Clinical examination still essential for Glaucoma diagnosis

When it comes to diagnosing glaucoma, the trend of replacing clinical examination with imaging is a move in the wrong direction, George L Spaeth MD told delegates at ESCRS Glaucoma Day 2016 in Copenhagen yesterday.   “Imaging in various forms provides helpful information, but the clinical examination is essential. Every step away from data that results from touching the patient – touching physically, emotionally, and spiritually – is a step away from understanding the essence of the patient and from engaging the patient in his or her own care and the promotion of health,” said Dr Spaeth, of Wills Eye Hospital, Philadelphia, USA.   Acknowledging that modern imaging tools offer a number of advantages, Dr Spaeth insisted they are not enough. He cautioned that machine-derived data are not infallible, and that statistically-derived outputs based on population averages may not be applicable to the individual. Issues to consider include the method of obtaining the data, its quality, and its interpretation for the particular situation.   As an unfortunate consequence, the increasing reliance on machine-driven markers of health and disease has resulted in deterioration of physicians’ ability to obtain an appropriate history, perform a proper examination, and interpret the results. Yet, resurrection of the necessary skills may be challenging. “How do you keep people down on the farm when they have seen Paris?” Dr Spaeth remarked. “I believe we need to preserve, teach and research the skills of direct physical examination,” he concluded.