Glaucoma Diagnosis: Measuring Up to Expectations
How can we use current imaging technologies to improve glaucoma diagnosis and follow-up – and, ultimately, patient care?
Sanjay Asrani |
At a Glance
- Current methods of glaucoma evaluation may fail patients in the early stage of the disease
- Application of OCT technology to measure multiple parameters improves the sensitivity and specificity of glaucoma diagnosis and monitoring
- In particular, measurement of the Bruch’s membrane opening-minimum rim width (BMO-MRW) can provide a clear indication of glaucomatous tissue loss, especially when it corresponds with findings from other measurements
- Use of multiple modalities to assess multiple retinal substructures may therefore assist physicians in assessing challenging patients and borderline diagnoses.
Traditionally, glaucoma diagnosis has relied on subjective assessments of optic nerve head (ONH) damage and/or measurements of visual field loss by automated perimetry. Though automated perimetry may use more objective scoring systems and algorithms, these can be unreliable – especially in the earlier, asymptomatic stages of disease, where nerve fiber loss may not translate into a detectable impairment in visual function.
The “hit and miss” nature of glaucoma diagnosis results in many patients remaining unrecognized and, therefore, being deprived of vision-preserving treatments. Similarly, where diagnostic techniques are insufficiently sensitive to detect markers of disease progression, patients may not have their treatment appropriately modulated in response to advancing disease.
Imaging tools and techniques able to reliably detect early glaucoma or identify patients for treatment intensification would be of great benefit to patients and public health.
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- BC Chauhan et al., Ophthalmology, 122, 1786–1794 (2015). PMID: 26198806.