A Brave New World in Glaucoma

American Academy of Ophthalmology 2013

Jonathan S. Myers, MD; George L. Spaeth, MD; Sonya B. Shah, MD; Victor Cvintal, MD


December 06, 2013

Editorial Collaboration

Medscape &

In This Article

Back to Basics: Exam vs Technology

Dr. Myers: Speaking of optic nerve improvement, on the other side, Dr. Felipe Medeiros[2] showed disc imaging -- spectral-domain optical coherence tomography (OCT) -- that seemed to show a patient whose inferior nerve fiber layer was disappearing over time. He asked for commentary. Dr. David Greenfield[3] spoke about a patient who has isolated OCT progression in the absence of visible optic nerve change or visual field change. It was interesting that the panel and the audience in general didn't think that was enough to lead to incisional surgery. What are your thoughts on that?

Dr. Shah: It brings us back to the basics that the examination is key here, and as much as we have new technology, we must rely initially on the clinical information that we have. In training young doctors, we should focus on that. The technology is a nice adjunct. We have to focus on that first.

Dr. Spaeth: It's important to recognize that all of these things have variable validities. Our own examination has variable validities too.

Dr. Shah: Absolutely.

Dr. Spaeth: Those examination techniques have been around so long that we are in a better position to assess whether they are something that we want to hang our hat on, whereas with OCT, I still look at it and say, "Gee, I'm not quite sure what to make of that." It's going to be a long time before we can fit that into our paradigm in a way that is convincing.

Dr. Shah: It's very exciting nonetheless.

Dr. Myers: Dr. Cvintal, you were excited about some software and apps for screening of glaucoma.

Victor Cvintal, MD: They are now developing some online software and some apps to screen for diseases -- not only glaucoma, but amblyopia and even ametropia. Patients test themselves, and the results are sent to the doctor. According to the results, they are going to call this person and examine this person. Imagine if you could do this in Africa, for instance, or in the Amazon in Brazil. It's going to be huge. It's going to be extremely valuable. The costs are going to go way down. It's really exciting.

Dr. Spaeth: Is the cost high for the patient?

Dr. Cvintal: No. The whole idea is that it is free for the patient. It has to be free for the patient -- just like Google. You don't pay to search on Google. Someone pays, but not the patient. That's the whole idea.

Dr. Myers: That is a different approach.