Quigley shares glaucoma pearls, predicts the future of care

NEW ORLEANS – Harry A. Quigley, MD, urged attendees here at the Optometric Glaucoma Society meeting to perform visual field testing more frequently.

The conference was held prior to the American Academy of Optometry.

Quigley, director of the Glaucoma Center for Excellence and a professor of Ophthalmology at Johns Hopkins Hospital, said visual field testing is performed just under once per year, according to Medicare data.

“If you do one a year, it will take 10 years to predict average progression,” he said, “and at three fields per year you find average progression in 4 years.

“Do a bunch of fields early on, within that first 2 years, and find those who are catastrophic,” he continued. “Then you know who you have to test more frequently. Do three fields the first year, one every 6 months the second year – this is pretty good at identifying people – then scale it back.”

Quigley said a new visual field test is needed, one that takes only 2 minutes and has lower variability.

He also envisions a tube shunt device “in which there’s an ability to control the flow postsurgery and increase or decrease it,” he said. “It will have a continuous intraocular pressure sensor sitting on it that controls that valve, and I can make the pressure anything I would want.”

Quigley also offered tips on matching structure and function.

“When you try to match the cup-to-disc ratio, it won’t match the visual field tests,” he said. “Attempts to match field to structure near the disc are frustrating; there are overlaps, broad areas and many points and zones.”

Quigley recommended performing a central 10-2 visual field.

“Go to the thickness of the ganglion cell interplexiform layer and match those two up,” he said. “That way, you’ll be able to match the structure of the ganglion cells that are giving you that response in that field. The problem is there’s so little actual information that we won’t have a great dynamic range for the measurement of this. It may add information to identify the presence of damage more than a measure of progression.”

Quigley said he has begun targeting family members of glaucoma patients because many of them do not know what glaucoma is, despite the fact that one in eight of existing first-degree relatives of glaucoma patients also have glaucoma.

He also focuses on compliance among those patients who are diagnosed with and being treated for glaucoma.

Studies have shown that patients are taking only half of their prescribed doses of glaucoma medication.

“Noncompliers tend to be younger than 50, African-derived, have glaucoma for a shorter duration and health worse than excellent,” he said.

“When you ask questions about compliance, open the door by saying you take high blood pressure medicine and forget it once or twice a week,” Quigley suggested. “Ask them if they forget their drops once or twice a week. They will say yes, and that means their compliance is 50%. Suggest they use a reminder app, and tell them you use it, too.”

Sustained delivery of existing or new agents could reduce side effects, improve pressure, and reduce issues with compliance, he said. It would also have “huge potential for decreasing surgical complications because it will decrease the number of procedures we do.” – by Nancy Hemphill, ELS, FAAO

Disclosure: No products were mentioned that would require financial disclosure.