| 1. |
A method for detecting abnormality and also documenting optic nerve structure should be part of
routine clinical management of glaucoma.
Explanation: It is known that documentation of optic nerve structure is often missing in
routine ophthalmology practice. |
| 2. |
According to limited evidence available sensitivity and specificity of imaging instruments for
detection of glaucoma are comparable to that of expert interpretation of stereo color photography
and should be considered when such expert advice is not available.
Explanation: Experts evaluating stereophotographs are those who have had specialized training and
experience in this technique. |
| 3. |
Digital imaging is recommended as a clinical tool to enhance and facilitate the assessment of
the optic disc and retinal nerve fibre layer in the management of glaucoma.
Explanation: Digital imaging is available for scanning laser tomography,scanning laser polarimetry
and optical coherence tomography. Digital imaging also is possible for photography, but assessment
remains largely subjective. |
| 4a. |
Automated analysis of results using appropriate databases is helpful for identifying
abnormalities consistent with glaucoma.
Explanation: The comparison of results of examination of individual patients with those of an
appropriate database can delineate the likelihood of abnormality.Structural assessment should
preferably include such a biostatistical analysis. |
| 4b. |
(2007 addition) Automated analysis of change using appropriate assessment of
variability is helpful for identifying change consistent with glaucoma.
Explanation: An eye can be changing and still be within normal limits of a normative database. |
| 5. |
Different imaging technologies may be complementary, and detect different abnormal
features in the same patients.
Note: At this time, evidence does not preferentially support any one of the above structural tests
for diagnosing glaucoma. |
| 6. |
A method for detecting abnormality and documenting functional status should be
part of routine clinical management of glaucoma. |
| 7. |
It is unlikely that one functional test assesses the whole dynamic range. |
| 8. |
Standard Automated Perimetry (SAP), as usually employed in clinical practice, is
not optimal for early detection. |
| 9. |
With an appropriate normative database, there is emerging evidence that short
wavelength automated perimetry (SWAP) and possibly also frequency doubling technology perimetry
(FDT) may accurately detect glaucoma earlier than SAP.
Updated comment 2007: SAP-SITA has similar sensitivity to detect visual field abnormalities as SWAP-full threshold. |
| 10. |
There is little evidence to support the use of a particular selective visual function
test over another in clinical practice because there are few studies with adequate comparisons.
Updated comment 2007: FDT N30 may provide better sensitivity than SAP-SITA or SWAP-full threshold.
Evidence concerning the sensitivity of SWAP-SITA and FDT Matrix 24-2 is not yet available.. |
