Home Glaucoma Updates Literature Updates Drugs Antibiotics Antiviral Drugs Corticosteroids Glaucoma Medications Ocular Allergy Drugs Steroid Antibiotic NSAIDS Oral Medications Dry Eye Intervention Plaquenil Updates Diabetes Updates Diabetes A1C Test GDx-VCC/HRT/OCT Exam Room Essentials Contact Us   When Is Early Diagnosis Too Early? Our charge in glaucoma is profoundly simple: Keep our patients with glaucoma asymptomatic until they die, hopefully using therapeutic options wisely to minimally impact their quality of life. So when should we step in therapeutically? This will vary radically from patient to patient, and the genius, or lack thereof, of your care will not be known for ten years or so, in retrospect! What if we had a device that could accurately count the individual ganglion cells? Would we start therapy when one cell was unequivocally lost from glaucomatous optic neuropathy? What about 10 cells, or 100, or 1,000, or 10,000? When is the “right” time to intercede therapeutically? At what stage of optic nerve demise do image analyzers discern? If the instrument-generated data indicates early glaucoma, is it just physiologic variance, or indeed early glaucoma? This technology has now evolved to the point of being clinically valuable.  It is not a perfect (i.e. 100% sensitive and specific), but is now refined to the point of being clinically valuable for many patients. While we submit that the astute clinician using applanation tonometry, corneal pachymetry, state-of-the-art static threshold perimetry, and stereoscopic evaluation of the optic nerve head will be able to assess risk for glaucoma development plenty early enough to meet the goal stated in the first sentence, we have found glaucoma imaging technology further enhances our clinical decision making. We now recommend all doctors providing glaucoma care acquire one of these available instruments. The one we use is the GDx-VCC, and we are pleased with its clinical performance. Does it serve the overall good of humanity and public health to presume abnormal findings on one test parameter or result (in the absence of other confirmatory clinical findings) to represent a disease entity for which treatment may needlessly exact a toll of diminished quality of life? Carrying a disease diagnosis and its attendant anxiety, expense of therapy, and exposure to potential side effects is a step that should be taken only when an appropriate assessment of risk or a definitive diagnosis is made and the institution of therapy meets the wisdom of risk versus benefit.