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EW GLAUCOMA
June 2016
Contact information
Blumberg: dmb2196@cumc.columbia.edu
Coleman: coleman@jsei.ucla.edu
Friedman: david.friedman@jhu.edu
Okeke: iglaucoma@gmail.com
Robin: arobin@glaucomaexpert.com
quite healthy if the nerve's small size
in not appreciated.
How to screen?
Another challenge is what testing
paradigm should be used?
Screening by IOP is of very
little value. As Dr. Friedman pointed
out, half of glaucoma patients have
normal IOP. Also, most people with
elevated IOP do not have glaucoma.
Therefore, we would miss at least
half of the glaucoma patients, and
most of the screen fails would be
ocular hypertensive but not have
frank glaucoma.
Structural screening could be
as easy as looking with the direct
ophthalmoscope or as innovative as
using advanced imaging such as op-
tical coherence tomography (OCT).
The former has been shown to be
poorly sensitive and specific for
glaucoma detection, and the latter is
both expensive and not portable.
Perimetry is a hallmark of
glaucoma and the "gold standard"
in defining the presence of disease.
Most perimeters are not portable.
The frequency doubling technology
platform is portable but requires
constant power and has not been
associated with favorable screening
performance, said Alan L. Robin,
MD, Baltimore.
Dr. Robin described several web-
based and device-based perimetry
platforms that can be administered
using a tablet. "Some of these show
good correlation with standard
suprathreshold perimetry in detect-
ing moderate and severe glaucoma
damage and may have value in
community-based screening efforts,"
he said.
Screening patients' families
In our quest to find the undiagnosed
glaucoma patients in our communi-
ties, the lowest hanging fruit may be
closer than we think: our patients'
relatives.
"A family history of glaucoma
is strongly correlated with POAG,"
said Constance Okeke, MD, Nor-
folk, Virginia. "In the Baltimore Eye
Survey, a positive family history was
associated with a 3.5-fold increased
risk of developing glaucoma."
She added, "In the Barbados Eye
Study, 23% of relatives of known
glaucoma patients had manifest
open-angle glaucoma."
She recommended that we
encourage our patients to encour-
age their relatives to get tested.
"We need to educate our glaucoma
patients to talk to their family mem-
bers about glaucoma risk and the
value of screening evaluations." EW
Editors' note: The physicians have
no financial interests related to their
comments.
For information & Updates
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