Glaucoma Diagnosis: From the Artisanal to the Defined

Purpose: To chronicle the history of glaucoma diagnosis from its subjective ancient origins to the modern, formerly aspirational goal of objective, precise, accurate quantitative diagnostics. Methods: A review of the literature was performed to assess the method of diagnosis of glaucoma and determination of glaucoma progression. Main Outcome Measures: Glaucoma diagnosis, glaucoma progression detection, and the tools and techniques used for the same. Results: Glaucoma diagnostics have progressed from simple observation to actual quantitative measurement. In the 19th and 20th centuries, accurate, precise measurement techniques were developed and used, and by the late 20th and early 21st centuries, the presence and progression of glaucoma could be determined not only quantitatively but also objectively, and with a high degree of precision and accuracy. Conclusions: Over the past 3 millenia, glaucoma diagnostics have evolved from subjective observation to quantitative, objective, accurate, precise measurement. Applanation tonometry has replaced finger tension intraocular pressure measurement; automated perimetry and statistical analysis have supplanted subjective assessment of manual visual field (VF) assessment; and imaging technologies, such as OCT, have provided measurable, unbiased, correct, and reproducible alternatives to clinical observation and optic disc drawings. The net effect of this innovation has been a paradigm shift from dependence on subjective physician interpretation to incorporation of objective data for discerning the presence and progression of glaucoma from health and stability. Ophthalmologists are now able to detect glaucoma and its progression earlier than ever before, enabling precise and personalized clinical decision-making that ultimately serves patients by triggering escalations of treatment even before the development of grossly detectable damage. Further, the objective, quantitative, accurate, and precise measures allow expert diagnosis to occur without the necessity of an expert observer. This permits high-quality glaucoma care in nearly any setting.