More focus needed on optic nerve to diagnose severe glaucoma
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WAILEA, Hawaii — Clinicians should look more closely at the optic nerve to diagnose cases of severe glaucoma, according to a speaker at Hawaiian Eye 2024.
Louis B. Cantor, MD, said there is an overreliance on using visual fields to diagnose severe glaucoma, which can lead to missing patients with really sick eyes.
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“Glaucoma is fundamentally still an optic neuropathy,” he said. “It’s not a visual field. The visual field is a reflection and supposed to help guide us as to what’s going on.”
Specifically, Cantor said ophthalmologists should focus on eyes with a “disc at risk” that might not meet all the criteria for advanced visual field loss.
He said to look for optic disc excavation, focal thinning, exposed laminar pores and peripapillary atrophy as well as features such as focal notching, corresponding retinal nerve fiber layer defects, changes in the path of blood vessels, disc hemorrhage, nasalization of vessels and increased vertical cupping.
Cantor said the ideal of glaucoma care is to stabilize patients for the rest of their lives so they do not go blind. However, that is unrealistic because treatment is often delayed, and while patients may be controlled for a while, the disease course continues, and they eventually fall into blindness.
“The earlier we start ... that gives us what I like to call ‘more shots on goal,’” he said. “We know that many of our therapies are not going to control this disease forever, but if we can start earlier by reframing how we think about disease, especially severe disease, and start treating them more aggressively earlier, I think we’ll allow ourselves, throughout that patient’s lifetime, more shots on goal to keep them seeing.”
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Cantor LB. Lessons learned preventing and managing severe glaucoma. Presented at: Hawaiian Eye 2024; Jan. 13-19, 2024; Wailea, Hawaii.
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