Monitoring Advanced Glaucoma

In this interview from AGS 2017, Dr. Joel Schuman offers his advice on how to monitor patients with advanced glaucoma. OCT alone is not enough due to the concept known as the “floor effect”. Because OCT measurements of the average retinal nerve fiber layer thickness rarely go below 40 or 30 µm, it’s hard to track changes in the thin nerve fiber layer of a patient with advanced disease. The patient may appear stable on OCT because the device can no longer detect changes, giving the clinician false confidence that the disease has stabilized. Dr. Schuman suggests using 10-2 over 24-2 visual fields test or Goldmann visual field perimetry, which is not widely available because it requires skilled perimetrists who manually map the visual field without the aid of a computer algorithm. He believes OCT angiography shows promise as an alternative method of following patients with advanced glaucoma.