Eyeworld

EW MEETING REPORTER 60 World Glaucoma Congress August 2011 (HRT, Heidelberg Engineering, Heidelberg, Germany). Dr. Nicolela said, "Use a method that is easily in- corporated into your normal clinical routine." Boel Bengtsson, Ph.D., Lund University, Sweden, discussed the detection of glaucoma progression using visual fields. Each visual field machine has built-in software to de- tect change over time. Visual field change can be detected using either event analysis, which relies on the occurrence of specific events (a set number of test locations changing by a specified amount) and can de- tect change but does not quantify the rate of change, or trend analysis, which assesses the rate of change of visual field parameters over time, can quantify the rate at which glau- coma is progressing, and can aid in identifying patients at risk of going blind in their lifetime. Jeff Liebmann, M.D., New York, pointed out that while progres- sion can be detected using either structural or functional tests, the best approach is to combine the two strategies. Any new change in struc- ture or function should be con- firmed with retesting to rule out false-positive results. If change is ob- served on both a structural test and a functional test, this corroboration is strong evidence of true progres- sion. Tetsuta Yamamoto, M.D., Gifu University, Japan, listed disc hemor- rhage as a strong predictor of glau- coma progression. Eyes with disc hemorrhage, an indication for more aggressive IOP-lowering therapy, have higher rates of progression than eyes without hemorrhage. One important note: Disc hemorrhages are easy to overlook. In the Ocular Hypertension Treatment Study, 84% of disc hemorrhages were missed on clinical examination and only de- tected by optic nerve head photogra- phy. Roberto Carassa, M.D., Italian Glaucoma Center, Milan, suggested that an individual patient's rate of progression should guide therapeu- tic choices. Progression rates can be determined using software available on most visual field machines. There is no established rate that would be classified as rapid progression. In- stead, the rate of progression (usu- ally measured in decibels per year) should be considered in the context of age, systemic health, and life ex- pectancy. Patients at risk of blind- ness in their expected lifetime should be treated more aggressively, with perhaps an additional 20-30% IOP reduction. These patients should also be evaluated more fre- quently than patients who are stable or progressing more slowly. Editors' note: Dr. Nicolela has no finan- cial interests related to his comments. Considerations in glaucoma treatment: A preservative-free option In this session, physicians discussed when to commence IOP-lowering therapy, concerns surrounding chronic preservative use, and preser- Reporting live from the 2011 World Glaucoma Congress, Paris Post-op predictability you can count on with the EX-PRESS ® Glaucoma Filtration Device. The peace of predictability. © 2011 Novartis AG 7/11 EXP10587JAD World continued from page 59

• Cover