Imaging - a marketing pitch to patients or ancillary test used appropriately?

I posted the following on 5Mar2011 in the Members’ Only Glaucoma Blog at the American Academy of Ophthalmology Community. I am sharing it here as well to open it up for discussion with a wider audience.


I’m reporting live from the American Glaucoma Society 21st Annual Meeting in Dana Point, California. There were two talks today that warrant more discussion in terms of figuring out if we are using imaging devices appropriately in the care of our glaucoma patients. One talk was from Josh Stein on the changes in diagnostic evaluation of patients with open angle glaucoma from 2001-2009. The other talk by Mitra Sehi looking at topography and nerve fiber layer imaging as a predictor for visual field progression.

The good: temp-inf moorfields’ parameter as well as GDx-ECC inferior rim and TD-OCT inferior rim were the only 3 parameters of the dozens of values produced by these three devices that was shown to be a predictor of visual field progression. This helps to justify that these ancillary tests can help guide us in caring for our glaucoma patients.

The bad: more optic nerve imaging is now being done than visual field testing in patients with open angle glaucoma. Does this contravene the AAO Preferred Practice Pattern guidelines for the care of open angle glaucoma in which imaging is an ancillary test that may show increasing merit as the technology evolves but is not a replacement for visual field testing.

Is imaging being pushed by some eye care providers to patients as an integral part of a full eye exam thus making patients feel pressured to pay for imaging that may not be needed or in their best interests? Or, are our guidelines out of date and imaging is now more important than visual field testing?

Please discuss.