Surgeon: Glaucoma should be studied as a central nervous system disease

BUENOS AIRES — In studying glaucoma, its effects and possible treatments, researchers should look at the entire central nervous system and not focus solely the eye, according to a surgeon speaking here.

"If you need to diagnose glaucoma and manage glaucoma ... this is not [something] to base on measurements of IOP alone," said Robert N. Weinreb, MD, during the Advances in Glaucoma International Symposium.

No matter how effective a physician is at lowering IOP, a patient will continue to experience visual field loss and retinal ganglion cell death because that is where glaucoma begins and is not treated or addressed with current methods, he said.

"Glaucoma is not just a disease of the eye," Dr. Weinreb said. "Glaucoma is the most prevalent neurodegenerative disease."

There are as many as 100 million people with glaucoma, he said, and more than half of them are undiagnosed because visual field testing is still limited. Problems with visual field testing include the need for long-term follow-up, the need for multiple exams to establish disease progression, which can require several years of examination, and the fact that perimetry has a poor sensitivity for detecting glaucoma, he said.

However, there are various new tools that are improving the detection of glaucoma and helping to detect disease progression at earlier stages. These new technologies include selective functional perimetry and frequency doubling technology perimetry.

"What changes first: structure or function?" Dr. Weinreb asked. His answer was to look for corresponding abnormalities and introduce more advanced tools into daily practice for earlier diagnoses.

"It's not enough to just diagnose," he said. "We need a process of collaboration and cooperation."

Dr. Weinreb said many studies are being conducted on neuroprotective agents that may have the potential to slow or prevent retinal ganglion cell death, some of which have proved somewhat effective in animal studies.