The challenges of monitoring glaucoma progression

Diagnosing glaucoma progression is complex: it requires the precise assessment of functional loss and structural change compared with baseline measurements. Establishing reliable baseline data is essential in this process. Determining a functional baseline requires repeated visual field testing, while documentation of the optic disc appearance is needed for the acquisition of a structural baseline. The latter can be achieved using both clinical and imaging methods, which are complementary. Although imaging-based modalities to assess absolute and rate of progression are likely to prove more important in the future, more guidance is currently required for their use in clinical practice. Because the rate of progression provides important information about the risk of vision loss, guidelines recommend determining the rate of progression for each individual patient when planning management. Adherence issues must be addressed before changing the treatment strategy, since poor compliance can play a considerable role in many patients' disease progression. In conclusion, we must strive to improve the management of glaucoma to limit the impact disease progression has on the patient's quality of life.