Glaucoma progression

Ananth C Viswanathan Detection of visual field progression in glaucoma has advanced considerably in recent years. This is thanks to the introduction of advanced software systems that can meaningfully assist the clinician in the measurement and detection of progression, said Ananth C Viswanathan MD at Glaucoma Day. “The bottom line is that we do have good methods now available to measure visual field progression, and we also have solid guidelines to show us how to use those methods properly. If we ally computer-aided decision-making to our clinical skills then we can rise to the challenge of measuring and detecting progression for the benefit of our patients,” he said. Detection of visual field progression is a critical component of glaucoma patient management said Dr Viswanathan, as it guides decisions about whether or not existing treatment is working. The traditional method of using clinical judgment alone based on comparisons of serial visual field printouts is insufficient, and leads to poor decision-making. “Studies have clearly shown that clinical judgement alone really does not work, and is not very good in terms of intra-observer agreement. If you take glaucoma experts and ask them to look at a visual field series for one patient and decide if they are progressing or not, the level of agreement between those experts is little better than chance,” he said. However, using specialised software to analyse the same data and highlight areas of possible change means that the level of agreement goes up substantially. “This shows that we really should be using a computer-assisted system to complement our own clinical judgement and increase the chance of making the right call when it comes to deciding whether the patient is progressing or not,” he said.