Advances in Glaucoma Technology
Douglas J. Rhee, MD: Hello. I am Dr. Douglas Rhee, Associate Professor of Ophthalmology at Harvard Medical School in Boston at the Massachusetts Eye and Ear Infirmary. Joining me today by Skype is Dr. Shuchi Patel, Associate Professor and Director of the Glaucoma Service at Loyola University in Chicago. We will be discussing the latest developments in glaucoma presented at the American Society of Cataract and Refractive Surgery (ASCRS) meeting for Medscape Ophthalmology. I thought it was a great ASCRS meeting.
Shuchi B. Patel, MD: This was one of the best ASCRS meetings that I have been to.
Dr. Rhee: Let's talk about some of the interesting things. The session started off with a diagnostics discussion about visual fields, optical coherence tomography (OCT), and progression. What do you think the take-home messages were from the presentations by Drs. Chopra and Harris-Movich?
Dr. Patel: They brought up the point that if we are going to be using these modalities -- structural and functional -- to monitor for progression, which is what they are used for, then we have to make sure that we are changing our baseline at appropriate times and that we have good baseline testing to begin with. If we have appropriate baseline testing and are monitoring for progression, and then if we make any intervention (such as surgery) or there is a large spike in the patient's pressure (so that we have already noticed some progression), then we have to reestablish baselines so that we can keep using these modalities to monitor for progression. Without that, it may seem that the patients are progressing despite having adequate therapy because of the intervention that we have done.
Dr. Rhee: That is a great point. They also brought up the question of what a good baseline is. Many of us do 2 visual fields or 2 scans for baseline, but do you think that you can accomplish that with a patient fairly easily when you are reestablishing a new baseline to make sure that it's more than just 1 test? What do you do in your practice?
Dr. Patel: I recall hearing or from reading somewhere that they were recommending 3 reliable visual fields or 3 reproducible structural tests. It is a little easier to get 3 reproducible structural tests, but to get reliable visual fields is often very difficult. There can be definite obstacles in establishing a good baseline exam, and even more so in establishing another adequate baseline exam. So, I try my best to get reliable fields within a short time period, especially if I'm trying to establish a baseline. I might have a patient come in, do a visual field, and then repeat it again within about 2 months to see whether I can get reproducible results. I admit that it is pretty difficult sometimes.
Dr. Rhee: I try to make it easier for my patients. I bring them back in about a month and tell them, "You don't have to have a visit with me. You can just come in and have the test. We are just trying to get a baseline." That way, it might ease some of the burden because oftentimes they are waiting for the doctor, not necessarily for the test. Does that sound reasonable to you?
Dr. Patel: The anxiety of seeing the doctor again could make it more difficult for them to take the visual field test. Having them come just to have the baseline tests is probably a great idea.
Latest Developments in Glaucoma
Douglas J. Rhee, MD: Hello. I am Dr. Douglas Rhee, Associate Professor of Ophthalmology at Harvard Medical School in Boston at the Massachusetts Eye and Ear Infirmary. Joining me today by Skype is Dr. Shuchi Patel, Associate Professor and Director of the Glaucoma Service at Loyola University in Chicago. We will be discussing the latest developments in glaucoma presented at the American Society of Cataract and Refractive Surgery (ASCRS) meeting for Medscape Ophthalmology. I thought it was a great ASCRS meeting.
Shuchi B. Patel, MD: This was one of the best ASCRS meetings that I have been to.
Dr. Rhee: Let's talk about some of the interesting things. The session started off with a diagnostics discussion about visual fields, optical coherence tomography (OCT), and progression. What do you think the take-home messages were from the presentations by Drs. Chopra and Harris-Movich?
Dr. Patel: They brought up the point that if we are going to be using these modalities -- structural and functional -- to monitor for progression, which is what they are used for, then we have to make sure that we are changing our baseline at appropriate times and that we have good baseline testing to begin with. If we have appropriate baseline testing and are monitoring for progression, and then if we make any intervention (such as surgery) or there is a large spike in the patient's pressure (so that we have already noticed some progression), then we have to reestablish baselines so that we can keep using these modalities to monitor for progression. Without that, it may seem that the patients are progressing despite having adequate therapy because of the intervention that we have done.
Dr. Rhee: That is a great point. They also brought up the question of what a good baseline is. Many of us do 2 visual fields or 2 scans for baseline, but do you think that you can accomplish that with a patient fairly easily when you are reestablishing a new baseline to make sure that it's more than just 1 test? What do you do in your practice?
Dr. Patel: I recall hearing or from reading somewhere that they were recommending 3 reliable visual fields or 3 reproducible structural tests. It is a little easier to get 3 reproducible structural tests, but to get reliable visual fields is often very difficult. There can be definite obstacles in establishing a good baseline exam, and even more so in establishing another adequate baseline exam. So, I try my best to get reliable fields within a short time period, especially if I'm trying to establish a baseline. I might have a patient come in, do a visual field, and then repeat it again within about 2 months to see whether I can get reproducible results. I admit that it is pretty difficult sometimes.
Dr. Rhee: I try to make it easier for my patients. I bring them back in about a month and tell them, "You don't have to have a visit with me. You can just come in and have the test. We are just trying to get a baseline." That way, it might ease some of the burden because oftentimes they are waiting for the doctor, not necessarily for the test. Does that sound reasonable to you?
Dr. Patel: The anxiety of seeing the doctor again could make it more difficult for them to take the visual field test. Having them come just to have the baseline tests is probably a great idea.