1th Consensus Meeting:
San Diego, Ca, November 13-14, 2003
Glaucoma Diagnosis and Function
The World Glaucoma Association
The Global Glaucoma Network
GLAUCOMA DIAGNOSIS. STRUCTURE AND FUNCTION
edited by Robert N. Weinreb and Erik
2004. viii and 152 pages with 17 figures, of which 12 in full color, and
one table. Hardbound.
ISBN-10: 90 6299 200 5. ISBN-13: 978-90-6299-200-3
Kugler Publications. Click
here for more information on all publications in the
Function & Structure
- A method for detecting abnormality and also documenting optic nerve structure
should be part of routine clinical management of glaucoma.
Explantion: It is known that documentation of optic nerve structure is often
missing in routine ophthalmology practice.
- According to limited evidence available sensitivity and specificity of imaging
instruments for detection of glaucoma are comparable to that of expert interpretation
of stereo colour-photography and should be considered when such expert advice
is not available.
Explantion: Experts evaluating stereophotographs are those who have had
specialized training and experience in this technique.
- Digital imaging is recommended as a clinical tool to enhance and facilitate
the assessment of the optic disc and retinal nerve fibre layer in the management
Explantion: Digital imaging is available for scanning laser tomography,
scanning laser polarimetry and optical coherence tomography. Digital imaging
also is possible for photography, but assessment remains largely subjective.
- Automated analysis of results using appropriate databases is helpful for
identifying abnormalities consistent with glaucoma.
Explantion: The comparison of results of examination of individual patients
with those of an appropriate database can delineate the likelihood of abnormality.
Structural assessment should preferably include such a biostatistical analysis.
- Different imaging technologies may be complementary, and detect different
abnormal features in the same patients.
Note 1: At this time, evidence does not preferentially support any one of
the above structural tests for diagnosing glaucoma
- A method for detecting abnormality and documenting functional status should
be part of routine clinical management of glaucoma.
- It is unlikely that one functional test assesses the whole dynamic range.
- Standard Automated Perimetry (SAP), as usually employed in clinical practice,
is not optimal for early detection.
- With an appropriate normative database, there is emerging evidence that
short wavelength automated perimetry (SWAP) and possibly also frequency doubling
technology perimetry (FDT) may accurately detect glaucoma earlier than SAP.
Explantion: Earlier detection of glaucomatous damage with SWAP and FDT than
with SAP has been consistently demonstrated.
- There is little evidence to support the use of a particular selective visual
function test over another in clinical practice because there are few studies
with adequate comparisons.
Explantion: At this time, there is no evidence to
support the superiority of either SWAP vs. FDT.
Function & Structure
- Published literature often lags behind the introduction of new technology.
Therefore literature based on previous versions of current technology should
be viewed with caution.
- In different cases, either structural examination or functional testing
may provide more definitive evidence of glaucoma, so both are needed for detection
and confirmation of the subtle early stages of the disease.
Note 2: Data from both functional and structural examinations always should
be evaluated in relation to all other clinical data