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Subspecialties Imaging & Diagnostics, Glaucoma

Window of Opportunity

  • SAP is considered to be the gold standard technique for identifying visual field loss in patients with glaucoma
  • However, there is debate over whether changes seen on OCT alone can be used to support treatment decisions in glaucoma
  • I believe that OCT can – and should – be used, because it provides a window of opportunity into early management of the disease
  • Presenting supporting evidence, I justify my position and explain how basing clinical decisions on OCT (even in the absence of a concomitant visual field defect) can improve outcomes for patients

The introduction of imaging with optical coherence tomography (OCT) has allowed clinicians to acquire quantitative information about the eye structures affected by glaucoma with unprecedented detail. Despite this fact, clinicians are often confused about how to use OCT information in clinical practice. Should we make treatment decisions based only on OCT? I am asked this question very often and so below I provide some evidence of why I believe OCT should be used in clinical decision-making – even in the absence of concomitant visual field loss.

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  1. RY Abe et al., “The relative odds of progressing by structural and functional tests in glaucoma”, Invest Ophthalmol Vis Sci, 57, OCT421–428 (2016). PMID: 27409501.
  2. A Miki et al., “Rates of retinal nerve fiber layer thinning in glaucoma suspect eyes”, Ophthalmol, 121, 1350–1358 (2014). PMID: 24629619.
  3. M Yu et al., “Risk of visual field progression in glaucoma patients with progressive retinal nerve fiber layer thinning: a 5-year prospective study”, Ophthalmol, 123, 1201–1210 (2016). PMID: 27001534.
  4. CP Gracitelli et al., “Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma”, JAMA Ophthalmol, 133, 384–390 (2015). PMID: 25569808.
  5. FA Medeiros et al., “A combined index of structure and function for staging glaucomatous damage”, Arch Ophthalmol, 130, 1107–1116 (2012). PMID: 23130365.
  6. RS Harwerth et al., “Linking structure and function in glaucoma”, Prog Retin Eye Res, 29, 249–271 (2010). PMID: 20226873.

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