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A. U. Bayer, S. Dunker, J. Sebag, German Eye Disease Study Group; German Eye Disease Study: Outcomes Research in the Diagnosis and Management of Glaucoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):855.
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The German Eye Network (GEN) provides glaucoma services to 20 million people via 100 diagnostic centers, all with digital equipment, standardized testing paradigms, and centralized data processing. This pilot study evaluated the impact of GEN on the diagnosis and management of glaucoma.
Functional tests (SWAP and Matrix) and imaging methods (stereo photography, HRT, GDx, and OCT) as well as pachymetry were performed on 488 patients who have been recently diagnosed of having pre-perimetric glaucoma (346) or ocular hypertension (142). Since diagnosis, all patients have been treated with pressure-lowering agents.
After evaluating stereo photographs of the optic nerve head and measuring central corneal thickness (CCT) by an expert (A.U.B.), 162 out of the 488 patients have been proven to be misdiagnosed. Of the 142 OHT patients, CCT measurements revealed that 39 had normal IOP's whereas 14 OHT patients already had glaucoma, at least in one eye. Of the 346 pre-perimetric glaucoma patients, 109 patients showed bilateral normal optic nerve heads and peripapillary regions. To differentiate between the 237 confirmed glaucoma cases and the 109 misdiagnosed non-glaucoma patients, Receiver Operating Characteristic (ROC) analysis was performed. SWAP (ROC 0.907), Matrix (0.889), OCT (0.871), GDx (0.874), and HRT (0.871) performed all clinically promising. All confirmed glaucoma and OHT cases underwent treatment following the recommendations of recent clinical trials (AGIS, CIGTS, OHTS, CNTGS and EMGT) and risk calculation following OHTS and DIGS. Stable target IOP's were achieved using monotherapy with prostaglandins in 69%, a combination of 2 drugs in 28%, or 3 drugs in 3%. Prostaglandins were used either as monotherapy or in combination therapy for 93% of POAG eyes. To reach the target IOP, none of the patients needed any surgical procedure.
The widespread availability of newer diagnostic technologies that GEN provides is likely responsible for an improvement of glaucoma diagnosis. GEN is therefore a useful network for clinical care and outcomes research in glaucoma.
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