Progressive thinking in imaging, risk factors provide better understanding of ACG

In a symposium, entitled "Progressive thinking: advances in the diagnosis assessment and management of glaucoma," a panel of glaucoma specialists provided their expertise on imaging, risk factors that determine glaucoma progression, and understanding angle-closure glaucoma (ACG).

Robert Weinreb, MD, of the University of California, San Diego, opened the Sunday session by discussing the value of imaging in the diagnosis of glaucoma. He outlined how imaging of the optic nerve can improve accuracy in assessing structural changes to the optic nerve as glaucoma progresses.

Dr. Weinreb reviewed consensus statements, developed by the World Glaucoma Association, which emphasize how the imaging of the optic nerve detects the progression of glaucoma. He also presented the parameters of the latest technologies, pointing out the pros and cons of each platform.

Dr. Weinreb explained that imaging is essential to document the appearance of the optic disk and the retinal nerve fiber layer. Imaging allows the physician to stage the disease within the glaucoma continuum. Imaging also evaluates risk assessment and corroborates and confirms glaucoma damage and progression.

Neeru Gupta, MD, of the University of Toronto, discussed risk factors for the progression of glaucoma. Incorporating evidence found in the Ocular Hypertension Treatment Study (OHTS), Dr. Gupta offered a preamble to understanding glaucoma progression. She outlined a framework for risk management for patients with glaucoma.

Dr. Gupta defined a risk factor as any element that is independently related to the occurrence of the disease. From the OHTS Study, central corneal thickness was identified as an independent prediction factor for glaucoma. Other elements identified were age, IOP, cup-to-disk ratio, and the pattern standard deviation. The European Glaucoma Study also substantiated these factors.

For patients with glaucoma, risk factors to determine progression were identified as IOP, pseudoexfoliation, disk hemorrhage, involvement of both eyes, age, and higher baseline deviation. Risk assessment models can be developed from these factors and, when successfully applied, can affect treatment procedures, Dr. Gupta added.

Dr. Gupta said that when physicians understand the risk factors, it will help them to understand and develop proper treatment in preventing glaucoma progression and, hopefully, limit visual disabilities.

Tim Aung, MD, of the University of Singapore, discussed the advances in the diagnosis and management of ACG. He started by explaining ACG and the epidemiology of the disease.

Dr. Aung outlined the proposed revision of the consensus classification for ACG. He explained how the new definition of the disease is more uniform with the classification used for primary open-angle glaucoma.

He also discussed the recent data that discovered the role which plateau iris and uveal effusion play in ACG, suggesting that ACG is a heterogeneous disease.