cell complex and optic nerve head parameters; and visual-field testing captures the functional consequence of disease. AI and deep learning can assist with image classification, segmentation and progression analysis, with recent meta-analyses demonstrating high diagnostic performance for fundus photography and OCT, although performance is generally lower in external validation than in internal datasets. Vision-transformer and multimodal approaches are particularly promising because they can model long-range relationships and combine heterogeneous ophthalmic information. Nevertheless, AI cannot substitute for clinical examination, especially in atypical disease, myopia, media opacity and angle-closure mechanisms. This review discusses conventional and emerging diagnostic approaches, discusses their strengths and limitations, and proposes a practical multimodal diagnostic pathway for earlier and more reproducible glaucoma detection.

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