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Diagnostic, therapeutic advances make glaucoma more treatable than ever
Like many of you, I’ve witnessed tremendous changes in optometry over the years. Ongoing research, improved technologies and a better understanding of disease entities have dramatically enhanced the services we provide our patients. Perhaps in no other aspect of eye care is this more evident than that of glaucoma.
A mere two decades ago glaucoma was very much a mystery. It was largely underdiagnosed, as direct ophthalmoscopy and Goldmann bowl perimetry were not always conducive to early detection. It was occasionally over treated, as elevated intraocular pressure was still considered an absolute diagnostic finding. In addition, our treatment options left a bit to be desired. For those patients for whom a beta-blocker was contraindicated, our only other choices were pilocarpine or epinephrine. In essence, protocols for diagnosis, treatment and monitoring were all rather nebulous.
Better understanding
Today, we have a much better understanding of — and appreciation for — glaucoma. Clinical trials such as the Ocular Hypertension Treatment Study, Early Manifest Glaucoma Trial and Advanced Glaucoma Intervention Study have given us a better understanding of who is at risk, the importance of early intervention and the significance of vigilant IOP control.
Today, we also have better technologies. Stereoscopic ophthalmoscopy, pachymetry, glaucoma specific threshold visual field tests and optic nerve imaging provide us with an incredible level of sensitivity in detecting disease and monitoring progression. And, today, we certainly have more therapeutic choices. While prostaglandin analogues have become a first-line therapy, we also have very effective beta-blockers, alpha-agonists and carbonic anhydrase inhibitors for additive or alternate therapy.
Advancements create questions
Granted, these advancements in glaucoma research, diagnosis and treatment have, in and of themselves, created a number of questions as well. However, the questions of today are much different. They are rooted in a deeper understanding of the disease process and are questions whose answers will ultimately result in a higher level of care.
For certain, it’s an exciting time in which to manage glaucoma. With so many resources at our disposal, this once daunting disease is more treatable than ever. While we should never trivialize this condition, it’s reassuring to know that glaucoma patients have a markedly improved prognosis for preserving sight. As optometrists, preserving sight is what it’s all about.