The unique problem of glaucoma: Under-diagnosis and over-treatment

Nayak, Barun Kumar; Maskati, Quresh; Parikh, Rajul

doi:10.4103/0301-4738.73677

Cited by 25 publications

(19 citation statements)

References 12 publications

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“…PPG presents a diagnostic and management conundrum for clinicians. Waiting for progression prior to the initiation of treatment may mean the development of irreversible visual field loss, while over‐treatment of some patients may reduce overall quality of life . Although studies have shown that treatment reduces progression rates of patients with pre‐perimetric glaucoma, it is suggested that some patients progress so slowly that early treatment may not be indicated …”

Section: The Problem Of Structure‐function Discordancementioning

confidence: 99%

“…Waiting for progression prior to the initiation of treatment may mean the development of irreversible visual field loss, while over-treatment of some patients may reduce overall quality of life. 163 Although studies have shown that treatment reduces progression rates of patients with preperimetric glaucoma, it is suggested that some patients progress so slowly that early treatment may not be indicated. 22,23 One of the most frequently quoted statements in ophthalmology 164 is a variation upon: 'at least 25 to 35 per cent retinal ganglion cell loss is associated with abnormalities in visual field testing', 20,21 with the implication that SAP is relatively insensitive to the loss of neural tissue, accounting for PPG.…”

Section: The Problem Of Structure-function Discordancementioning

confidence: 99%

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The value of visual field testing in the era of advanced imaging: clinical and psychophysical perspectives

Phu

Khuu

Yapp

et al. 2017

Clinical and Experimental Optometry

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White‐on‐white standard automated perimetry (SAP) is widely used in clinical and research settings for assessment of contrast sensitivity using incremental light stimuli across the visual field. It is one of the main functional measures of the effect of disease upon the visual system. SAP has evolved over the last 40 years to become an indispensable tool for comprehensive assessment of visual function. In modern clinical practice, a range of objective measurements of ocular structure, such as optical coherence tomography, have also become invaluable additions to the arsenal of the ophthalmic examination. Although structure‐function correlation is a highly desirable determinant of an unambiguous clinical picture for a patient, in practice, clinicians are often faced with discordance of structural and functional results, which presents them with a challenge. The construction principles behind the development of SAP are used to discuss the interpretation of visual fields, as well as the problem of structure‐function discordance. Through illustrative clinical examples, we provide useful insights to assist clinicians in combining a range of clinical results obtained from SAP and from advanced imaging techniques into a coherent picture that can help direct clinical management.

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Section: The Problem Of Structure‐function Discordancementioning

confidence: 99%

Section: The Problem Of Structure-function Discordancementioning

confidence: 99%

The value of visual field testing in the era of advanced imaging: clinical and psychophysical perspectives

Phu

Khuu

Yapp

et al. 2017

Clinical and Experimental Optometry

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“…On the other hand, glaucoma is paradoxically often overtreated: many subjects are treated although they have no real disease [7]. This strongly advocates a worldwide improvement in the accurate detection of the disease [8]. …”

Section: Appropriate Detection Of Glaucomamentioning

confidence: 99%

Glaucoma: Present Challenges and Future Trends

Bettin

Matteo

2013

Ophthalmic Res

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The authors indicate four key issues which, in their opinion, represent the most stimulating challenges in the field of glaucoma today, and describe the present approaches and the developments that can be expected or advised in the near future: (1) Glaucoma is often undiagnosed or diagnosed too late. Accurate detection is crucial to correctly recognize and treat affected subjects, thus reducing the disability and the social burden of the disease. Is glaucoma screening advisable and cost-effective? What strategies can be implemented to achieve an earlier diagnosis? (2) What role can genetics play in glaucoma clinics? (3) What are the fundamentals and the limits of medical hypotensive and nonhypotensive treatment of glaucoma today, and what novelties could be introduced in the next few years? (4) What are the current and future options for glaucoma surgery? Should we aim at reducing aqueous production or at enhancing aqueous outflow? What are the success figures and the pros and cons of ab externo procedures with external filtration (trabeculectomy, nonpenetrating techniques and glaucoma drainage devices) and of ab externo techniques with internal filtration (viscocanalostomy and canaloplasty)? Will microinvasive procedures ever play a role in the treatment of the disease? These questions and the possible future developments in the management of glaucoma are discussed critically, based on the current clinical state of the art, on a review of the literature, and on an everyday experience in a busy university hospital glaucoma service.

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“…Os olhos com GH mostraram uma média significativamente reduzida da amplitude de resposta de P1 do hemicampo inferior (p=0,038), um tempo de pico de P1 do hemicampo superior significativamente estendido (p=0,021), mas um encurtamento significativo do tempo de pico de N2 do hemicampo inferior (p=0,015) em relação aos controles (Tabela 3). Amplitude ( (86) . Por isso, esforços para reduzir a ambiguidade e por tanto estreitar a faixa de pacientes denominados GS são extremamente importantes para os pacientes individualmente e para saúde pública.…”

Section: Resultsunclassified

Eletrorretinograma de padrão reverso macular e multifocal e tomografia de coerência óptica em olhos suspeitos de glaucoma e glaucomatosos com perda de hemicampo

Kreuz¹

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The unique problem of glaucoma: Under-diagnosis and over-treatment

Cited by 25 publications

References 12 publications

The value of visual field testing in the era of advanced imaging: clinical and psychophysical perspectives

The value of visual field testing in the era of advanced imaging: clinical and psychophysical perspectives

Glaucoma: Present Challenges and Future Trends

Eletrorretinograma de padrão reverso macular e multifocal e tomografia de coerência óptica em olhos suspeitos de glaucoma e glaucomatosos com perda de hemicampo

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