Dr Pazos’s experience in glaucoma control with the aim of achieving “0” disease progression
Dr Marta Pazos MD, PhD, the glaucoma specialist at the Institut de la Màcula, has explained how to optimise the results obtained in the tests that are habitually used to monitor the disease. During a training session organised by Carl Zeiss Meditec AG, the international leader in the area of optics applied to medicine, Dr Marta Pazos said that gaining the greatest benefit from tests enables more exact information to be obtained and proper monitoring carried out: “The aim is to achieve to achieve “0” progression and keep the vision at the highest possible level despite the disease”, she said.
The most frequent tests are Campimetry and Optical Coherence Tomography (OCT). The two are complementary but different, as while OCT is an anatomical test that enables structural damage to be viewed, Campimetry is a functional test used to detect changes that have occurred in peripheral vision.
Based on her experience, Dr Marta Pazos set out some of the operational keys to achieving this optimisation. Firstly, she recommended assessing the tests in terms of the degree of glaucoma as it has been proven that in incipient glaucoma the information provided by an OCT is better, while in a more advanced form it is more efficient to carry out Campimetry. In glaucoma, structural changes begin ahead of functional ones. It is believed that 30-50% of axons may be lost before a change can be shown by a campimetric test.
She also recommended observing the evolutionary trend reflected by the diagnostic tests as well as including the age factor -whenever possible- as an element of assessment. The development of glaucoma possesses an important hereditary component that increases with age. Moreover, the software that assesses progression is not adapted for the physiological loss produced by age and must be considered in order to avoid confusing glaucomatous progression with ageing.
Dr Marta Pazos said that in order to be able to carry out proper monitoring of the disease it is also vital to perform control tests at least twice a year, and to increase controls in those cases that present greater known risk factors like pseudo-exfoliation or bleeding of the optic nerve, among others.
Glaucoma has no symptoms and therefore it is recommendable to visit an ophthalmologist once a year from the age of 65 in order to screen earlier: “When the disease is detected, the aim is to undertake personalised treatment and control its evolution so that it does not continue to cause further damage”, Dr Marta Pazos said.