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Four Questions for Every Clinician Diagnosing and Monitoring Glaucoma

Hood, Donald C., PhD*,†; De Moraes, Carlos G., MD, MPH

doi: 10.1097/IJG.0000000000001010

We pose 4 questions for the clinician diagnosing and monitoring glaucoma, and supply evidence-based answers. The first question is: “When do you perform a 10-2 (2-degree grid) visual field (VF) test?” We argue the best answer is: anyone you would do, or have done, a 24-2 (6-degree grid) VF on should have both a 24-2 and a 10-2 VF within the first 2 visits. Second, “When do you perform an optical coherence tomography (OCT) scan of the macula?” We argue that, if you are performing an OCT test, then it should include both the macula and disc, either as a single scan or as 2 scans, one centered on the macula and the other on the disc. Third, “How do you know if the VF and OCT tests agree?” The poor answer is, “I use summary statistics such as 24-2 mean deviation and global or quadrant average of retinal nerve fiber layer (RNFL) thickness.” It is much better to topographically compare abnormal regions on the OCT to abnormal regions on the VF. Finally, the fourth question is: “When do you look at OCT images?” We argue that, at a minimum, the clinician should be directly examining an image of the circumpapillary RNFL, and this image should be sufficiently large and with sufficient resolution so that local damage can be seen, and the segmentation evaluated.

*Department of Psychology, Columbia University

Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY

D.C.H. receives lecture fees, research support, and equipment from Topcon Inc. and Heidelberg Engineering. NIH/NEI grant: EY002115 (D.C.H.) and EY025253 (C.G.D.M.).

Disclosure: The authors declare no conflict of interest.

Reprints: Donald C. Hood, PhD, Columbia University, New York, NY 10027 (e-mail:

Received May 28, 2018

Accepted June 8, 2018

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