Those who treat patients with glaucoma, know that many patients that are on glaucoma treatment, really don`t have glaucoma. As in many other chronic diseases, overdiagnosis and overtreatment are big problems in glaucoma. Nevertheless very few publications have addressed this issue.
Which strategies should be implemented to reduce the problem of overdiagnosis in glaucoma?
Proper training to the health care workers is important. We see a lot of over-diagnosis and conversely a number of patients with glaucoma being treated as conjunctivitis or cataract. If the doctors and non-medical staff are knowledgeable enough we can rule out true glaucoma from false cases.
In my opinion the cutting-edge advancements in devices for glaucoma objective diagnosis are required, currently only OCT, which will help the clinicians made an exact diagnosis preventing overdiagnosis
Over diagnosing glaucoma is really a big issue in settings like Africa, where there is high proportion of people with physiologic cupping as well risk of high progression of glaucoma if not treated earlier.
I think it is not that easy and that the use of diagnostic technology that is more and more sensitive every day, increases the risk of overdiagnosis and overtreatment.
I think, one measure with airpuff tonometry increases the risk of overdiagnosis and overtreatment
1- applanation tonometry , central corneal thickness, corrected IOP
2- fundus examination , character of cupping and head of optic disc
3- risk factors , as family history
4- perimetry test,
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Overdiagnosis in glaucoma is quite prevalent among the clinical community
Only definitive evidence of glaucoma diagnosis is characteristic optic neuropathy
on dilated 90D or 78D biomicroscopic examination
The early clinical diagnosis depends much to the experience of clinician on optic nerve head evaluation and is subjective still
IOP is not sensitive enough for the diagnosis of glaucoma unless is significantly high at multiple point in times
The more objective OCT may underdiagnose or overdiagnose GON and may give non correlating findings many a times due to poor quality and centration of picture acquisition and due to biologically variable Optic disc morphology
Like to conclude saying that it is better to observe and not treat somebody who doesn't have glaucoma rather than overdiagnosing and treating them giving the burden of long terms medications with its attendant local and systemic side effects, monitory loss and above all psychological trauma of a blinding disease
Discussion with the "glaucoma suspects" and close observation is the key to prevent overdiagnosis and overtreatment, considering the risk factors of glaucoma in a particular suspect
A mutually correlating documented progression in clinical or test wise evaluation is the key to diagnosis and the starting point of treatment
As Doctors we should at least not harm somebody if not treating them
I medicate the ocular hypertension which is high enough to cause any headache, "allergic" rhinitis, sinusitis, migraine, or any other sign or symptom.
The word "glaucoma" is useless, it causes stress in the patient, and it must not be used or told to them. All my patients are medicated "to prevent the glaucoma", and they like to hear this.
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