Produção Nacional
Revisado por pares
Staging Glaucoma Patient: Why and How?
2009; Bentham Science Publishers; Volume: 3; Issue: 2 Linguagem: Inglês
10.2174/1874364100903020059
ISSN1874-3641
AutoresRemo Susanna, Roberto M. Vessani,
Tópico(s)Retinal Imaging and Analysis
ResumoStaging glaucomatous damage into appropriatecategories enhances management of the disease.Automated static perimetry is the benchmark for testing visual function in glaucoma.Numerous examples of standard automated perimetry staging systems have been proposed but difficulties such as lack of accuracy, absence of information related to location and depth of the defect(s) and need of time-consuming analysis of every visual field test result may reduce their day-to-day clinical usefulness.A new visual field staging system is proposed: the University of São Paulo Glaucoma Visual Field Staging System (USP-GVFSS).In this system, qualitative and quantitative characteristics of the visual field defect are described.The method is intuitive, comprehensible and describes severity, extension and hemi field involvement. WHY STAGE GLAUCOMA PATIENT?Staging glaucomatous damage into broad categories of damage such as, mild, moderate, and advanced enhances management.It promotes careful assessment and documentation of clinical damage, thereby facilitating monitoring for stability versus progression and provides a common language for both clinical and research purposes. HOW TO STAGE GLAUCOMATOUS DAMAGE?Glaucomatous damage can be quantified using either structural or functional loss criteria, or a combination of both.Patients with glaucoma may present with the disease before damage is detectable with standard achromatic automated perimetry ("pre-perimetric glaucoma") or with clear glaucomatous visual field defect(s).In pre-perimetric glaucoma, clinicians may detect structural changes.However, manual systems based on clinical examination are subjective, relatively poorly reproducible, and require specific clinical experience.Automated computerized devices analyze and quantify the optic nerve and RNFL thickness objectively with good reproducibility.These include scanning laser ophthalmoscopy, scanning laser polarimetry and optical coherence tomography; each may quantify and allow broad staging of structural damage.However these expensive and sophisticated technologies are evolving faster than clinical assessment of their utility. Perimetric GlaucomaAutomated static perimetry is the benchmark for testing visual function in glaucoma; in the first evaluation it detects and quantifies damage, and in follow-up of a diagnosed patient, it detects stability or progression of loss.Patients
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