Eyeworld

EW GLAUCOMA 112 OCT results may cause doctors to over treat some glaucoma patients who may never lose any functional vision. "I think OCT has a role, but there's a lot more than just looking at a number on an OCT result and deciding what a patient can do," Dr. Richman said. Visual field testing, OCT, and patient questionnaires don't paint an accurate picture of how a patient is functioning day-to-day. Dr. Spaeth and colleagues developed ADREV to test how glaucoma affects these pa- tients' ability to function while doing everyday tasks on nine points: reading in the dark, recognizing fa- cial expressions, detecting motion on a computer, reading signs at a distance, finding large and small ob- jects in a room, navigating an opti- cal course, putting a stick into holes of different sizes, dialing a tele- phone, and matching socks. For example, to measure facial expressions, patients were presented with four photographs placed in their central vision of people ex- pressing emotions like sadness and surprise, and patients were asked to tell what emotion the person was demonstrating. Finding objects in a room involved patients searching for, for example, a beige-colored boxed up against a beige-colored wall. Patients performed the test with both eyes open. Each item on the test was scored from 0-7, with 7 being perfectly performed. Patients were recruited based on how much damage their optic disk and visual field had, but interestingly, the re- searchers concluded that those two measurements didn't matter in terms of ADREV performance. Instead, contrast sensitivity turned out to be the closer indicator of what people can do in their daily lives, calling into question how glau- coma patients should be evaluated. "The results of the ADREV study suggest that we have to rethink our assumptions about how vision re- lates to function," Dr. Spaeth said. "When patients become sympto- matic, they may say, 'I have trouble reading signs.' Believe them even if the visual field test looks fine. Some- thing else is happening there." Doctors need to be more alert and intense in striving to under- stand why a patient's symptoms are worsening. On the flip side, if a pa- tient is functioning just fine but his or her visual field tests are getting worse, don't be so quick to over treat. "What are we taking care of? Are we taking care of the patient or the patient's visual field?" Dr. Spaeth asked. "Who gives a darn about the field by itself? Certainly the patients don't. The patients are, and we should be, interested in how they are feeling and how they are func- tioning. We still have to do visual fields, and they may continue to be an important aspect of patient care for many years to come. But there may be better ways to evaluate the things that are important to pa- tients. Perhaps that will be contrast sensitivity." EW Editors' note: The physicians inter- viewed have no financial interests related to their comments. Contact information Richman: jesse_richman@yahoo.com Spaeth: gspaeth@willseye.org February 2011 March 2011 Contrast continued from page 111 © 2011 Reichert, Inc. All rights reserved. 02/11 Reichert and Ocular Response Analyzer are registered trademarks of Reichert, Inc. Reichert Technologies and "Advancing Eye Care. Preserving Sight." are trademarks of Reichert, Inc. D. Rex Hamilton, MD, MS, FACS, is an Ocular Response Analyzer user and has no financial interest in Reichert, Inc or its products. " Am I a LASIK candidate, Doctor? " " The information obtainable using the Ocular Response Analyzer ® complements corneal topography, providing a higher level of confidence in determining refractive surgery candidacy than is attainable with topography alone. We implemented the ORA as a standard part of our refractive surgery screening process 4 years ago and have never looked back. " D. Rex Hamilton, MD, MS, FACS Director, UCLA Laser Refractive Center Assistant Professor of Ophthalmology Jules Stein Eye Institute Reichert is Corneal Biomechanics. Learn more at www.reichert.com Make corneal biomechanics part of your determination. ORA_LASIK_testim_EyeWorld_7-1x9-75_0211.indd 1 2/18/11 3:17:16 PM

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