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Abstract #6341 Published in IGR 3-2
Early detection of moderate glaucoma: redefining clinical care in 2001
Lee PPArchives of Ophthalmology 2001; 119: 1069-1070
This editorial deals with a paper by Zangwill et al. on the discrimination between normal and glaucomatous eyes using several imaging techniques. The author first mentioned the fact that early glaucoma is now defined as a glaucomatous optic neuropathy as found by structural examination, but without detectable visual field damage. The consequence of this is that the presence of any characteristic visual field loss defines the severity as at least moderate in nature. Zangwill et al. reported that the evaluation of stereoscopic photographs is at least as good as evaluation by either of the two imaging techniques. The author of this editorial stresses the rigors of the research performed by Zangwill et al. He feels that, in the future, changes may occur to the definition of glaucoma, resulting from instrument-based observations other than visual field testing. He feels that Zangwill et al. provide support for the use of any of these techniques as supplements to a comprehensive clinical evaluation in the detection of patients with moderate glaucoma. He stresses that diagnosis is a separate issue from screening. Prevent Blindness America's screening criteria for moderate glaucoma are: a specificity of 95% or even 98% and a sensitivity of at least 85%. Neither stereophotographs nor imaging techniques on their own perform sufficiently in this respect. Only some of the visual function testing instruments have been approved by Prevent Blindness America to screen for glaucoma. The author's final remarks are on the understanding of a positive test. Even at a high specificity, many glaucoma patients will be missed and false positives will be enormous.
Classification:
2.13 Retina and retinal nerve fibre layer (Part of: 2 Anatomical structures in glaucoma)
2.14 Optic disc (Part of: 2 Anatomical structures in glaucoma)
6.9.1 Laser scanning (Part of: 6 Clinical examination methods > 6.9 Computerized image analysis)
6.9.2 Optical coherence tomography (Part of: 6 Clinical examination methods > 6.9 Computerized image analysis)
