NHMRC Glaucoma Guidelines - ANZGIG

More documents

Recommendations

Info

<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 6 – Identifying those at risk of developing glaucoma ■ 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 about whom to treat and how aggressibely to treat each person. • All involved in their health care need to adopt a standard approach to risk factor assessment for each individual. 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. • Survey for glaucoma particularly in patients greater than 50 years old, any myopia, abnormal blood pressure, a history of migraine, diabetes, peripheral vasospasm, eye injury and ongoing steroid use. • Monitor for glaucoma particularly in patients greater than 70 years old, with IOP >21 mmHg, large and/or asymmetric cup-to-disc ratio (compared with disc size), disc haemorrhage, and thin central corneal thickness. National Health and Medical Research Council 47
<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 6 – Identifying those at risk of developing glaucoma Recommendation 7 Assess risk of progression of glaucomatous damage Good Practice Points • Calculate the rate of visual field loss regularly (for example review every four months) for the first two years, and then less frequently (for example every six months) thereafter if stable. This will depend on the health care setting and the individual patient’s risk of progression. • Reduce IOP by 20-50% in patients with glaucomatous optic neuropathy depending on the level of risk to preserve visual field and to reduce progression. • Reduce IOP more aggressively in those patients with greater risk factors for progression. • Patients diagnosed late, with more advanced glaucoma damage, suffer higher rates of progression of visual loss. More aggressive IOP reduction is required. Introduction There is a strong body of research, developed over many years that has established the risk factors for glaucoma development and progression. However, a standard approach is still required to organise these risk factors into a hierarchy of risk, including the best ways of assessing them, and identifying how they interact with disease incidence, prevalence and progression. There are ongoing questions regarding which patients should be treated, how vigorously to treat them, and when to initiate treatment. Overall, the literature presents general agreement regarding the significant association between elevated intraocular pressure (IOP), advancing age, ethnicity and family history concerning the risks for developing most types of glaucoma. Risk calculators have been developed to facilitate the application of research findings into clinical practice. Risk calculators work by applying risk-prediction coefficients from multivariate analysis from clinical trials and epidemiological studies into risk-modelling formulae that can be applied to individual patients. Risk calculators are based on an assumption that each patient comes from a similar population as participated in the clinical trial. Health care providers enter the patient’s clinical findings into the formulae to calculate the likelihood of that patient developing glaucoma, or progressing to another stage of the disease. Risk calculators have also been useful for assisting patients and their health care providers to make decisions about treatment (Mansberger & Cioffi 2006; Gordon, Torri, Miglor et al 2007). However, risk calculators tend not to include confidence intervals (which are often quite large) and thus can give a false impression of reliability in terms of prediction. The performance of the predictive models derived from the Ocular Hypertension Treatment Study was assessed by Meirdeiros, Zangwill, Bowd et al (2007). They concluded that the Ocular Hypertension Treatment Study-derived predictive models performed appropriately in independent patient samples. Their reduced model included age, IOP and central corneal thickness (CCT). The full model included these and visual field (VF) pattern standard deviation and vertical cup:disc ratio. Both models predicted conversion of ocular hypertension (OH) to glaucoma at five years in 70% of cases. A prediction score of 50% indicates random chance, i.e. no additional predictive value whereas 100% indicates perfect prediction. Whilst these models have some value, they are far from perfect. Future refinement of optic nerve damage indices and indicators of nerve structure should improve the accuracy of these models. The majority of risk factors which are significantly associated with the development of glaucoma can be identified and measured using a comprehensive patient history. However other important 48 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 104 and 105:
NHMRC GUIDELINES FOR THE SCREENING,
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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?