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    Precision medicine: Tracking glaucoma progression


    “Everyone should know that there is no age-related loss progression correction on these OCT calculations,” Dr. Chang said. “On average, age-related loss is about 2-3 µm every decade or 0.2 µm per year,” he said.

    In some patients, the disease may progress very slowly, he said. He cited the Canadian Glaucoma Study (Arch Ophthalmol. 2010;128(10):1249-1255), in which 216 patients were followed up at 4-month intervals with perimetry and were monitored for progression.

    Related: New approaches and technologies offer hope in vision restoration

    The patients who reached an end point based on total deviation analysis underwent 20% or greater reduction in IOP. The researchers found that median mean deviation rate in progressing patients prior to the first end point was − 0.35dB/y.

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    Dr. Chang recalled a patient he had followed for about 5 years and was “very noncompliant.” At baseline, the patient’s untreated IOP was a maximum of 32 mm Hg, he said. The patient refused surgery, so Dr. Chang was “almost just documenting the natural course of disease.” Interestingly the patient’s right eye did not progress as fast as the right, despite high pressure in both.

    More: How to succeed in today's glaucoma brave new world

    The structural changes generally precede the functional changes, he said. But eventually if a patient loses a certain amount of nerve fiber layer, the patient will experience a visual field defect.

    How can clinicians make use of this information? Dr. Chang pointed out that more glaucoma treatments are available than in the past. Ophthalmologists have to decide whether to prescribe medications, perform conventional surgery, or implant a minimally invasive glaucoma surgery (MIGS) device.

    Peronsalized progression

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