NHMRC Glaucoma Guidelines - ANZGIG

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA
Chapter 1 – Recommendations and Evidence statements
Recommendation
• Appropriate investigations:
standard automated
perimetry (white-on-white)
including comparison with
age-corrected normals
on a point-wise, regional
(eg. hemifield) and
global basis, optic disc
photography and imaging
of the optic nerve and
optic nerve fibre layer.
• Careful and informed
interpretation of results
from all imaging and
functional tests in order
to detect disease or
to detect progression.
With the multi-faceted
nature of glaucoma and
the large variability in
normal values of all tests,
consider results from all
tests and assessments.
Evidence Statements
Setting target intraocular pressure at diagnosis
Evidence strongly supports a minimum target intraocular
pressure reduction of 20% in patients with suspected primary
open angle glaucoma with high-risk status. It is advised that
intraocular pressure remains under 24mmHg. Those without
high-risk factors can simply be observed.
Evidence strongly supports a minimum target intraocular
pressure reduction of 20% in patients with early and
established primary open angle glaucoma without high-risk
status. It is advised that intraocular pressure remains under
16-19mmHg.
Evidence strongly supports a minimum target intraocular
pressure reduction of 30% in patients with established
primary open angle glaucoma with high-risk status, and
patients with advanced primary open angle glaucoma.
Evidence strongly supports the maintenance of intraocular
pressure below 18mmHg in patients with established primary
open angle glaucoma, and even lower to below 15mmHg in
patients with advanced primary open angle glaucoma.
Professional roles in diagnosis
Evidence strongly supports that all health care providers
involved in glaucoma screening and diagnosis receive
appropriate training and continuing support from health care
providers who regularly manage glaucoma. Co-management
involving an ophthalmologist is recommended.
Summary of diagnostic standards
Evidence strongly indicates the multifaceted nature of
glaucoma and the large variability in the normal values of
test findings. This evidence therefore strongly supports using
findings from more than one diagnostic procedure or test
before a glaucoma diagnosis can be made.
Evidence strongly supports the need for health care
providers only involved in the screening and diagnosis of
glaucoma, to possess the skills and equipment to measure
intraocular pressure (by Goldmann Applanation Tonometry
or well-calibrated non-contact tonometry), test visual field,
perform gonioscopy and examine the optic disc for typical
glaucoma signs. They should receive appropriate training
and continuing support from health care providers who
manage glaucoma.
Evidence supports the following assessment methods for
diagnosing glaucoma, which are independent of cost and
patient preference:
−−
full medical history examination of eye structure with
optic nerve image recording examination of eye function
with two automated visual field examinations using a
threshold program for determination of the baseline
assessment of intraocular pressure, including diurnal
variation with a calibrated tonometer checked regularly,
and assessment of the angle by gonioscopy.
Evidence
Statement
Grade
B
B
B
B
A
B
A
B
National Health and Medical Research Council 17