Quigley: Technology, proactive stance key to glaucoma management in 21st century

CLEVELAND — Physicians can no longer wait for glaucoma patients to enter their offices; they must be proactive in seeking these patients out.

That is the message Harry A. Quigley, MD, delivered in his Roscoe J. Kennedy Lecture here at the Cleveland Clinic Foundation’s Glaucoma Summit 2003.

Dr. Quigley also said that, in both developed and developing countries, technology will play a key role in improving glaucoma therapy.

Surgeons must find ways to identify the “silent majority” of glaucoma patients who would otherwise go undiagnosed, he said.

“While I’ve been talking, several thousand people have gotten glaucoma in the world,” Dr. Quigley said. “Primary open-angle glaucoma is not a U.S. problem — it’s the world’s problem.”

Dr. Quigley identified several emerging technologies that may play important roles in glaucoma management in coming years. These include a so-called “smarter chart,” compliance monitors and genetic screening.

“What we need is more help,” he said. “I don’t think our charts have moved along. We need to organize them better and provide better data management. We are now using an initial prototype of what we're calling the SmarterChart.”

This device is an electronic patient record that allows direct entry of information at point of service, performs automatic billing and coding, gives immediate access to summaries of patient histories and more. It might also generate predictions of a patient’s future treatment course based on existing data, Dr. Quigley suggested.

Compliance monitors would allow 24-hour measurement of IOP through a device implanted in the eye. In addition, so-called genie-in-the-bottle technology — also in the works — could record patients’ compliance with therapy regimens by monitoring eye drop use.

Dr. Quigley stressed that the significance of these and other emerging technologies lies in their ability to save time so ophthalmologists can invest more time and energy into diagnosing the cases of glaucoma.

Practitioners also need to “get out of the office” to find the 50% of undiagnosed glaucoma cases in their communities, Dr. Quigley said. One emphasis should be on aggressively identifying and “chasing the family” of known glaucoma cases.

“We don’t go after the family members enough,” he said.

Dr. Quigley said the developing world will also benefit from new technologies in coming years. One need is a diagnostic instrument that can cheaply and efficiently target those with glaucomatous functional loss, he said. Another useful instrument in developing countries would be a “practical glaucoma filtering device that can be implanted through a small conjunctival incision, allowing for surgery in a matter of minutes with no anesthesia,” he said.

Furthermore, more extensive research is necessary to determine why the Asian population is disproportionately affected by primary angle-closure glaucoma and to predict who will develop it. An appropriate test would require a mass-produced, hand-held instrument combining measurement of the lens position with orbital venous pressure, he said.

All of these initiatives demand that active diagnosis and preventive medicine become a priority for physicians and researchers in the coming years, he said.

“I don’t know if any of these things are going to actually happen. All of it is possible, but only if you people with energy make it happen,” he told the crowd.