NHMRC Glaucoma Guidelines - ANZGIG

More documents

Recommendations

Info

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 6 – Identifying those at risk of developing glaucoma Risk factors for specific glaucoma types and stages Angle closure The American Academy of Ophthalmology [AAO] (2005a) states that risk factors for developing angle closure are hypermetropia, family history of angle closure, advancing age, female gender, Asian or Inuit descent and shallow anterior chamber for PACG. However, there is limited quantification of the risk. Medical interactions/effects are also a proposed risk, however even less is known about them. Schmier, Halpern and Jones (2007) state that the higher prevalence of primary angle closure (PAC) and PACG in Asian and certain indigenous ethnic groups (e.g. Inuit) suggests that ethnicity is a risk for that glaucoma type. These guidelines report medications and conditions associated with the development of angle closure states in Chapter 9. Evidence Statement • 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. Secondary glaucoma There is no evidence from the secondary literature regarding the risk factors for, or progression of secondary glaucoma. Progression of established glaucoma Risk factors for developing glaucoma are not necessarily the same as the risk factors for progression of diagnosed glaucoma. However, the importance of IOP in early stage glaucoma has been underlined by the results of the Ocular Hypertension Treatment Study (Budenz et al 2006), wherein univariate and multivariate analyses found that every 1 mmHg increase in mean IOP level was associated with a 10% increased risk of progression from OH to glaucoma. A meta-analysis of five relevant and adequately powered studies (Maier, Funk, Schwarzer et al 2005) also concluded that using topical pressure lowering medications for primary prevention of glaucomatous VF defects in patients with OH appears to be effective. The Ocular Hypertension Treatment Study (Budenz et al 2006) also reported that subjects with optic disc rim haemorrhage were four to six times as likely to progress to glaucoma as those without optic disc rim haemorrhage. The Early Manifest Glaucoma Treatment Trial (Leske et al 2004) concurred, reporting that patients with optic disc rim haemorrhage were more likely to progress to glaucoma, with a strong relationship established between frequency of optic disc rim haemorrhage and risk of progression. Evidence Statement 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. National Health and Medical Research Council 59
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 6 – Identifying those at risk of developing glaucoma Progression to visual loss To date, there is limited evidence of the impact of risk factors on the progression and outcomes of patients with severe and advanced glaucoma. The results of the Advanced Glaucoma Intervention Study (AGIS) studies reported by Friedman, Wilson, Liebmann et al (2004) provide limited evidence that older age at diagnosis, lower formal education, male sex and diabetes are significant risk factors for the progression of advanced glaucoma to blindness. Reminder to health care providers Health care providers should use a patient’s history to elicit information about risk factors that are significantly associated with developing most types of glaucoma: • elevated or fluctuating intraocular pressure • strong family history of glaucoma • advanced age • African or Asian ethnicity • current diabetes • myopia • rural location. Health care providers should use a patient examination to elicit information about other risk factors that are significantly associated with developing most types of glaucoma: • elevated or fluctuating intraocular pressure • significant alterations in cup:disc ratio and cup:disc ratio asymmetry • nerve fibre layer defects • optic disc haemorrhage. An assessment of these risk factors should aid in therapeutic decision-making regarding who to treat, when to treat, how to treat, and how aggressively to treat. If appropriate, health care providers may also consider other risk factors which have more limited evidence of their association with developing most types of glaucoma: • central corneal thickness • current smoking • current migraine and peripheral vasospasm • long-term steroid use • previous eye injury. 60 National Health and Medical Research Council
Page 1:
NHMRC Guidelines for the Screening,
Page 4 and 5:
NHMRC GUIDELINES FOR THE SCREENING,
Page 6 and 7:
Page 8:
Page 12 and 13:
Page 14:
Page 17 and 18: NHMRC GUIDELINES FOR THE SCREENING,
Page 38: NHMRC GUIDELINES FOR THE SCREENING,
Page 65: NHMRC GUIDELINES FOR THE SCREENING,
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?