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Clinician debates treatment of pre-perimetric glaucoma
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NEW YORK — A presenter here at a Vision Expo East continuing education session argued against points made by another clinician regarding glaucoma management in a previous publication.
In the PRIMARY CARE OPTOMETRY NEWS coverage from Hawaiian Eye 2012, presenter Kuldev Singh, MD, outlined the reasons he believes pre-perimetric glaucoma patients should not be treated. "Most of these patients with pre-perimetric glaucoma do not have symptoms of the disease, and treatment may make the patient symptomatic," Dr. Singh told attendees at Hawaiian Eye 2012.
At the Vision Expo East debate, PCON Editorial Board member Murray Fingeret, OD, FAAO, said, "To start with, no glaucoma has symptoms. If you're going to wait for symptoms, it's too late."
Dr. Singh said there is no way to predict the course of the disease, which is generally slow.
"Glaucoma is a slow disease, but, on the other hand, people are living older and older," Dr. Fingeret said. "I practice at a VA hospital. When I first started, an 80-year-old person was old. We wouldn't see too many 80-year-olds. Today, on any given day, my average patient age could be 85. Every day I see at least one person in their 90s."
Dr. Singh reported at the Hawaii meeting that there is no evidence that treatment will improve quality of life for the patient, but it may cause an increase in the patient's insurance rate or a denial of coverage.
"No treatment improves quality of life," Dr. Fingeret countered. "It prevents deterioration.
"It may increase the patient's insurance rates or denial of coverage," he added. "What I understand of the new affordable care act is that prior diagnosis has no impact upon further insurability. So I don't quite know if that's still pertinent."
Dr. Singh noted that glaucoma rates will rise exponentially with a globally aging population.
"Yes, people are getting older, but does that mean we don't treat anybody because there's going to be more of them?" Dr. Fingeret challenged.
The American Academy of Ophthalmology preferred practice guidelines categorize glaucoma as early, moderate and advanced, Dr. Fingeret said. "What is the definition of early glaucoma? No field loss," he said "It used to be called 'pre-perimetric glaucoma.' Now AAO calls it early glaucoma."
What Dr. Singh said "went against everything we've learned," Dr. Fingeret, who mentioned he is friends with Dr. Singh, said. "I would take the other approach and, if you think it's glaucoma, I would treat."