Use of GlaucoChart (Medisoft®) in the Identification of Stable Ocular Hypertensive and Glaucoma Suspect Patients

Abstract

Purpose: : The ability to use objective measures to differentiate stable glaucoma suspect and ocular hypertensive patients from those that have progressive disease is increasingly recognized as a priority in glaucoma management. The present study uses a glaucoma summary chart (GlaucoChart) that incorporates currently accepted individually measured parameters to create an overall trend analysis, thereby identifying those stable patients who could be safely followed up in the community.

Methods: : Parameters for the GlaucoChart were chosen based on published literature, as previously described. A GlaucoChart was created on Medisoft® (an ophthalmic electronic patient record system) for each patient who had at least three reliable Humphrey visual field tests and three reliable HRT examinations. Patients were diagnosed as "glaucoma", "glaucoma suspect" or "ocular hypertension" according to the EGS guidelines (2008). Visual field index (VFI) was incorporated into the visual field parameters in addition to mean deviation (MD) and pattern standard deviation (PSD). HRT indices included rim volume, linear cup-to-disc ratio and mean retinal nerve fibre layer thickness. Patients were categorized as progressive if there was a deteriorating linear trend in any ONE of the six parameters detailed above.

Results: : A total number of 117 patients with 197 eyes fulfilled the inclusion criteria. 98 eyes had a diagnosis of "glaucoma" and 30 (31%) of these were shown to be stable by all six parameters measured. 38 eyes had a diagnosis of "glaucoma suspect" and 25 (66%) of these were shown to be stable. 61 eyes had a diagnosis of "ocular hypertension" and 25 (41%) of these were shown to be stable.

Conclusions: : This study clearly shows that it is possible to differentiate between stable and progressing patients using the GlaucoChart. Furthermore, it highlights the utility of GlaucoChart in providing easily interpretable data to identify patients requiring more specialist follow-up. This is demonstrated by the higher percentage of glaucoma suspect patients with stable disease compared to those with a definitive diagnosis of glaucoma. The GlaucoChart can potentially be used to safely monitor glaucoma patients in community eye clinics allowing hospital clinicians to focus on unstable patients.

Keywords: imaging/image analysis: clinical • visual fields • optic nerve