Nov
13
Written by:
John Murphy
11/13/2009 9:00 AM
George L. Spaeth, MD, the Louis J. Esposito Research Professor at Wills Eye Institute and Jefferson Medical College, is one of the foremost glaucoma experts—and he says eye doctors are doing a lousy job at glaucoma.
“We can do much better than we’re doing,” he says, including himself in the bunch.
(I’m reporting live from the American Academy of Optometry meeting in Orlando. Instead of working in my tiny cubicle in the dank, dark sub-basement of the venerable Review of Optometry building, I’m writing this from a stuffy, windowless back room in an enormous conference center. A nice change.)
Back to Dr. Spaeth … He was an honored speaker at two different lectures organized by the Optometric Glaucoma Society. Dr. Spaeth had a lot to say, but he mostly focused on evaluating the optic disc. He said we need more valid techniques than cup-to-disc ratio, which should be tossed out. “It’s useful for following, but not diagnosing,” he said.
The principal elements of glaucoma examination, according to Dr. Spaeth, are a thorough patient history and a specific evaluation of optic disc damage. He introduced a nomogram for evaluating optic disc damage called the Disc Damage Likelihood Scale (DDLS). It’s done by estimating the width of the neuroretinal rim along with the size of the disc diameter.
Visual fields are helpful, he says, but you can’t put too much faith in them. Specifically, he wants to “put the nail in the coffin” of normative databases. “You can’t reliably apply population statistics to individuals,” he said.
Dr. Spaeth also described an experiment that showed how bias influences clinical evaluation. You can get the evaluation wrong merely by what you assume. So, look at the patient’s optic disc before looking at past photos or visual fields, he said. “We need to be more rigorous in masking ourselves to clinical information.”
Dr. Spaeth had a lot of “take home” points, but the one I came away with was … Here’s a 77-year-old glaucoma expert at the top of the heap. He could easily rest on his laurels (which is even less comfy than it sounds). Instead, he’s relentlessly demanding improvement and advancement—from himself as well as all eye doctors.
Wouldn’t it be great if we could all be that rigorous and vigorous?
Tags: