Douglas Rhee, MD Covers Highlights of the 2009 ASCRS Glaucoma Day
Dr. David Goldman Interview with Dr. Douglas Rhee
Dr. David Goldman: Hi, I'm David Goldman, Refractive Editor for OphthamologyWeb.com, speaking today with Dr. Douglas Rhee from the Massachusetts Eye and Ear Infirmary. Thank you so much for joining us today.
Dr. Douglas Rhee: Thank you, David. Thank you for having me.
Dr. David Goldman: Now, you were one of the organizers for the "Glaucoma as a Specialty" today here at ASCRS.
Dr. Douglas Rhee: Yes.
Dr. David Goldman: I was hoping we could talk about some of the highlights that you found in the meeting.
Dr. Douglas Rhee: Um-hmm.
I thought the meeting was very well done. I think the biggest--the two biggest highlights are, one, this year there's a real evidence-based approach to trying to examine some of the newer procedures, surgical procedures in glaucoma, as well as the fun part, which is always the surgical complications video.
Dr. David Goldman: Absolutely.
Now, obviously, there are a lot of surgical options now for the glaucoma patient.
Dr. Douglas Rhee: Um-hmm.
Dr. David Goldman: How does one sort of pick and choose between all of these different modalities?
Dr. Douglas Rhee: There are a lot of competitors now for trabeculectomy, and it's because, although trabeculectomy is a wonderful procedure, it does have its limitations, particularly with long-term risks and side effects and adverse events.
Some of the newer procedures do better in that category, but in terms of effectiveness the data is still very young and still very early. So, we still have a little bit of time, I think, to see if any one procedure will come out as a definitive winner, but at this point they all remain very interesting, and the data seems very promising thus far.
Dr. David Goldman: Um-hmm.
And in addition to trabeculectomy type procedures--.
Dr. Douglas Rhee: --Um-hmm--.
Dr. David Goldman: --There are also laser procedures available, and it sounds like--.
Dr. Douglas Rhee: --Um-hmm--.
Dr. David Goldman: --There's a lot of advances or at least research going into advancing the laser technologies as well.
Dr. Douglas Rhee: With--in terms of therapeutics, lasers are of particular interest. There was a discussion in terms of whether lasers should be used as first-line treatment because the scientific evidence indicates that it is at least as good as primary medical therapy. However, there's a cultural barrier to get over with changing glaucoma into a primary surgical disease rather than primary medical disease.
There's also excellent discussions on, and updates, with diagnostics and, in particular, the practical uses. These technologies, like OCT, HRT, GDx, have been around for a while, so there's reporting on them. What was new was not telling people about the technology, but, more so, after years of experience, what are these technologies really good for.
Dr. David Goldman: Um-hmm.
Dr. Douglas Rhee: And I thought in this meeting that was well discussed and was certainly a highlight for the people who attended.
Dr. David Goldman: Sure.
And in your practice, are you using any of these imaging modalities now for certain cases--?
Dr. Douglas Rhee: --Nearly all of them. And I find them to be particularly helpful early when you're trying to diagnose glaucoma, when you're not sure. And why might you not be sure is because the achromatic white-on-white visual field test doesn't show any abnormalities, but there are suspicious anatomic findings that make you believe that there might be glaucoma there. And so, these technologies can be very helpful at that stage.
With regard to progression, these technologies can help point you in the right direction of saying, "Well, this is someone that I need to keep a closer eye on--."
Dr. David Goldman: --Um-hmm--.
Dr. Douglas Rhee: --No pun intended.
But, it's not yet at the stage where I think most people would intervene to a significant level based on the thought that there might be progression solely on one of these newer diagnostic technologies--.
Dr. David Goldman: --Sure.
In terms of making the diagnosis of glaucoma, are there some caveats when using these technologies that doctors should be aware of that they might falsely call someone a glaucoma patient--?
Dr. Douglas Rhee: --Well, that's an excellent question, David. I think even with our established technologies of optic nerve photography and visual field testing, if you see something that doesn't look right, in other words it looks worse, you should always confirm it. And I think that's not unique to just the new technologies; I think that's also very important for our more established diagnostic methodologies.
Dr. David Goldman: Sure.
And regarding the surgical complications, were there any pearls that came out of the discussions on those?
Dr. Douglas Rhee: Oh, there--those are always, you know, entertaining and very educational because there's a large panel of people who will present their surgical complications, and the rest of the panel will comment on what could have been done differently, their approaches to that same issue--and the speaker is also involved--.
Dr. David Goldman: --Um-hmm--.
Dr. Douglas Rhee: --It's done, you know, in a very supportive sort of way. It's not attacking the person who--.
Dr. David Goldman: --Sure--.
Dr. Douglas Rhee: --You know, is brave enough to show a complication.
Dr. David Goldman: And where do you think we'll be 10 years from now in our diagnosis and treatment of glaucoma?
Dr. Douglas Rhee: Well, that's a tough--difficult question, David. I think we'll still be relying heavily on structural imaging technologies. I think that there's always going to be some component of functional testing, whether that remains the standard achromatic white-on-white testing that we've been doing for decades now. Probably, but hopefully in the next 10 years, we'll actually start to see movement towards biomarkers for testing, whether functional biomarkers with higher order imaging or whether it be genetic testing.
So, I think we're on the cusp, and in the timeframe that you asked, 10 years, I think it's possible that we might start to see some of that emerging.
Dr. David Goldman: Well, thank you very much for joining us today.
Dr. Douglas Rhee: David, it's been a pleasure. Thank you very much for having me.
Dr. David Goldman: For more information, please click on the links below this video.