Moderne diagnostische Verfahren bei Glaukomverdacht und Glaukom

Zusammenfassung

Hintergrund: Die Grenzziehung zwischen frühen glaukomatösen Schäden und Normalbefunden, aber auch die Verlaufsbeobachtung von Glaukompatienten bereiten noch immer häufig Probleme. In den letzten Jahren wurden zahlreiche neue Untersuchungsmethoden für Glaukom erprobt und teilweise bereits am Markt eingeführt. Methoden: Die vorliegende Zusammenfassung gibt einen Überblick über die Ziele apparativer Untersuchungen bei Glaukom und Glaukomverdacht. Die für einen breiteren Einsatz in der ophthalmologischen Praxis infrage kommenden Untersuchungsmethoden werden bezüglich ihrer Eignung für die Ziele der Frühdiagnose, objektiver Diagnostik, Progressionsanalyse und Screeningeinsatz beurteilt. Schlussfolgerungen: Bislang haben die neuen apparativen Methoden das diagnostische Vorgehen nur gering beeinflusst. Dies liegt im Wesentlichen daran, dass gerade bei den problematischen Glaukomgrenzfällen auch diese Methoden nur über eine limitierte Aussagekraft verfügen oder noch nicht ausreichend untersucht wurden. Dennoch können hier der Heidelberger Retina Tomograph (HRT), der Nervenfaseranalysator GDx, die Blau/gelb-Perimetrie sowie der Frequenzverdopplungstest (FDT) eine gewisse Rolle spielen. Zur Therapiekontrolle haben sich der HRT und das GDx vor allem in frühen Krankheitsstadien bewährt. Der FDT eignet sich durch sehr kurze Untersuchungsdauer, gepaart mit guter Spezifität, gut als Screeningtest.

Abstract

Background: Diagnosis of early glaucomatous damage as well as the detection of glaucomatous change are still difficult tasks. During the last years numerous new diagnostic techniques have been investigated and some of them have been introduced to the market. Methods: This paper reviews the different aims of diagnostic technologies in the field of glaucoma. Methods appearing suitable for a large-scale use by ophthalmologists will be judged according to their suitability to meet the goals of early diagnosis, objective diagnosis, progression analysis and screening. Conclusions: The new diagnostic techniques have not yet greatly influenced our diagnostic procedure. This is mainly due to the fact that, for the most difficult borderline cases of glaucoma, these methods are of limited value, or have not yet been sufficiently investigated. Nevertheless, the Heidelberg retina tomograph (HRT), the nerve fiber analyzer GDX, short wavelength perimetry (SWAP), and the frequency doubling test (FDT) may play a role in these cases. For follow-up, HRT and GDx have proven valuable, especially in early stages of the disease. The very short testing time of FDT together with good specificity qualifies this test for glaucoma screening.

Schlüsselwörter

Glaukom - okuläre Hypertension - HRT - GDX - Blau/gelb-Perimetrie - FDT - OCT - Progressionsanalyse - Frühdiagnose - Screening

Key words

Glaucoma - ocular hypertension - HRT - GDX - SWAP - FDT - OCT - progression analysis - early diagnosis - screening

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