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 1 – Recommendations and Evidence statements<br />
Recommendation<br />
Chapter 9 – Medication<br />
Recommendation 11<br />
Reduce IOP by<br />
using medications<br />
Good Practice Points<br />
• Due to the potential<br />
efficacy and once-daily<br />
usage, a topical<br />
prostaglandin analogue<br />
is usually the first choice,<br />
unless contraindicated.<br />
When more than<br />
one agent is required,<br />
fixed-dose combinations<br />
should be considered<br />
to encourage improved<br />
compliance.<br />
• Topical medications may<br />
be the simplest and safest<br />
first choice for treatment,<br />
except for pregnant and<br />
lactating women.<br />
• Facilitate adherence<br />
and perseverance<br />
with a patient-centric<br />
self-management approach<br />
to a medication plan.<br />
Provide ongoing tailored<br />
information (such as from<br />
<strong>Glaucoma</strong> Australia) to<br />
reinforce a patient’s<br />
understanding of<br />
glaucoma and realistic<br />
goals of treatment.<br />
Evidence Statements<br />
Expert/consensus opinion suggests that in highly unstable<br />
established glaucoma, where intraocular pressure targets are<br />
not being achieved, the management plan requires alteration<br />
and a review undertaken within one to four weeks.<br />
Evidence supports using tonometry on every visit, for patients<br />
with established glaucoma, once a baseline has been set.<br />
Expert/consensus opinion suggests that monitoring timelines<br />
for patients with angle closure glaucoma are guided by<br />
angle morphology, optic disc and/or visual field stability and<br />
intraocular pressure.<br />
Starting medication regimens<br />
Evidence strongly supports using topical medications as the<br />
simplest and safest first choice for glaucoma management.<br />
Evidence strongly supports limiting the use of systemic<br />
medication to situations where patients cannot tolerate<br />
topical medications, are unable to safely and effectively instill<br />
topical medications, are failing to achieve intraocular pressure<br />
targets, or when laser therapy or surgery either had poor<br />
outcomes, or are contraindicated.<br />
Evidence strongly supports using a topical prostaglandin<br />
analogue or beta-blocker in the initial management of<br />
glaucoma unless contraindicated.<br />
Evidence strongly supports carbonic anhydrase inhibitors<br />
and alpha 2<br />
-agonists as second and third choice medication<br />
management, with dosing regimens of two to three<br />
times daily.<br />
Facilitating adherence<br />
Evidence supports a patient-centric self-management<br />
approach that facilitates optimal adherence to the medication<br />
management plan.<br />
Evidence supports the value of ongoing, tailored information<br />
to support patients’ understanding of their disease and<br />
its management.<br />
Evidence strongly supports using combination preparations,<br />
rather than separate instillations of individual medications, to<br />
improve patient adherence. There is no evidence however,<br />
showing that one combination preparation is more effective<br />
than any other for reaching target intraocular pressure.<br />
Medication interaction<br />
Expert/consensus opinion suggests the need to establish<br />
the presence of other disease states when initiating, assessing<br />
or altering medication regimens for patients with glaucoma.<br />
These include, but are not limited to, diabetes, depression,<br />
hyperthyroidism, heart disease, asthma, liver and<br />
renal impairment.<br />
Evidence<br />
Statement<br />
Grade<br />
A<br />
A<br />
A<br />
A<br />
B<br />
B<br />
A<br />
20 National Health and Medical Research Council