Glaucoma Diagnosis: Past, Present and Future

Amal Moustafa Elbendary*

Glaucoma Diagnosis: Past, Present and Future

Glaucoma diagnosis is one of the most challenging situation in ophthalmology.
In daily clinical practice, many of glaucoma patients are missed on diagnosis and a lot of those
receiving antiglaucoma therapy may not have the disease.

This difficulty may be attributed to sensitivity and specificity of the diagnostic tools
as well as the nature of disease in its early stages.

In the past, subjective clinical evaluation of optic nerve head and Retinal Nerve Fiber
Layer photography enabled diagnosis but with wide variability even among expert observers.

Visual field analysis is a major subjective beneficial test, but requires patient cooperation,
frequently shows fluctuation. Even tests with reliable indices should be repeated several
times to ensure a reproducible defect.

At present, diagnosis has been switched to objective computerized
analysis techniques including Spectral domain-optical coherence tomography.

Given the fact that, structural changes precedes functional changes,
peripapillary NFL thickness measurement is the most sensitive and discriminating
parameter for glaucoma diagnosis up to the moment.

The ability of SD-OCT to differentiate between normal, glaucoma suspect and glaucomatous
eyes is better for RNFL thickness than optic nerve head parameters.

Furthermore, application of OCT may revolutionize our knowledge about disease
mechanisms. Based on OCT findings, Hood, et al. found that the inferior arcuate bundle −
though thicker − is narrower than the superior one at comparable locations.

The ganglion cell layer occupies about one third of the macular region.
In this way, another anatomical area; the macular region had contributed to glaucoma diagnosis.

Ophthalmol Open J. 2015; 1(1): e6-e8. doi: 10.17140/OOJ-1-e003