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Editors Selection IGR 14-1
Perimetry: Trends in ancillary diagnostic tests
Comment by Gustavo de Moraes on:
48863 Trends in use of ancillary glaucoma tests for patients with open-angle glaucoma from 2001 to 2009, Stein JD; Talwar N; Laverne AM et al., Ophthalmology, 2012; 119: 748-758
Stein and colleagues analyzed the data of patients with and suspected glaucoma enrolled in a United States managed care network between 2001 and 2009 and explored the trends in use of ancillary diagnostic tests, namely visual fields, fundus photographs, and objective imaging devices. They found that while testing with objective imaging devices increased dramatically in the past decade, visual field testing declined meaningfully whereas fundus photography remained fairly steady. Despite small differences between patients assisted by ophthalmologists versus optometrists, the type of eye care provider followed the same trend. Nonetheless, optometrists were more likely to change from fundus photography and visual field testing to objective imaging technologies than ophthalmologists during the same period.
The most surprising observation, however, was that more than 25% of patients with newly diagnosed suspected or established glaucoma have not undergone visual field testing within two years of diagnosis.
More than 25% of patients with newly diagnosed suspected or established glaucoma have not undergone visual field testing within two years of diagnosis
Although new imaging technologies have had remarkable improvements in resolution and patients often prefer objective to behavioral tests, visual fields still have a key role in glaucoma diagnosis and monitoring. Moreover, automated achromatic perimetry correlates significantly with vision-related quality of life and has been employed to determine progression endpoints in the main clinical trials in glaucoma, which heightens that much of the current knowledge on risk factors and effectiveness of therapy in glaucoma is based on data obtained from functional tests. Another important point is that the technology behind visual field testing has remained relatively stable over the past decades and given its wide availability, has provided longer and more consistent information regarding the disease process than imaging technologies which are rapidly evolving and often provide results that are not interchangeable with older techniques.
Nonetheless, this does not mean that new imaging devices do not have an important application in daily practice. In fact, the initial consensus meeting of the World Glaucoma Association almost ten years ago proposed that all patients with or suspected glaucoma should be diagnosed and followed using both structural and functional tests, and these new objective technologies have considerable advantages over fundus photography. Moreover, recent studies have proposed effective methods to diagnose and detect glaucoma progression by integrating data from structural and functional tests. The authors of the present paper should be congratulated for the task of managing a database of over one million patients and for calling our attention to a potential aggravation of quality of care if this trend persists.
