NHMRC Glaucoma Guidelines - ANZGIG
NHMRC Glaucoma Guidelines - ANZGIG
NHMRC Glaucoma Guidelines - ANZGIG
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<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA<br />
Chapter 8 – Monitoring: long-term care<br />
1. Target achieved<br />
Follow-up reviews are dictated by the stability of the VF and the disc findings.<br />
2. Target not achieved<br />
Health care providers should fully review patients’ capability to adhere to the medication<br />
regimen. When reviewing patients who have previously undergone surgery, it is important<br />
to review drainage blebs.<br />
The therapeutic regimen should then be altered, as appropriate. This guideline provides<br />
evidence-based hierarchies of choice regarding therapeutic intervention (see the Chapters<br />
on medication (9), laser therapy and surgery (10)). Options include increased support<br />
for adherence, change of medication, laser or surgery. Frequent review (every four to six<br />
weeks) may be required whilst altering treatment and re-establishing baseline IOP.<br />
3. Target not achieved and concurrent fluctuation of intraocular pressure<br />
When there is very unstable IOP, more frequent review (every one to four weeks) may be<br />
required, whilst altering treatment and re-establishing baseline IOP.<br />
Evidence Statements<br />
• Expert/consensus opinion suggests that in established glaucoma where intraocular pressure targets<br />
are being achieved, monitoring schedules are guided by the severity and stability of disc and visual<br />
field examinations.<br />
• Expert/consensus opinion suggests that in established glaucoma where intraocular pressure targets<br />
are not being achieved, the management plan requires alteration and a review undertaken within four<br />
to six weeks.<br />
• Expert/consensus opinion suggests that in highly unstable established glaucoma, where intraocular<br />
pressure targets are not being achieved, the management plan requires alteration and a review<br />
undertaken within one to four weeks.<br />
• Evidence supports using tonometry on every visit, for patients with established glaucoma, once a<br />
baseline has been set.<br />
• Expert/consensus opinion suggests that monitoring timelines for patients with angle closure glaucoma<br />
are guided by angle morphology, optic disc and/or visual field stability and intraocular pressure.<br />
After surgery for primary open angle glaucoma<br />
This section outlines the evidence for monitoring patients after surgery. This evidence has been<br />
distilled from guidelines included in this review.<br />
Post-laser treatment for glaucoma<br />
The laser treatments for glaucoma tend to require very similar post-operative care. The only<br />
exception here is cyclodiode laser. The commonest lasers performed for glaucoma are YAG laser<br />
iridotomy, Argon laser trabeculoplasty, laser iridoplasty and selective laser trabeculoplasty. All these<br />
four laser types can cause an elevation in intraocular pressure which may last from hours to days or<br />
weeks. The most likely situation in which this will occur is in elderly patients, those with narrowed<br />
angles and, in particular, those with an inflammatory component to their glaucoma. All of these<br />
laser procedures should be treated with an alpha-2 agonist (Brimonidine or Iopidine) prior to or<br />
just after the laser is performed (using one drop in the treated eye).<br />
102 National Health and Medical Research Council