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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
Perspective Article (Invitation Only): PDF Only

We pose four 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° grid) visual field test?” We argue the best answer is: anyone you would do, or have done, a 24-2 (6° grid) visual field on should have both a 24-2 and a 10-2 visual field within the first two 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 two scans, one centered on the macula and the other on the disc. Third, “How do you know if the visual field 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 visual field. 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, New York, NY

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

Financial disclosures: DCH receives lecture fees, research support and equipment from Topcon, Inc. and Heidelberg Engineering. CGDM has no financial disclosures relevant to content.

Supported by: NIH/ NEI grant: EY002115 (DCH) and EY025253 (CGDM).

Disclosure: The authors declare no conflict of interest.

Reprints: Donald Hood, PhD, Columbia University, NY, NY United States

Received May 28, 2018

Accepted June 8, 2018

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