Consensus 1

edited by Robert N. Weinreb and Erik L. Greve
2004. viii and 152 pages with 17 figures, of which 12 in full color, and one table. Hardbound.
ISBN-10: 90 6299 200 5.
ISBN-13: 978-90-6299-200-3
Published by Kugler Publications.
Click here for more information on all publications in the Consensus series.

Consensus Statements

• Structure
• Function
• Function & Structure

Structure

1. A method for detecting abnormality and also documenting optic nerve structure
   should be part of routine clinical management of glaucoma.
   Explantion: 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 colour-photography and should be considered when such expert advice
   is not available.
   Explantion: 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.
   Explantion: 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.
   
4. Automated analysis of results using appropriate databases is helpful for
   identifying abnormalities consistent with glaucoma.
   Explantion: 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.
5. Different imaging technologies may be complementary, and detect different
   abnormal features in the same patients.

Note 1: At this time, evidence does not preferentially support any one of
the above structural tests for diagnosing glaucoma

Function

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.
   Explantion: Earlier detection of glaucomatous damage with SWAP and FDT than
   with SAP has been consistently demonstrated.
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.Explantion: At this time, there is no evidence to
    support the superiority of either SWAP vs. FDT.

Function & Structure

11. Published literature often lags behind the introduction of new technology.
    Therefore literature based on previous versions of current technology should
    be viewed with caution.
12. In different cases, either structural examination or functional testing
    may provide more definitive evidence of glaucoma, so both are needed for detection
    and confirmation of the subtle early stages of the disease.

Note 2: Data from both functional and structural examinations always should
be evaluated in relation to all other clinical data