NHMRC Glaucoma Guidelines - ANZGIG

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<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 7 – Diagnosis of glaucoma Table 7.7: Hierarchy of glaucoma examination required for reliable diagnosis, extracted from Tuulonen et al (2003) and modified by information from Burgoyne (2004) Very good level* Good Satisfactory Insufficient IOP** and Gonioscopy and Visual Field *** and Optic disc images and RNFL images IOP** and Gonioscopy and Visual Field *** and Optic disc images or RNFL images IOP** and Gonioscopy and Visual Field *** and Clinical optic disc examination IOP * Examination with blue-on-yellow perimetry, the central 10 degree VF and quantitative optic nerve head analysis (e.g. Heidelberg Retinal Tomography) may provide useful additional information ** Diurnal IOP when needed. Regular calibration of the tonometer is required. *** Preferably two automated VF examinations with a threshold program for determination of the baseline Point of note In rural/remote settings, fundus photography is valuable if the results are to be relayed to a diagnosing health care provider. For a summary of examination components refer to the end of this chapter for sections on: • What should I examine to identify open angle glaucoma? • What should I examine to identify angle closure? Evidence Statements • 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 Goldman 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 base line −−assessment of intraocular pressure, including diurnal variation with a calibrated tonometer checked regularly −−assessment of the angle by gonioscopy. National Health and Medical Research Council 85
<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 7 – Diagnosis of glaucoma Questions to ask patients with suspected glaucoma What are your symptoms? Do you have any first-degree relatives with eye disorders (e.g. parents or siblings)? What is your age? Do you have existing eye conditions? (e.g. myopia and hypermetropia, eye trauma) Do you other medical conditions? (e.g. diabetes) Are you of African or Asian descent? Are you taking any prescription or over-the-counter medicines, if so what? Are you pregnant or breastfeeding? When did you last have an eye examination? Have you heard of glaucoma? What do you know about glaucoma? Questions to ask patients with established glaucoma How are you? How are your eyes and vision? Are you managing to take your medication as advised? If no, what are the problems and difficulties you face? Is there anything about your condition or treatment plan you would like explained? Are you experiencing any side effects from the medication? Do you have other medical conditions? If yes, have they been exacerbated recently? Are you taking any prescription or over-the-counter medicines, if so what? Do you have plans to conceive/are you already pregnant? If yes, do you plan to breastfeed? When did you last attend an eye exam or have your condition monitored? At what age were you diagnosed and how long ago was that? What should I examine to identify open angle glaucoma? Assess anterior chamber and angle with gonioscopy and biomicroscopy Key signs • abnormal trabecular meshwork • abnormal ciliary base (angle or cyclodialysis cleft) • blood reflux in Schlemm’s canal 86 National Health and Medical Research Council
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NHMRC Glaucoma Guidelines - ANZGIG

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