Numbers help tell the story of glaucoma diagnosis, treatment

In general, if we can put a number on something, it is easier to understand and interpret. Advanced diagnostics along with older well-established techniques are providing us more numbers, and especially more reliable numbers, to better diagnose and treat glaucoma.

IOP is a number we have followed for more than a century. Yet, we need better numbers even for this old reliable marker. Ideally, we need to know the patient’s IOP at least every hour 24 hours a day, 7 days a week, 365 days a year to fully understand an individual’s disease, response to therapy and adequacy of treatment. In addition, it would be extremely helpful to know at least the patient’s blood pressure, systolic and diastolic, 24/7, as they say. Even better, an exact measurement of blood flow at the optic nerve, along with the pO2 to measure for things such as sleep apnea, would be great.

Richard L. Lindstrom

We are on our way to accessing these diagnostics from many sources, including perhaps the exciting collaboration between Google and Alcon/Novartis to develop electronic contact and IOLs with diagnostic capability. Visual fields provide us with pattern recognition opportunities such as Seidel and Bjerrum scotomas and nasal steps. But as we go deeper, measures such as mean standard deviation and pattern standard deviation to evaluate decibel sensitivity are powerful tools.

As our visual field instruments advance, we can hope for an ability to measure the threshold sensitivity of any spot on the retina to any desired color and intensity of light stimulus. Perhaps the variability in patient cooperation and fatigue can be circumvented some day with potentially objective tests such as an ERG.

Click here to read the full publication exclusive, Lindstrom’s Perspective, from Ocular Surgery News U.S. Edition, October 25, 2014.