Hi,

The detection of glaucoma mainly depends on the intraocular pressure, thickness of retinal nerve fiber, optic nerve and visual field examination..

i commented your blog..

Best Wishes..

Hi Dr Gomathy. You are right. These are parameters useful in the diagnosis of glaucoma. Now the need is to use some kind of AI platform to bring all these and others such as angle studies, central Corneal thickness and stereophotos of the optic disc to one common point and help in instant diagnosis of glaucoma.

Dear Dr. Syed Shoeb Ahmad

The short answer is yes, Arificial intelligence helps the detection of glaucoma; According to the GRF (Glaucoma Research Foundation), you should also take into account the RISK FACTORS and integrate them into the diagnostic test, since they increase the reliability; these are:

Over 60 years

Elderly Hispanics

Of African descent

Relatives of people with glaucoma

Myopic

With diabetes

They use steroids for a long time.

Finally it is important to give the patient some good indications for the future, such as: the periodic review and the probability of suffering in the future this disease even if the test is negative.

Dear Adolfo Catral Sanabria like any other disease, glaucoma is diagnosed on the basis of 3 things: history, examination and investigations. So, we need to integrate all and as I mentioned use AI to make diagnosis simplified.

Dear DR.

you're right, if you are able to integrate the three parts of the diagnosis, you will have achieved a considerable improvement in the diagnosis, definitely the artificial intelligence is your tool to achieve it.

Please read this Article A deep learning model for the detection of both advanced and...

For any glaucoma theory to be valid it must also explain ( whether via real intelligence or artificial) the reason for the orderly loss of nerve fibers occurring in glaucoma otherwise it would be of no value and a waste of time and resources. The orderly loss of nerve fibers is the basis for doing perimetry in glaucoma otherwise it would had been meaningless.

I would like to ask a question. Is glaucoma or not a disease of retinal ganglion cells? Perg is the only objective evaluation that is able to detect the dysfunction of these retinal neurons. If Perg are normal, especially steady-state, it is not glaucoma. If the Perg are altered all other evaluations are by the clinician. In my opinion Perg are first level of diagnostic evaluation.

Dear Alberto,

No, the retinal ganglion cells can’t be the primary site of injury in glaucoma due to following reasons.

One million or so densely packed NFs in ONH are being destroyed in an orderly sequence, never, never haphazardly. Glaucomatous field defects reveal a specific pattern such as arcuate scotoma and Ronnie’s nasal step. In order to achieve this goal the RGCs in the ganglion cell layer must also be lying in similar arcuate pattern with nasal step but they are not.

The arcuate scotoma and Ronni’s nasal step correspond fully with the arrangement of NFs in the nerve fibers layer of retina and in the ONH until they make a 90- degree turn towards the lamina cribrosa. This suggests that the site of injury to NFs in glaucoma has to be any where from the retinal NFs layer to the point the NFs make their 90-degree turn and become vertically oriented.

After the NFs become vertically oriented the horizontal arcuate pattern is lost in the onward journey to LC and beyond. In other words both ganglion cells layer and lamina cirbrosa can’t be the site of injury in glaucoma since any injury at these two sites can’t produce arcuate field defects. I believe the RGCs are dying due to retrograde degeneration resulting from the axotomy of the NFs at their 90 degree turn against the scleral edge.

Pattern ERG test only tells us that RGSc are damaged but it is not a specific test for glaucoma since several other conditions such as hereditary, demyelinating and ischemic can also result in abnormal PERG. Unless PERG is specific only for glaucoma it will be of limited value in glaucoma diagnosis. In essence the glaucoma is not an optic neuropathy but an axotomy- a paradigm shift.