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Searching for the tipping point in glaucoma


The reality of glaucomatous progression bites, said Joel S. Schuman, MD-and it can bite even before structural or functional change is clinically noted by current technology.

New Orleans-The reality of glaucomatous progression bites, said Joel S. Schuman, MD, as he delivered the Robert N. Schaffer Lecture-and it can bite even before structural or functional change is clinically noted by current technology.

He offered a retrospective look at the history of detecting glaucoma-while presenting data showing a glaucoma tipping point-and discussed the new paradigm for how structure and function relate to each other.

“Many of us were wondering: How do we put together changes in structure and function … can you predict one with the other?” asked Dr. Schuman, director of the University of Pittsburgh’s School of Medicine Eye Center, Pittsburgh.

Searching for a better, more objective way of diagnosing glaucoma before symptoms become present, Dr. Schuman said he developed optical coherence tomography (OCT), which provides for earlier detection of glaucoma.

OCT quickly and noninvasively produces a three-dimensional map of the eye and compares it with images of what healthy eye tissue should look like.

Older studies, Dr. Shuman said, led the ophthalmology community to believe that structural changes followed functional change.

“(But) we know that in very early glaucoma, people report loss of quality of life,” he said. “We knew there must be something missing.” 

Refrencing a graphic with hundreds of data points, Dr. Shuman said the points where structure and function changes grow very close-and then to what he calls the tipping point-a point where structure and function seem to change at the same time.

“The regions of disconnect are likely an artifact of how we measure structure and function,” he said.


For more articles in this issue of Ophthalmology Times Conference Brief click here.

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