Early diagnosis, treatment of glaucoma using advanced technology is an ethical obligation

Key Takeaways

  • Due to OCT and other new technology, eye doctors now have an “ethical obligation” to diagnose glaucoma early before blindness decreases the patient’s quality of life.
  • OCT allows for earlier detection, and more rapid education and treatment of patients.

Optical coherence tomography, or OCT, is an imaging method used to generate a picture of the back of your eye, called your retina. The noninvasive method produces an image by measuring the amount of a dim red light that reflects off of your retina and optic nerve. Before the introduction of OCT, the standard of care for identifying initial damage from glaucoma was based on the physical examination. Identifying and tracking changes over time, however, was hindered by the non-objective method of measurement. Physicians often had to wait until visual field testing showed a scotoma (blind area) consistent with glaucoma in order to quantify disease effect and stratify treatment. 

We now know that by the time ganglion cell (RGC) loss can be identified as a scotoma on visual field testing, anywhere from 30% to 45% of them have been lost. By today’s criteria, this would indicate moderate glaucoma at the very least.  Before laser treatment and microinvasive glaucoma surgery were available and their value established in evidence-based clinical trials, this strategy was acceptable. 

Today, with the help of advanced OCT modalities, we have the ability to identify disease sooner and intervene earlier, well before 30% or more ganglion cell loss. The paradigm shifts from a goal of ensuring patients lose as little vision as possible to helping patients keep as much vision as possible. The fact that we have the ability, with the aid of modern technology, to detect disease earlier and protect vision for longer also makes it an ethical obligation to our patients that we employ these tools. In the best interest of our patients, we must find and track disease, identifying changes before noticeable vision loss occurs –  maintaining their quality of life for longer.

OCT images can be viewed immediately, and remotely, after an OCT exam. This allows providers to immediately educate patients on their condition and status. If they need pressure reduction with drops, surgery or laser, treatment can begin that much faster. In today’s age of glaucoma management, we have many tools that we can use to avoid patients losing vision needlessly. When a patient is properly educated about all the aspects of glaucoma and how we plan to manage it, they are happier, trust that they are in good hands and satisfied that they are receiving proper care.

OCT improves our clinical management of glaucoma with invaluable data. We know how much of an impact glaucoma has on our patients’ quality of life. Our ethical obligation is to use technology to benefit our patients. We owe it to them.

Source: Sanket S. Shah, MD, Healio Ocular Surgery News, February 16, 2024; see source article