Glaucoma surveillance essential for optimizing patient outcomes
Glaucoma progression occurs slowly in the vast majority of patients, and most patients with glaucoma will not go blind from the disease. However, it is important to get early diagnosis, treatment when indicated, and develop a disease surveillance protocol.
Glaucoma progression occurs slowly in the vast majority of patients, and in the United States, most patients with glaucoma who are less than optimally treated, or even undiagnosed, will not go blind from the disease.
These facts, however, should not diminish the importance of early diagnosis, treatment when indicated, and, most importantly, ongoing surveillance, said Kuldev Singh, MD, MPH during the Glaucoma Symposium CME at the
Kuldev Singh, MD, said the combination of high risk and lack of diagnosis/surveillance creates a perfect storm for severe visual disability.
“Studies suggest that if we identified 20 individuals residing in the United States with primary open-angle glaucoma, about half would know that they have the disease and only half of those would be receiving optimal care including appropriate compliance and surveillance,” said Dr. Singh, professor of ophthalmology and director, Glaucoma Service, Stanford University, Stanford, CA. “Two or three of those undiagnosed and/or untreated would represent individuals who are at very high risk of glaucomatous vision loss.”
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Dr. Singh pointed out that the combination of high risk based upon genetic factors and lack of diagnosis/surveillance creates the “perfect,” or more fittingly “imperfect surveillance-related storm” for developing severe visual disability from the disease.
While large clinical trials have provided tremendous information relating to individual risk factors for the development and progression of disease, ophthalmologists still are unable to accurately predict, in a prospective manner, which patients are going to demonstrate rapid- versus slow-disease progression. Family history and ethnicity are helpful in making predictions regarding disease course, but each individual is unique and only time will reveal their true individualized risk, Dr. Singh said.
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“With that in mind, it is desirable to find glaucoma early in every patient, but tailor the treatment approach to what happens over time rather than simply using an approach that assumes all patients represent the average from clinical trials,” he commented.