Nav: Home

Traditional glaucoma test can miss severity of disease

November 08, 2018

The most common tests for glaucoma can underestimate the severity of the condition by not detecting the presence of central vision loss, according to a new Columbia University study.

The study, published Nov. 8 in JAMA Ophthalmology, found that administering a variation of the visual field test that better assesses macular damage can improve diagnosis of glaucoma at no extra cost and an additional 10 minutes of examination time.

"When looking for signs of early glaucoma, clinicians tend to focus on loss of peripheral (side) vision and seldom on the macula, the central area of the retina - which determines our ability to read, drive, and to see our children's faces," said Donald C. Hood, the James F. Bender Professor of Psychology and a Professor of Ophthalmic Science at Columbia University, who co-authored the study with C. Gustave De Moraes, an associate professor and the Medical Director of Clinical Trials in the Department of Ophthalmology at Columbia University Irving Medical Center.

"Our work has shown that damage can and does occur in this area, and the most commonly used field test can fail to detect most of the damage," Hood said. "It is important to detect this damage, because early diagnosis and treatment can prevent further vision loss."

Glaucoma, which affects an estimated 3 million people in the United States alone, is the second leading cause of irreversible blindness in the world, according to the National Eye Institute. In its early stages, the disease has no symptoms, pain or perceived vision loss. If left untreated, however, glaucoma results in decreasing vision, and eventually tunnel vision and blindness.

The most common exam for glaucoma is the visual field test, which uses an instrument to assess how each eye can see, looking one eye at a time. The patient looks into a dimly lit bowl-shaped area and small blinking lights appear briefly in different places in the field of view. The patient presses a button to indicate when lights are seen and the instrument records which were not seen.

For the study, the researchers examined 57 eyes from 33 patients diagnosed with early-stage of glaucoma using two different visual field measures. All participants were tested with the 24-2 visual test, which uses with a grid of 54 test points (projected lights). They then conducted an additional assessment using a 10-2 visual field test, which uses a grid of 68 test points. In addition, optical coherence tomography (OCT) - which is a high-resolution imaging device analogous to an MRI - was used to confirm the presence of damage.

"In an early study, we found that in using the 10-2 visual field that over 75 percent of patients diagnosed with early glaucoma had central vision loss," said Dr. Hood. Because conventional 24-2 tests often miss or underestimate damage in the central vision, it therefore underestimates disease severity.

Patients with more severe disease require closer monitoring and often require more aggressive treatment, which is unlikely to happen if 10-2 tests and OCT are not performed at some point during follow-up.

The researchers recommend that clinicians test all patients with or suspected to have glaucoma with the finer test grid in the macular area within the first two visits, Dr. De Moraes said. "By having a better assessment of the true severity of glaucomatous damage to the eye, doctors can tailor the most appropriate treatment to help prevent future vision loss."
-end-


Columbia University

Related Glaucoma Articles:

Long-term statin use associated with lower glaucoma risk
A new study brings the connection between statin use and risk of glaucoma into sharper focus.
Health burden of glaucoma has risen worldwide
The health burden of glaucoma has continuously increased around the globe in the past 25 years, according to an Acta Opthalmologica study.
UAlberta scientists first to pinpoint a cause of pigmentary glaucoma
An international team of researchers has identified a gene responsible for the onset of pigmentary glaucoma, which may lead to new therapies for the condition.
Using EHR-linked medication reminders for glaucoma patients
Mobile device reminders have been associated with better medication adherence and linking reminders to patient electronic health records (EHRs) could potentially allow some oversight by clinicians.
Traditional glaucoma test can miss severity of disease
The most common test for glaucoma can underestimate the severity of the condition by not detecting the presence of central vision loss, also known as macular degeneration, according to a new Columbia University study.
Biomarkers facilitate early detection of glaucoma
Researchers at Ruhr-Universität Bochum have identified new potential biomarkers that may facilitate early detection of glaucoma in patients.
Study suggests glaucoma may be an autoimmune disease
A new study from MIT and Massachusetts Eye and Ear finds glaucoma may be an autoimmune disorder, mediated by T cells that target heat shock proteins in the retina.
Autoimmune response drives vision loss in glaucoma
A research team from Massachusetts Eye and Ear and MIT has shown that immune cells in the eye that developed in response to early exposure to bacteria are a key contributor to progressive vision loss from glaucoma, the second leading cause of irreversible blindness in the world.
Turmeric eye drops could treat glaucoma
A derivative of turmeric could be used in eye drops to treat the early stages of glaucoma, finds a new study led by UCL and Imperial College London researchers.
New glaucoma treatment could ease symptoms while you sleep
Eye drops developed by UBC researchers could one day treat glaucoma while you sleep -- helping to heal a condition that is one of the leading causes of blindness around the world.
More Glaucoma News and Glaucoma Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#541 Wayfinding
These days when we want to know where we are or how to get where we want to go, most of us will pull out a smart phone with a built-in GPS and map app. Some of us old timers might still use an old school paper map from time to time. But we didn't always used to lean so heavily on maps and technology, and in some remote places of the world some people still navigate and wayfind their way without the aid of these tools... and in some cases do better without them. This week, host Rachelle Saunders...
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.