NHMRC Glaucoma Guidelines - ANZGIG

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA
Chapter 6 – Identifying those at risk of developing glaucoma
considered a secondary glaucoma related to its external causation (South East Asian Glaucoma
Interest Group [SEAGIG] 2003). Steroidal-like substances can also be found in traditional and
natural medicines. Case-control and retrospective data suggest that prolonged inhaled corticosteroid
use is a significant risk for developing glaucoma; however, the cumulative inhaled corticosteroid
use dosage that poses a risk has not been ascertained (Leone, Fish, Szefler et al 2003).
Evidence Statement
• Evidence indicates that long-term users of steroids by any route of administration are at increased risk of
glaucoma, and thus require surveillance.
Point of note
Surveillance activities include, but are not limited to, patient education about risk, consideration of
concurrent medications, and encouraging attendance at basic ocular checks.
Migraine and peripheral vasospasm
Migraine headache and peripheral vasospasm have been identified as risk factors for progressive
glaucomatous optic nerve damage by studies including the Ocular Hypertension Treatment Study
(Budenz, Anderson, Feuer et al 2006) and the Blue Mountains Eye Study (Mitchell et al 1996).
Peripheral vasospasm has also been proposed as one possible mechanism for, or a factor contributing
to, optic nerve damage in glaucoma. This theory is supported by evidence of an association of normal
tension glaucoma (NTG) with migraine headaches and Raynaud’s syndrome (AOA 2002).
Evidence Statement
• Evidence indicates that individuals with migraine and peripheral vasospasm dysfunction are at increased
risk of glaucoma.
Eye injury
Eye trauma is widely accepted as a risk factor for glaucoma. Traumatic glaucoma can occur
immediately after a blunt trauma or penetrating injury eye, or years later (Williams 1999). Eye trauma
with angle recession is a risk factor for open angle glaucoma. It is usually considered as secondary
open angle glaucoma and is therefore not included in studies of POAG. It is uncommon and difficult
to quantify, consequently there is little data concerning epidemiology of trauma in glaucoma.
Evidence Statement
• Evidence indicates that individuals with migraine and peripheral vasospasm dysfunction are at increased
risk of glaucoma.
Systemic blood pressure
There is a paucity of evidence concerning high systemic blood pressure as a significant risk factor
for glaucoma. The literature is equivocal on the association between systemic hypertension and
POAG (AOA 2002). There is a complex relationship between POAG and systemic blood pressure,
as both patient age and the duration of systemic hypertension impact upon the relationship
between hypertension and POAG.
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