Structural imaging plays an integral but not solo role in glaucoma management

Article

Imaging is an essential part of glaucoma management, but while structural damage is frequently apparent before identifiable visual field loss occurs, both functional testing and quantitative imaging should always be performed in eyes with either early or moderate disease, said David F. Garway-Heath, MD.

Imaging is an essential part of glaucoma management, but while structural damage is frequently apparent before identifiable visual field loss occurs, both functional testing and quantitative imaging should always be performed in eyes with either early or moderate disease, said David F. Garway-Heath, MD.

Dr. Garway-Heath, consultant ophthalmologist, Moorfields Eye Hospital, London, addressed the question of what is the best way to detect change in the optic disc and retinal nerve fiber layer (RNFL) during a glaucoma symposium held during the World Ophthalmology Congress.

In deciding what imaging technique to use, stereodisc photography should be considered the minimum requirement in the management of patients with suspect and established glaucoma. Among the advantages of sterodisc photography are: that it is the only imaging technique that provides full color, it has high resolution, and the images are similar to what the ophthalmologist sees in the clinical evaluation. However, this technique has limitations. Obtaining good image quality is difficult in eyes with media opacity, there is a lack of adequate systems for viewing the photos in the clinic, interpretation is highly subjective and observer-dependent, and changes that occur cannot be quantified.

Modern imaging devices, including confocal scanning laser tomography, scanning laser polarimetry, and optical coherence tomography, provide objective data and measurements that are highly repeatable. Nevertheless, these devices still lack statistical support, and the clinical relevance of the findings remains uncertain - as it is not known how to translate the structural change they detect into future functional loss.

"Irrespective of what imaging approach is used, always perform an adequate clinical exam and recording the findings in the chart with an accurate drawing and description of the quality of the RNFL. That information has value both as a comparator against the results obtained in the imaging studies and for future monitoring," said Dr. Garway-Heath.

Newsletter

Join ophthalmologists across Europe—sign up for exclusive updates and innovations in surgical techniques and clinical care.

Recent Videos
ARVO 2025: Anat Loewenstein, MD, shares data from herself and her colleagues on meeting needs of patients with diabetic retinopathy
At the American Society of Cataract and Refractive Surgeons annual meeting, Sheng Lim, MD, FRCOphth discusses the benefit of endoscopic cyclophotocoagulation for patients with primary open angle glaucoma and cataracts in the CONCEPT study
A photo of Seville, Spain, with the Congress on Controversies in Ophthalmology logo superimposed on it. Image credit: ©francovolpato – stock.adobe.com; logo courtesy COPHy
Anat Loewenstein, MD, Professor and Director, Department of Ophthalmology, Tel Aviv Medical Center, discusses the Congress on Controversies in Ophthalmology (COPHy)
(Image credit: Ophthalmology Times Europe) AGS 2025: Clemens Strohmaier, PhD, on improving aqueous humour outflow following excimer laser trabeculostomy
3 experts are featured in this series.
Anat Loewenstein, MD, speaks about the 22nd Annual Angiogenesis, Exudation, and Degeneration Meeting in February 2025 and shares her global forecast for AI-driven home OCT
3 experts are featured in this series.
3 experts are featured in this series.
Sarah M. Thomasy, DVM, PhD, DACVO, a veterinary ophthalmologist at UC Davis, talks about how her research at the Glaucoma 360 symposium
© 2025 MJH Life Sciences

All rights reserved.