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Ibopamine provocative test may be useful in diagnosing early stages of glaucoma
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The ibopamine provocative test may detect an increased risk of glaucoma at an early stage of the disease, according to a study.
The prospective study compared 44 subjects with suspicious optic discs with 37 subjects with normal optic discs and no ocular pathology to evaluate the diagnostic ability of the ibopamine test.
Of the 81 total subjects, 26 were diagnosed with early preperimetric glaucoma.
“The average global retinal nerve fiber layer thickness and the average of the temporal, inferotemporal and inferonasal sectors were significantly lower in the group of patients with a positive ibopamine test than in those with a negative ibopamine test,” the study authors said.
The test had 78.7% sensitivity and 71.6% specificity to discriminate subjects with early glaucoma. “The positive predictive value was 61.67%, and the negative predictive value was 85.2%,” the study said.
After adjusting for age, sex, baseline IOP and pachymetry, subjects with a positive test had eight times more risk of glaucoma compared with subjects with a negative test, and those with a positive test and a suspicious optic disc had a 32.4 times higher risk of having glaucoma vs. those with a normal optic disc. – by Kristie L. Kahl
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Most glaucoma patients initially present without symptoms and with normal IOP. Disc anatomy is naturally quite variable, and glaucomatous changes, including disc hemorrhages, are subtle and easily missed. Disc and macula scans are “abnormal” due to natural variation, and visual field testing is difficult and fraught with false positives. These factors and others make glaucoma diagnosis a challenge.
Dominguez-Dueñas and colleagues offer assistance in their paper on a previously developed yet seldom used pharmacologic provocative glaucoma test. Similar to the water-drinking test, the ibopamine test is an indirect measurement of aqueous outflow facility. It stands to reason that people with decreased facility of outflow would be more susceptible to glaucoma.
The authors apply this test to normal and early glaucoma patients and find it helpful in early glaucoma diagnosis. Will this test take clinical practice by storm? Unlikely. However, when you are sitting on the fence, a little drop of ibopamine may push you to one side or the other. I would use it if it were commercially available, but then I occasionally use the water-drinking test. When it comes to making glaucoma diagnoses, we need all the help we can get.
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Domínguez-Dueñas F, et al. J Glaucoma. 2015;doi:10.1097/IJG.0000000000000343.
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