Advances seen in glaucoma evaluation, management

Evaluation and management of glaucoma have continued on a steady path forward during 2006 thanks to continued advances across the entire spectrum of the field.

Imaging technology continues to mature and improve with the introduction of new platforms as well as new software algorithms for existing devices that are designed to aid in both the diagnosis of glaucoma and longitudinal assessment of the disease. Surgical treatment has been an area of highly active research, and with several approaches being studied, hope exists that better alternatives to trabeculectomy will be available in the future. Developments have occurred in medical therapy as well, and clinicians in the community are becoming increasingly cognizant of the importance of structural evaluation, early detection, and compliance monitoring for optimizing patient care.

In addition, it has been a year of reflection, as accumulating data are challenging existing concepts about IOP and have prompted rethinking of current practices for patient evaluation and treatment initiation.

Diagnostics advances

In the area of diagnosis, Dr. Schuman said he believes the biggest development has been the introduction of high-speed, high-resolution optical coherence tomography (OCT) systems that are based on Fourier domain technology. Whereas the previously available OCT device (Stratus, Carl Zeiss Meditec) acquired 400 axial scans per second and had a resolution of 10 µm, these new instruments acquire images at between 16,000 and 40,000 scans per second and have resolution in the 5- to 6-µm range, he explained.

"The excitement about the high-speed, high-resolution devices relates to their ability to allow improved visualization of structural details of the retina and to acquire enough information in a short enough period of time to create a three-dimensional image," said Dr. Schuman, the Eye and Ear Foundation Professor and chairman of ophthalmology, University of Pittsburgh School of Medicine.

"The new OCT technology displayed in the technical exhibit hall at the annual meeting of the American Academy of Ophthalmology (AAO) provides marvelous high-resolution images of both the optic nerve head and nerve fiber layer," noted Dr. Liebmann, a clinical professor of ophthalmology, New York University School of Medicine, and director, glaucoma service, Manhattan Eye, Ear, and Throat Hospital, New York.