Speaker: Researchers still search for glaucoma definition
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ATLANTA — Harry A. Quigley, MD, led a special session on glaucoma at this year’s SECO meeting that ranged from “what do we really know about glaucoma” to how glaucoma is treated with surgery and lasers.
“The most important thing we can do for glaucoma patients is to improve the diagnosis of their disease, to find them in the first place and to properly queue what things we’re going to do for them, which are going to be more important than eye drops or surgery,” Quigley, director of the Glaucoma Center for Excellence and a professor of ophthalmology at Johns Hopkins Hospital, said during his presentation.
He said that while “we know where it happens, do we know what glaucoma is?”
A few years ago, Quigley — along with 163 glaucoma specialists from international centers — conducted a study involving 2,500 eyes with or without “definite glaucoma” from 13 centers to determine an objective definition for glaucoma using OCT and field findings.
Quigley said the specialists were asked to provide OCT findings for the superior and inferior quadrants of the retinal nerve fiber layer on OCT or instances where the two upper and two lower clock hours were abnormal. They were also asked to provide glaucoma hemifield tests that were abnormal or had three abnormal points at a 5% level.
The researchers found that, “if you were to only use the OCT findings you would identify 82% of the eyes that the doctors said were abnormal, but you would also have 9% not glaucoma,” Quigley said. “The specificity wasn’t really good enough with OCT alone.”
Looking at the visual field alone, 85% of those with definite glaucoma could be identified; “however, not glaucoma is 15% of that,” he said.
instead said, ‘I’m going to have a lower OCT abnormality in the scan match with an upper hemifield test,’ that identified 77% of people, and the specificity was almost perfect,” he continued.
Quigley said this information would be published soon.
“There may be some better ways to use the OCT and field data,” he said. “Maybe we should be using artificial intelligence on the raw data and come up with a better glaucoma definition.”
Quigley also suggested a management course for a new glaucoma patient with real field loss. Clinicians should consider doing three fields in the first year and one every 6 months the next year, for a total of five in 2 years, for good identification of the catastrophically worsening patient. Then the frequency can be scaled back to one per year.
Quigley reviewed several new options for improving patient compliance, one of which is using cell phone robocall reminders for drops (one study saw an improvement from 49% compliance to 67%), and another is intravitreal therapy.
When asked, “What would convince you to use a new procedure?” most eye care providers would consider an approach that was more effective than currently available therapy, applicable to many surgical candidates, safer and more acceptable to the patient, lower cost to the surgeon and care system, would not preclude later surgery, rapid to learn and easy to perform.
With these in mind, Quigley stated that “surgical innovation is vital.”
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Quigley HA, et al. 21st century glaucoma care: What do we know and how do we know it? Presented at: SECO; March 4-10, 2020; Atlanta, Ga.
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