The Glaucoma Handbook
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)

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