Symposiym focuses on reframing glaucoma evaluation

Ophthalmologists can improve glaucoma care by employing a systematic approach to optic nerve evaluation to determine disease severity and risk of progression, according to speakers at a continuing medical education symposium held during the American Academy of Ophthalmology meeting.

The moderator for the program was Robert N. Weinreb, MD, professor of ophthalmology, University of California, San Diego, and director, Hamilton Glaucoma Center, La Jolla, CA.

"Glaucoma is now defined as an optic nerve disorder, and that means you may or may not have functional visual field loss although you can see damage to the optic nerve," Dr. Coleman said. She is professor of ophthalmology, Frances and Ray Stark Chair in Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles.

She added that evidence-based glaucoma management guidelines recommend careful evaluation of the optic nerve and RNFL as well as the visual field during both diagnosis and follow-up. The results of each examination should be documented in charts through a description and a detailed drawing or optic disc photographs.

The baseline examination can detect disc hemorrhages and nerve fiber layer defects and help the clinician diagnose early glaucomatous optic nerve damage. At follow-up, the examination can help the clinician determine whether progression has occurred or if a patient seems to be at risk of progression.

Ideally, optic nerve examination should take place at regular intervals, but Dr. Coleman acknowledged that this doesn't always happen in the busy practice setting. Dilation and testing take up more of the patient's time and may trigger complaints of discomfort. Also, the increased exam time can affect scheduling.

However, the benefits of optic nerve examination are significant and outweigh the costs, Dr. Coleman said.

"Glaucoma is an optic neuropathy, and you can't diagnose an optic neuropathy without looking at the optic nerve," she added.

Conducting such examinations will help clinicians improve their diagnostic skills, detect more cases of glaucoma and miss fewer cases, help more patients, and reduce progression, she added.