Clinically sensible follow-up for glaucoma

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Abstract

Detecting glaucoma progression is clinically challenging. It is unclear how structural and functional measurements are best used. Data from several long-term structure and function follow-up studies into glaucoma progression have revealed a poor overlap between the two, suggesting that one should ideally use both structural and functional measurements for detecting glaucomatous progression in individual cases, with the risk of overcalling and overtreating so-called progression. With ever more limited resources, however, clinicians are probably forced to restrict their measurements to as few exams as possible in individual patients, calling for sensible choices which measurements to perform. Structural measurements appear to be more useful in early, including preperimetric, glaucoma and functional measurements in more advanced glaucoma. Descriptions, drawings or 2D photography of the optic disc are, on the whole, probably of limited value, whereas standard automated perimetry and imaging of the retinal nerve fibre layer appear to be most useful. This will be discussed in an interactive, clinically oriented presentation. A limitation of this study is that scanning laser tomography of the optic disc has not been evaluated.

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