Multiple tools help to monitor glaucoma progression
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NASHVILLE, Tenn. — It is important to use all of the tools available to diagnose glaucoma progression, according to a presentation at the American Glaucoma Society meeting.
“Particularly in early glaucoma, we can use optic nerve photographs and imaging, specifically OCT and automatic static perimetry,” Donald L. Budenz, MD, MPH, said. “I don’t rely on one any more than the others. I use them all in early glaucoma.”
Budenz said he uses serial stereoscopic optic nerve photographs at baseline and looks at the optic nerve annually. If there appears to be any change, he takes a new photo to compare it with the baseline images. This allows him to track focal and diffuse neuroretinal rim loss.
OCT offers the greatest sensitivity for detecting progression in mild glaucoma and can show progression before visual field or optic nerve head changes. Budenz said to look for “progression in the green,” observed in the retinal nerve fiber layer (RNFL) thickness.
“There’s just a lot of difference between what a ‘normal’ RNFL layer is,” he said. “That gives us an opportunity to actually detect progression before a patient gets to a yellow or red parameter on OCT. We don’t want to miss that opportunity.”
Budenz said it is important to remember visual fields in patients with glaucoma, specifically when looking for change. Finding new defects, as well as enlargement or deepening of existing defects, is made easier with glaucoma progression analysis software, he said.
“We really need to use all of our modalities we have available,” Budenz said.
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Budenz DL. How do I detect worsening in a patient with mild glaucoma? Presented at: American Glaucoma Society meeting; March 3-6, 2022; Nashville, Tennessee.
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