Interesting new research from Moorfields is helping the eye care community better understand the visual performance of glaucoma patients in real-world settings. After using eye tracking to monitor saccades while patients and controls watched TV, researchers identified telltale ‘scanpaths’ indicative of glaucoma. “Such a procedure would have the potential to provide a continuous assessment of changes either as the disease developed, or during treatment, within a more realistic visual environment,” they write in the online journal Frontiers in Aging Neuroscience.
Seeing glaucoma as your patients see it humanizes the experience and might lead to better care. Many articles in our 21st annual Glaucoma Report this month highlight just such a patient-centered approach.
Since intraocular pressure is the only clinical factor in glaucoma that’s amenable to intervention, it’s no surprise that IOP plays such a central role. In just about all the important decisions—making the diagnosis, initiating treatment, changing meds, referring for surgery—IOP’s influence is inescapable. But pressure doesn’t matter to patients—vision does. They want to enjoy their normal daily activities unhindered by physical deficits that might diminish quality of life.
“Perhaps the time to start treating can’t be based on numbers alone,” glaucoma specialist Murray Fingeret, OD, explains in a feature on glaucoma’s real-world impact. “In fact, the patient’s ability to function visually day to day may be just as integral as any diagnostic measurement.”
Functional effects on vision are the focus of the Optometric Study Center CE, where Craig Thomas, OD, helps clinicians understand the relationship between structural damage and visual deficits. Can greater use of functional vision testing help you better realize the patient’s experience of their condition? And what constitutes ‘functional vision testing,’ anyway?
“When most of us talk about functional changes in glaucoma, we are usually talking about changes in the visual field measured by an automated threshold perimeter,” Dr. Thomas writes. “However, a disturbance of any test of visual function can indicate glaucoma-induced functional changes.” He goes on to explain the clinical relevance of visual evoked potentials, electroretinography and other sophisticated measures, and how they improve the care of glaucoma patients.ODs recognize that many patients who can’t maintain adequate control with topical therapies or just find the daily ritual too frustrating might be better served by a surgical procedure. Richard Zimbalist, OD, and Angela Gentry, OD, provide a great overview of the latest surgical interventions. When glaucoma surgery is delayed because of overreliance on topical drugs, patients may no longer be able to experience the desired outcome. Making the surgical referral need not be seen as relinquishing control; rather, you’re ensuring the best possible intervention and quality of life.