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Confocal scanning laser tomography useful in glaucoma management, study shows
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Confocal scanning laser tomography would be useful in assisting clinicians in predicting future visual field conversion, according to a study recently published in the Journal of Glaucoma.
Schrems-Hosel and colleagues conducted a prospective, controlled, longitudinal, single-center study to evaluate glaucoma probability score (GPS), Moorfields regression analysis (MRA) and three linear discriminant functions (LDF) in identifying visual field loss.
Participants underwent a comprehensive ophthalmic examination, which included 24-hour intraocular pressure profile, optic disc photography, standard automated perimetry and HRT measurements (Heidelberg Retina Tomograph I-III, Heidelberg Engineering). The participants included 110 eyes of patients with early glaucoma and 120 eyes of patients with ocular hypertension.
Researchers divided the participants into two groups based on whether or not they had developed primary open-angle glaucoma. Median follow-up in the study was 9.04 years.
According to the study, for analysis, researchers used their results to compare among the MRA, GPS and the classification of Bathija, Iester, Mardin and Mikelberg at baseline.
"The Kaplan-Meier survival curves were constructed, and the log rank tests were calculated to assess the equality of survival distributions for different test results of MRA, GPS and the LDFs of Bathija, Iester, Mardin and Mikelberg and colleagues," the authors stated.
Results showed that 26 eyes displayed glaucomatous visual field loss during the follow-up of the study. Additionally, researchers reported that MRA temporal inferior and superior outside normal limits at baseline was highly predictive of future visual field conversion.
"On the basis of our findings, scanning laser confocal tomography might facilitate glaucoma management," the authors concluded. "To date there are no published reports to demonstrate a negative predictive value of around 95% for all GPS classifications and the discriminant functions of Bathija, Iester, Mardin, and Mikelberg and colleagues. A within-normal-limits GPS classification or normal classification of the four LDFs could be used to lengthen control intervals for follow-up patients with early glaucoma.
"A baseline MRA classification outside normal limits, especially in inferotemporal or superotemporal sector, might correctly lead the clinician to go for short control interviews," they continued. "However, we do not recommend that isolated clinical decisions to be based solely upon confocal scanning laser tomography imaging results, although they might assist the eye care professional to improve the detection of clinically significant disease."
Disclosure: The authors have no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
It is well understood and generally accepted that glaucoma-induced structural change precedes vision loss as measured by automated threshold perimetry. Schrems-Hosel and colleagues put this idea to the test in their ambitious prospective study of glaucoma suspects and preperimetric glaucoma patients.
Not surprisingly, they found that confocal laser scanning tomography (HRT) is useful in predicting future visual field loss in glaucoma patients and suspects.
To quote one of my favorite rock bands from the 1980s, we now have “a richer understanding of what’s already understood.” This paper does little to influence our current approach to diagnosing and monitoring glaucoma, but we can now perhaps be a bit more assured that HRT can make a significant contribution to this process.
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