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Expert: Early glaucoma detection, assessment of risk factors improve treatment
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BOSTON — If glaucoma is diagnosed and treated early, patients benefit in numerous ways, including prevention of vision loss and enhancement of treatment regimens and physician-patient relationships.
 Ivan Goldberg |
"Earlier diagnosis and onset earlier treatment is likely to put the patient in a very much better position in terms of obtaining useful vision for the remainder of their lives," Ivan Goldberg, MBBS, FRANZCO, FRACS, said at the World Glaucoma Congress here. "There's more time to fine-tune our dynamic treatment strategies. There's more time for us to build that essential therapeutic alliance with the patient."
At the Hot Topics in Glaucoma Care symposium, partly sponsored by an educational grant from Alcon, Dr. Goldberg said that clinicians should analyze their approach to assessing risk factors for early diagnosis. In developing a patient's therapeutic index, physicians may begin with a static profile, establishing baseline assessment of damage and risk.
In treating glaucoma patients, physicians often use a dynamic profile, assessing ongoing damage and risk levels. He outlined the South East Asia Glaucoma Interest Group's "decision square" for assessing glaucomatous damage.
"This balance between assessment of risk and disease status is something we can do automatically," he said.
Advanced damage at the time of initial diagnosis is one of the most consistent prognostic factors for the risk of going blind from glaucoma. Thus, earlier detection of disease and/or disease progression through a more precise risk assessment of various patient factors offers several possible benefits, as outlined by Dr. Goldberg. The South East Asia Glaucoma Interest Group’s “decision square” provides guidance on how acute the need may be to rapidly control IOP based on the disease status (stable, uncertain or progressing) and the risk factor profile (increased, uncertain, stable). These practical algorithms can provide a quick tool to help guide the clinician’s thought process for the management of an individual patient.
– Douglas J. Rhee, MD
OSN Glaucoma Board
Member