| |
The structural damage to the retinal nerve fiber layer that leads to blindness in glaucoma begins before patients become symptomatic or experience noticeable losses in their visual acuity.1 This makes early detection, and therefore the early beginning of glaucoma treatment, crucial to successful glaucoma management.
The most used option for detection of glaucoma is visual field analysis, with the gold standard being standard automated perimetry (SAP). Data has indicated that despite the role of visual field analysis, this tool is not being used in many cases, possibly because of length of the exam and the burden on patients.3
There are methods that have been designed to reduce the time of the exam and to detect visual field loss earlier, including the Swedish Interactive Threshold Algorithm (SITA), an algorithm that samples responses and extrapolates visual field results, Short-Wave Length Perimetry (SWAP), an approach to perimetry that focuses on more sensitive retinal cells that may provide an accurate diagnosis as much as 10 years earlier than SAP, and Frequency Doubling Technology (FDT), which uses a stimulus that activities the more sensitive magnocellular pathway in the retina, and also may detect visual field loss years earlier than SAP.5
In 2005, the first Focusing Ophthalmology on Reframing Glaucoma Evaluation (FORGE) program was conducted, with an emphasis on anatomic structural changes that indicate glaucoma. As with the previous program, the goal for this session will be to present information on how ophthalmologists can improve glaucoma care by changing the approach to diagnosing and monitoring the disease, with an emphasis on early detection. Presenting faculty provide the audience with valuable tips for determining disease severity through optic nerve evaluation, employing a systematic approach to the evaluation, identifying patients at risk of disease progression, and determining the most effective treatment.
Survey results from the previous program showed that the FORGE program would impact practice and helped to develop ideas for the FORGE II. When participants were asked to comment on what aspects of their practice were expected to change as a result of the 2005 program activity, a resounding number of participants indicated that they were going to evaluate the optic nerve and nerve fiber layer earlier and more closely for better glaucoma management. Among the topics for future programs suggested by attendees was how to approach perimetry in a glaucoma practice.
For the clinician, proper interpretation of visual field results can be an onerous process, which may also limit its use. Improved understanding of visual field results may allow clinicians to interpret visual fields more rapidly and improve utilization.
Vindico Medical Education proposes a series of meetings to improve clinicians understanding about the role of visual field testing, the options for conducting visual field exams and the proper approach to interpreting results as a way to improve attendees ability to diagnose glaucoma sooner in the disease process.
References
1. Gillespie BW, Musch DC, Guire KE, et al. The collaborative initial glaucoma treatment study: baseline visual field and test-retest variability. Invest Ophthalmol Vis Sci. 2003;44(6):2613-2620.
2. Sommer A, Katz J, Quigley HA, et al. Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol. 1991;109(1):77-83.
3. Fremont AM, Lee PP, Mangione CM, et al. Patterns of care for open-angle glaucoma in managed care. Arch Ophthalmol. 2003 Jun;121(6):777-783.
4. Coleman AL, Yu F, Rowe S. Visual field testing in glaucoma Medicare beneficiaries before surgery. Ophthalmology. 2005;112(3):401-406.
5. Bowd C, Zangwill LM, Berry CC, et al. Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual function. Invest Ophthalmol Vis Sci. 2001;42(9):1993-2003.
|
