EyeWorld Asia-Pacific March 2020 Issue

GLAUCOMA 50 EWAP MARCH 2020 Supported by: College of Ophthalmologists, Academy of Medicine, Singapore MEETING POSTPONED to 29-31 july 2021 29 – 31 July 2021 Postponed to APACRS Phaco Essentials A Video & Didactic Course Stay tuned for more details Top level experts will provide most up-to-date and comprehensive teaching on the various steps in phaco ranging from biometry to surgical steps. Expect a fast and furious session from top international surgeons. some sort progression analysis, if you have it,” he said. Here’s a breakdown of the studies Dr. Richter performs the first time she sees a glaucoma suspect: • Gonioscopy to determine whether the angle is open • Visual field testing to assess any defects that could suggest actual glaucoma and to set a baseline in case there is other pathology present • Stereoscopic examination of the optic nerve to identify focal defects of the neuroretinal rim and retinal nerve fiber layer defects • Disc photos to capture a baseline of the optic nerve that can be followed over time with truly longitudinal comparisons • OCT to assess retinal nerve fiber layer thickness to identify focal glaucomatous defects and establish a baseline • OCT angiography of the peripapillary retinal nerve fiber layer microvasculature to identify early focal glaucomatous defects that other tests might not detect and establish a baseline Dr. Richter noted that patients should be allowed to practice and learn how to take visual field tests, due to the learning curve that’s often involved. After these tests, depending on the patient’s level of risk, Dr. Richter said she sees patients 6 months to a year after the initial visit and then every 1–2 years. During these visits, she’ll look for evidence of progressive thinning of their OCT retinal nerve fiber layer thickness in any focal regions around the optic nerve, development of visual field defects, development of focal peripapillary glaucomatous defects on OCT angiography, and evidence of increased thinning of the neuroretinal rim. She also pointed out that half of patients with open angle glaucoma have a baseline IOP in the normal range. As such, “it’s important not to develop a false sense of security that a patient doesn’t have glaucoma when their eye pressure is ‘good.’” Dr. Sheybani said if the optic nerve looks glaucomatous, but there is no pressure elevation and no angle closure, a primary optic nerve process, such as a compressive lesion or optic tract pathway lesion in the brain, vascular changes or ischemic optic neuropathies that could lead to cupping, should be ruled out through history and careful examination. “If your suspicion is high enough for something compressive, then you do need to do a scan,” Dr. Sheybani said. When it comes to talking with a patient who needs to be followed as a glaucoma suspect, the important thing is to not scare them. “You want to let them know that they may not notice the symptoms, which is why it’s so important to keep the follow- up,” Dr. Sheybani said. “If you tell them, ‘Look, we don’t think this is glaucoma, but we’re worried that this could progress to glaucoma, which is why we are following you a little closer. It’s important to make the follow- up because sometimes we’ll be able to detect it before you can notice it. If it happens, we can’t reverse the damage, so our whole goal is prevention. Make sure you keep the visits and the good news will be if it stays normal.’” EWAP Editors’ note: Dr. Richter is assistant professor of clinical ophthalmology, Glaucoma Service, University of Southern California, Roski Eye Institute, Los Angeles, and has relevant financial interests with Carl Zeiss Meditec. Dr. Sheybani is assistant professor of ophthalmology and visual sciences, Washington University School of Medicine, St. Louis, and has relevant financial interests with Allergan, Katena, Glaukos, and Ivantis.