Monitoring glaucoma progression.

Monitoring progression is fundamental in managing patients with chronic open-angle glaucoma, which is as important as an early diagnosis of the disease. It is essential that both structural and functional damage be considered, in order to assure a complete and reliable assessment of progression. The optic disc and retinal nerve fiber layer damage can be evaluated using either low-tech (slit lamp biomicroscopy with a 78-diopter lens) or high-tech (HRT, OCT, GDx) methods; the latter providing a more objective and standardized analysis. The current gold standard in detecting functional damage is using standard automated perimetry (SAP). Different approaches can be used to assess SAP progression: (1) clinical judgment; (2) defect classification systems; (3) trend analysis; and, (4) event analysis. Several statistical programs are currently available to assist the ophthalmologist in the difficult task of assessing progression. Clinically relevant progression should only be considered when the change--be it structural and/or functional--is statistically significant, reproducible, and indicative of glaucomatous damage.