Murray Fingeret, OD

by Murray Fingeret, OD

Murray Fingeret

SAN DIEGO – The definition of glaucoma is the first item that needs to be addressed as we progress in our understanding and therapy of glaucoma, according to Robert N. Weinreb, MD, in the AGS Lecture here at the American Glaucoma Society Meeting. In his lecture in honor of Paul L. Kaufman, MD, Dr. Weinreb listed 10 vital aspects of glaucoma diagnosis and treatment.

SAN DIEGO – The definition of glaucoma is the first item that needs to be addressed as we progress in our understanding and therapy of glaucoma, according to Robert N. Weinreb, MD, in the AGS Lecture here at the American Glaucoma Society Meeting. In his lecture in honor of Paul L. Kaufman, MD, Dr. Weinreb listed 10 vital aspects of glaucoma diagnosis and treatment.

Murray Fingeret The question of a possible association between an individual’s cardiovascular status and an increased risk for the development or progression of glaucoma has been discussed within the glaucoma literature for many years. While evidence exists identifying older age, elevated intraocular pressure, family history, central corneal thickness and African descent as risk factors, inconsistent evidence exists regarding vascular conditions. Still, reduced diastolic perfusion pressure has been described as being associated with the development of glaucoma in several studies including the Baltimore Eye Survey and Barbados Eye Study. Recent publications have shed further light on an association between ocular perfusion pressure and the development or progression of glaucoma.

Before the results of the Ocular Hypertension Treatment Study (OHTS) were published, there was little evidence as to the best course of management. Who to treat for ocular hypertension was not well defined. Some clinicians would initiate therapy to reduce the IOP when it reached 22 mm Hg while others would wait until the IOP was at least 25 mm Hg. Still others would not treat until the IOP was in the 30s. There was little consistency among clinicians at what point therapy should be initiated based on the IOP.

Murray Fingeret

A question I am often asked is: “What harm would occur if I wait until my patient with ocular hypertension (OHTN) develops optic nerve damage and visual field loss before I commence therapy?” This question is not easily addressed. The therapeutic approach of waiting until damage occurs was used 20 years ago, using the premise that only 0.5% to 1.0% of individuals with OHTN convert to glaucoma on a yearly basis. Given the low percentage of converters, it was felt that the best approach was a conservative one.

Murray Fingeret

Murray Fingeret