Measures of structure and function change can help ophthalmologists individualize treatment of glaucoma patients, according to Robert Chang, MD, assistant professor of ophthalmology, Stanford University.
Since glaucoma progresses faster in some patients than others, optical coherence tomography (OCT) and visual field progression analysis can be more useful than IOP in guiding treatment decisions, said Dr. Chang during the Glaucoma Symposium CME at the 2016 Glaucoma 360 meeting.
“I use structure and function glaucoma progression analysis to really customize therapy over a lifetime,” he said. “That’s my method of precision medicine in treating glaucoma patients today.”
Concept of precision medicine has gotten attention in recent years, he said, citing the Precision Medicine Initiative presented by President Barack Obama in his 2015 State of the Union address. The initiative calls on health care providers to take into consideration genetic, lifestyle, and environmental factors to tailor treatments to individual patients.
“How are we going to apply precision medicine when we don’t have much genetic data and we don’t know what the patient’s environmental effects are?” Dr. Chang asked. “Maybe there aren’t any specifically for glaucoma.”
The answer to treating glaucoma starts with preserving ganglion cells as long as the patient lives, he said. Clinicians must take into consideration the rate that the disease is progressing in each patient in order to choose a treatment that strikes the right balance between probable efficacy and the risk of adverse reactions.
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“We need something quantitative,” he said, “not just looking at the nerve or asking them how their vision is doing.”
OCT-guided progression analysis in early stages of glaucoma and visual field progression analysis in later stages can provide the data to monitor progression, he said. OCT is highly repeatable, so clinicians can compare a patient’s status to baseline measurements. And visual field index can be calculated against the patient’s age.
For example, he said, the Zeiss Forum Glaucoma Workplace (Carl Zeiss Meditec) displays visual field baselines against current visual fields, highlighting event-based analysis and trends.