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Detecting early glaucoma

Considerations needed for building certainty when diagnosing glaucoma

Cheryl Guttman Krader

Posted: Wednesday, September 25, 2019

Anders Heijl

Both computerised perimetry and structural tests are sensitive for detecting early glaucoma, but there is potential for false positives with each.

Speaking at the ESCRS/EGS Glaucoma Day meeting, Anders Heijl MD discussed considerations for building certainty when diagnosing glaucoma.

Patient age and IOP are two meaningful factors to think about, said Dr Heijl, Lund University, Malmö, Sweden.

“It is rather unlikely that young patients with a low IOP have glaucoma,” Dr Heijl said.

To avoid being misled by false positives with functional testing, clinicians should look to see if early apparent field loss is reproducible. When reviewing the OCT printout, the potential for mass significance should be considered, and structural findings should always be consistent with functional findings. “There are many analyses in the OCT printout, and it is very likely that at least one will be significant even if the subject is perfectly normal,” Dr Heijl said.

He concluded by cautioning against making uncertain glaucoma diagnoses, noting the potential harm.

“Receiving a diagnosis of glaucoma reduces quality of life and can lead to problems with anxiety and fear of blindness. Patients with suspect or uncertain glaucoma should usually be followed, but not receive a diagnosis or be treated,” Dr Heijl said.