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Subspecialties Glaucoma, Health Economics and Policy

It’s Nothing Personal

Our definition of glaucoma is inadequate. At a 1991 World Health Organization meeting of Collaborating Vision Centers, glaucoma was not cited on official publications as a cause of blindness, since, as one expert stated, “Glaucoma cannot be defined or treated, so it isn’t on the list.” Without a useful objective definition to lean on, specialists are instead left to diagnose glaucoma by judging characteristic optic disc and visual field changes for themselves. With about half of those with glaucoma left undiagnosed, we need better ways to both identify patients and keep them in care. An objective definition of glaucoma is vital to this goal.

Many glaucoma experts feel that they “know it when they see it” [...] This amorphous approach makes it difficult to compare results across large numbers of clinical studies in glaucoma.

There is a shortage of studies that compare how well glaucoma specialists agree on the structural features of optic nerve changes, or whether the visual field test was abnormal. Just as the US Supreme Court Justice, Potter Stewart, famously said about obscenity, many glaucoma experts feel that they “know it when they see it” (1). This amorphous approach makes it difficult to compare results across large numbers of clinical studies in glaucoma. And this challenge sparked the study that my team from the Glaucoma Center of Excellence at the Wilmer Institute in Baltimore, the Singapore National Eye Center, and the Department of Ophthalmology and Visual Sciences at Dalhousie University in Canada are currently conducting. We expect to publish the work in March/April 2020.

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About the Author

Harry Quigley

Harry Quigley is A. Edward Maumenee Professor of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University.

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