Comprehensive Glaucoma Imaging

Advancements in ocular imaging over the past four decades have revolutionized glaucoma practice worldwide. As glaucomatous vision loss cannot be restored, early diagnosis, proper management, and timely intervention are essential to slow disease progression. The emergence of advanced computerized imaging modalities has shifted glaucoma assessment from being largely subjective to mostly objective. These modalities can document and accurately quantify the optic nerve head and the macula regions, which are affected by the disease. With various ocular imaging devices evolving over the years, optical coherence tomography (OCT) has become the dominant imaging technology in glaucoma practice. From the first prototype device to the newest swept-source OCT, each generation improved in image acquisition time, scan resolution, and artifact reduction, making structural assessment more accurate and sensitive. This advancement allows clinicians earlier detection of glaucoma diagnosis and increased sensitivity in monitoring of progression enabling timely modification of treatment to halt further damage. Moreover, the introduction of OCT angiography (OCTA) drew attention to the vascular component as an important element in glaucoma pathogenesis. In addition to technical advancements, the imaging field continues to evolve by the incorporation of innovative software such as image processing and artificial intelligence. Taken together, the role of ocular imaging is expected to further expand with a substantial impact on clinical management.