Glaucoma risk calculators essential to clinical decision making, speaker says
NEW ORLEANS — Understanding and applying the concepts of risk assessment can help foster more informed treatment recommendations for glaucoma, as well as a better-educated patient, a speaker said here.
Risk assessment should be intuitive, quantitative and qualitative, Robert D. Fechtner, MD, FACS, said at Glaucoma Subspecialty Day preceding the American Academy of Ophthalmology meeting.
“Intuitively, in the blink of an eye, you use your life’s experience — every patient you’ve seen — and integrate that information and make your risk,” Fechtner said. “We can get the qualitative approach from data put forth in clinical study showing us clinically supported risk hazards.”
Using risk factors to assess a patient’s risk for progression, an application clinically supported, is useful for questionable, early cases and for difficult-to-diagnose cases, such as cases with atypical optic nerves or unreliable visual fields; it also can help determine the intensity of treatment, the intensity of surveillance and/or a target IOP, Fechtner said.
“These are tools that can help us train ourselves. Integrating our risk factors means getting knowledge of the risk factors, identifying them, assessing the individual risk and making a clinical decision,” he said. “It will inform our frequency of monitoring, our treatment thresholds, our targets. We need to think of quality of life, effectiveness of therapy and life expectancy. Estimate risk. Estimate life expectancy. Talk to your patients. Then make a clinical decision.”
Disclosure: Fechtner has no relevant financial disclosures.