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Do not ignore pre-perimetric glaucoma symptoms
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To the Editor:
After reading “Surgeon outlines reasons not to treat pre-perimetric glaucoma suspects” (March 2012, page 6), which covered a presentation at Hawaiian Eye 2012 by Kuldev Singh, MD, my only rational conclusion was that this was printed a month early, as it is appropriate only as an April Fools’ piece.
To ignore elevated IOP, optic nerve cupping, thin corneas, family history and nerve fiber layer defects and depend only on perimetric findings to initiate glaucoma therapy is like a cardiologist ignoring hypertension, elevated cholesterol, family history, obesity, smoking and lack of exercise and waiting for chest pains to initiate therapy for heart issues.
To resist early intervention because glaucoma therapy might cause symptoms or might cause higher insurance rates or denial of coverage is ludicrous, as is belittling irreversible vision loss as a quality of life factor. Further ignorance of research demonstrating the relationship between early nerve fiber layer defects and later perimetric defects – however slow the progression – further muddles any credibility to Dr. Singh’s conclusions.
Gary G. Gray Jr., OD
Decatur, Ill.
PCON Editor responds:
At Primary Care Optometry News we strive to provide our readers with the most contemporary information possible. While we take great pride in our editorial board – and encourage rigorous review – we are careful not to alter the content and intent of presentations such as Dr. Singh’s. They occasionally challenge conventional wisdom and are, almost universally, thought provoking. And isn’t that what clinical practice is all about?
Our ability to analyze each patient’s situation and implement a personalized treatment plan is the core of providing exceptional care. Or, to paraphrase the great French philosopher, René Descartes, “Cogito ergo sum (I think, therefore I am).”
Michael D. DePaolis, OD, FAAO
Editor
Primary Care Optometry News
It is important to note that Dr. Singh did not review the meeting coverage prior to it being published.