NHMRC Glaucoma Guidelines - ANZGIG

More documents

Recommendations

Info

<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 1 – Recommendations and Evidence statements Recommendation Recommendation 6 Detect glaucoma earlier Good Practice Points • Perform regular eye health checks for Caucasians over the age of 50, and for African-descended people over the age of 40. • Perform regular eye health checks for all first-degree relatives of glaucoma patients, commencing 5-10 years earlier than the age of onset of glaucoma in their affected relative. Remind all glaucoma patients to alert first-degree relatives of the benefits of early and regular eye checks. Evidence Statements Risk Factors identified from patient history – Family and Genetics Evidence strongly supports that all first-degree relatives of individuals diagnosed with glaucoma are considered at high risk of developing glaucoma themselves. It is recommended that they undergo a full ocular examination by a qualified health care provider, and receive ongoing monitoring for the development of glaucoma. Evidence strongly supports the need for all patients diagnosed with glaucoma to alert first-degree relatives of the benefits of ocular examination. Risk Factors identified from patient history – Ethnic origin Evidence strongly indicates that individuals of African descent are at higher risk of open angle glaucoma than Caucasians. Evidence strongly indicates that individuals of Asian ethnic origin are at increased risk of angle closure, compared with other ethnic groups. Risk Factors identified from patient history – Myopia Evidence strongly indicates that individuals with myopia requiring optical correction are considered at increased risk of glaucoma. Risk Factors identified from patient history – Long-term steroid users Evidence indicates that long-term users of steroids by any route of administration are at increased risk of glaucoma, and thus require surveillance. Risk Factors identified from patient history – Migraine and peripheral vasospasm Evidence indicates that individuals with migraine and peripheral vasospasm dysfunction are at increased risk of glaucoma. Risk Factors identified from patient history – Eye injury Evidence indicates that individuals with a history of eye trauma are at increased risk of glaucoma. Risk Factors identified from patient history – Systematic blood pressure Ongoing blood pressure monitoring and management is appropriate for all patients at risk of glaucoma. Evidence Statement Grade A A A A A C C C A National Health and Medical Research Council 13
<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 1 – Recommendations and Evidence statements Recommendation • Survey for glaucoma particularly in patients greater than 50 years of age, with any myopia, with abnormal blood pressure, with a history of migraine, with diabetes, with peripheral vasospasm, with eye injury and/or with ongoing steroid use. • Monitor for glaucoma particularly in patients greater than 70 years of age, with IOP >21 mmHg, large and/or asymmetric cup-to-disc ratio (compared with disc size), disc haemorrhage, and thin central corneal thickness. Evidence Statements Risk factors identified from patient history – Intraocular pressure Evidence strongly supports the assessment of intraocular pressure in all individuals with suspected glaucoma, as it is a significant risk factor for the development of all forms of glaucoma. Evidence strongly supports using 21mmHg as the upper limit for usual intraocular pressure. Risk Factors identified from patient history – Alterations in cup:disc ratio and asymmetry Evidence supports the assessment of cup:disc ratio, and cup:disc ratio asymmetry, when assessing the risk of glaucomatous damage occurring. Risk Factors identified from patient history – Optic disc haemorrhage Evidence supports past signs, or current presence, of optic disc haemorrhages as significant risk factors for the development and progression of glaucoma. Evidence supports more aggressive treatment of patients with ocular hypertension, or glaucoma, who present with optic disc rim haemorrhages, or evidence of past optic disc rim haemorrhages. Risk Factors identified from patient history – Central corneal thickness Evidence supports the assessment of central corneal thickness in patients with ocular hypertension, or suspected cases of glaucoma. Risk factors for specific glaucoma types and stages – Angle closure Expert/consensus opinion suggests that hypermetropia, family history of angle closure, advancing age, female gender, Asian descent and shallow anterior chamber are risk factors for the development of angle closure, and angle closure glaucoma. Risk factors for specific glaucoma types and stages – Progression of established glaucoma Evidence indicates that factors associated with greater risk of glaucoma progression include elevated/fluctuating intraocular pressure, optic disc haemorrhage, increased severity of glaucomatous disc damage and very low blood pressure. These patients require greater reduction in intraocular pressure. Evidence Statement Grade A A C B B B B 14 National Health and Medical Research Council
Page 1: NHMRC Guidelines for the Screening,
Page 4 and 5: NHMRC GUIDELINES FOR THE SCREENING,
Page 8: NHMRC GUIDELINES FOR THE SCREENING,
Page 71 and 72:
NHMRC GUIDELINES FOR THE SCREENING,
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 172 and 173:
Page 174:
Page 177 and 178:
Page 179 and 180:
Page 181:
show all

NHMRC Glaucoma Guidelines - ANZGIG

Create successful ePaper yourself

Delete template?

Save as template?