NHMRC Glaucoma Guidelines - ANZGIG

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NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 1 – Recommendations and Evidence statements ■ Chapter 1 Recommendations and Evidence statement The recommendations were derived from the evidence statements within each chapter. Evidence Statement Grade Key: For each recommendation, the Grade of Evidence is summarised and shown in an evidence table. An overall grade is represented beneath by a single capital letter, ranging from A to D. These grades are derived from the NHMRC Body of Evidence matrix (2009) and were determined in the same way that each of the five levels of evidence were determined. “Expert/consensus opinion suggests” “Evidence supports/indicates” “Evidence strongly supports/indicates” Denotes evidence from expert opinion provided by the Working Committee, or from a consensus opinion statement in a published guideline. This wording used consistently for these statements. Denotes moderate quality published evidence. Can include evidence gradings C and D. This wording used consistently for these evidence statements. Denotes high quality published evidence. All gradings within the matrix are A or B. This wording used consistently for these evidence statements. Recommendation Evidence Statements Evidence Statement Grade Chapter 4 – The role of population screening Recommendation 1 Screen high-risk groups Evidence strongly supports a screening approach that targets individuals at higher risk of developing glaucoma, rather than the general population. A Chapter 5 – Prognosis: understanding the natural history Recommendation 2 Reduce intraocular pressure Recommendation 3 Monitor visual field and determine rate of any field loss Recommendation 4 Assess risk of conversion from ocular hypertension to glaucoma Glaucoma Evidence strongly supports reducing intraocular pressure in glaucoma patients (including normal tension glaucoma), in order to preserve the visual field and reduce glaucomatous progression rates. Evidence strongly supports monitoring rates of visual field loss in patients with glaucoma (including normal tension glaucoma). Ocular hypertension Evidence strongly supports assessing risk of conversion of ocular hypertension to glaucoma, using factors such as intraocular pressure and central corneal thickness, in order to guide decision-making concerning which patients with ocular hypertension warrant treatment. A A A National Health and Medical Research Council 11
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 1 – Recommendations and Evidence statements Recommendation Good Practice Points • Patients at low risk of conversion should be considered for monitoring. • Patients at high risk of conversion should be considered for treatment. • Educate patients on the risks and consequences of conversion to glaucoma. Evidence Statements Evidence strongly supports intervention for individuals with ocular hypertension and major risk factors for the development or progression of glaucoma, in order to reduce the risk of visual loss within their expected lifespan. −− Major risk factors for developing glaucoma include elevated intraocular pressure, increased cup:disc ratio, disc rim haemorrhage, reduced central corneal thickness, older age, strong family history and ethnicity. −− Major risk factors for glaucoma progression include elevated and/or fluctuating intraocular pressure, increased cup:disc ratio, disc rim haemorrhage and reduced central corneal thickness. Evidence strongly supports careful monitoring, rather than active treatment of patients with ocular hypertension and low-risk status. Evidence strongly supports monitoring in order to detect conversion to glaucoma for all patients with ocular hypertension, frequency depending on other identified risk factors. Refer to Table 8.2 on p100. Early primary open angle glaucoma Evidence strongly supports implementing appropriate management plans for patients with early primary open angle glaucoma in order to reduce the risk of visual loss, and minimise glaucomatous progression within the patient’s expected lifespan. Evidence strongly supports management plans that are based on an evaluation of the relative benefits and risks of treatment for each patient with glaucoma. Evidence Statement Grade A A A A A Chapter 6 – Identifying those at risk of developing glaucoma Recommendation 5 Identify and assess glaucoma patients and suspects (those at high risk of the disease) Good Practice Points • Identification is essential in order to make therapeutic decisions, whom to treat, and how aggressively to treat each person. • All involved in their health care need to adopt a standard approach to risk factor assessment for each individual. Introduction Evidence strongly supports a standard approach to assessing risk factors when diagnosing patients with glaucoma, and also when identifying patients who may develop glaucoma. Standard risk assessment is also essential when making therapeutic decisions regarding who to treat, when to treat and how aggressively to treat. Risk Factors identified from patient history – Age Evidence strongly indicates that Caucasians and Asians over the age of 50 years undertake regular ocular health checks. Evidence indicates that individuals of African descent over the age of 40 years undertake regular ocular health checks. A A B 12 National Health and Medical Research Council
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