Top-Ten of the Glaucoma Society of India Meeting

December 17-18, 2005, Ahmedabad, India

G.C. Sekhar

• Structure & function: The appearance of a functional reserve may have been an artifact of use of older perimetric techniques plus how the data were presented. There is a strong but imperfect relationship between visual function and structure, as currently measured. Measures of structure and function are synergistic in everyday clinical practice and should be used in combination whenever diagnostic uncertainty exists.
• Psychophysical tests: SAP will remain the basic visual field testing method. FDT and Matrix will be used by those who are looking to rule out ophthalmic disease in a basically healthy population. With Sita, SWAP will become more widely used, especially in young high risk patients.
• Comparison of HRT, OCT and GDX: The area under the ROC curve for the best parameter of HRT, OCT and GDX were similar (0.84 to 0.91) in the diagnosis of early glaucoma with established field defect. Only eight of the 54 eyes were diagnosed by all three methods.
• Early diagnosis: To be able to intelligently and appropriately use the recent advances in imaging and psychophysical tests in the early diagnosis of glaucoma, one needs to understand the concept of pre test probability. Application of positive and negative likely hood ratios are the best way of ruling in or ruling out diagnosis in a given case.
• EBM: EBM is a great path to enhance the care of our patients. If we understand the nuances in EBM we will decide what is best for the individual patient in our care rather than extrapolate the recommendations for the average patient from the most recent RCT as packaged by the industry or taught by the authorities in the subject.
• Compliance: Increasing number of medications was associated with significant decrease in compliance. Adding additional medications resulted in a further decrease in compliance.
• Anecortave acetate in NVG: A single subconjunctival injection of anecortave acetate showed promise in long-term control of intraocular pressure in neovascular glaucoma.
• ISNT rule: In a study of 136 normal subjects and 63 early glaucoma patients by HRT II, ISNT rule was positive in 29% of normal subjects and negative in 32% of glaucoma eyes.
• Xalatan Vs generic latanoprost: In a single centre, prospective, randomized, observer masked, open-label, crossover, two-period comparative clinical study, the magnitude of difference in IOP reduction was small between the two drugs, but at all points, the IOP with Xalatan was lower than with generic latanoprost. Complication rates were similar with both medications.
• SAP vs. SWAP: In a comparative study of SAP and SWAP (full threshold strategy), among 27 eyes of 22 early glaucoma subjects, SAP detected more abnormality (MD, PSD and number of abnormal points in the pattern deviation probability map) as compared to SAP.
  
  

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