I would like to welcome you to the fifth edition of
the Glaucoma Handbook, a publication developed under the auspices of the Optometric Glaucoma Society
(OGS). This handbook is meant to serve as a guide
to
the diagnosis and management of glaucoma and is not
an exhaustive review. The material includes a
review
of basics in regards to glaucoma diagnosis and
therapy
while providing new insights into the condition.
Our
goal with each new edition is to keep the material
fresh and up-to-date.
In certain sections, there is
new
information while all chapters have been updated.
Glaucoma diagnosis and management is in an evolutionary
phase with small improvements occurring. In regards
diagnosis, spectral domain OCTs have been available
for
18 months with several companies now building these
devices. When first launched, OCT analysis schemes
used
older methods to assess the data such as TSNIT
curves
and optic disc cross-sectional cuts. The 3-D cube
of data
was not utilized except visually but this is now
changing with new schemes being developed to evaluate
this
huge amount of data.
On the cover are images taken
with the Carl Zeiss Meditec, inc. Cirrus Spectral
OCT that
provide examples of where imaging is going. Imaging
of
both the anterior and posterior segment are
available,
with resolution not previously possible in
commercial
instruments. In these examples, the angle and optic
disc
from a healthy individual are seen along with an
image
of optic disc drusen. The spectral OCTs are evolving
as
both the Cirrus and RTVue can also image the
anterior
segment, and software for glaucoma progression is
available on several instruments.
We should see the release of the Heidelberg Edge
Perimeter (HEP) shortly which continues in the
quest
for early perimetric detection of glaucomatous
damage.
Whether the HEP perimeter is a step forward will
not
be known for several years. Another new functional
test under development is pupil perimetry, which is
an
objective method to assess central vision and
reduces
patient involvement. Similar to the HEP, it will
take
several years before we know if this will be a
viable test.
In regards to therapeutics, we are anxiously
waiting for
the next class of drugs. It has been several years
since
a new glaucoma drug was made available with
combination drugs being the most recent addition to
glaucoma
medical therapy. Glaucoma surgery is evolving,
however
slowly, with the quest for procedures that reduce
IOP
with fewer complications.
I would like to thank the members of the OGS for
their support and help in developing these
materials.
On behalf of the OGS, I would like to thank our
team of
authors who contributed to this effort. I would
also like
to thank Karen Fixler, Ravi Pherwani, Tom Wright
and
Jill Burdge from Pfizer for their continuing
support of
the OGS, and specifically for the unrestricted
grant that
allowed us to continue with this publication. We
hope
that you find this handbook useful.
-Murray Fingeret, O.D.;
Executive Vice-President, Optometric Glaucoma
Society;
Editor, The Glaucoma Handbook
(The OGS can no longer provide hard copies of this handbook)
