NHMRC Glaucoma Guidelines - ANZGIG

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NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 7 – Diagnosis of glaucoma Assess and record eye structure with the best available instrument • ocular examination including –– refractive status –– pupil size and reactivity –– external appearance eye –– optic nerve head –– visual field Key signs • typically superotemporal or inferotemporal optic disc neuroretinal rim loss with excavation • disc haemorrhage • cup:disc ratio and cup:disc ratio asymmetry • nerve fibre layer atrophy • peripapillary atrophy Assess and record eye function with best available instrument Key signs • defects that are –– asymmetrical and cross midline –– located in mid periphery (5-25 from midline) –– clustered in neighbouring points –– correlate to defects on optic disc Assess IOP using best available instrument and taking patient preference into consideration Key levels • less than 21mmHg – consider normal tension glaucoma • over 26mmHg consider ocular hypertension • consider diurnal variation What should I examine to identify angle closure? Assess anterior chamber and angle with gonioscopy and biomicroscopy Key signs of closure • peripheral anterior synechaie • trabecular meshwork pigment patches • iris insertion above scleral spur • angle structures (trabecular meshwork) not being visible National Health and Medical Research Council 87
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 7 – Diagnosis of glaucoma Assess and record eye structure with the best available instrument • refractive status • pupil size and reactivity • external appearance eye Assess and record eye function with best available instrument Assess IOP using best available instrument and taking patient preference into consideration. References American Academy of Ophthalmology [AAO] (2005a): Primary angle closure preferred practice pattern. San Francisco: American Academy of Ophthalmology. American Academy of Ophthalmology [AAO] (2005b): Primary open-angle glaucoma preferred practice pattern. San Francisco: American Academy of Ophthalmology. American Optometric Association [AOA] (2002): Optometric clinical practice guideline: Care of the patient with open angle glaucoma (2nd edn.). St Louis: American Optometric Association. Azuara-Blanco A, Burr J, Thomas R, Maclennan G, McPherson S (2007): The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendations for glaucoma. British Journal of Ophthalmology; 91: 1639-1643. Burgoyne CF (2004): Image analysis of optic nerve disease. Eye; 18: 1207-1213. Burr J, Azuara-Blanco A, Avenell A (2004): Medical versus surgical interventions for open angle glaucoma. Cochrane Database of Systematic Reviews; 1. Burr JM, Mowatt G, Hernández R, Siddiqui M, Cook J, Lourenco T, Ramsay C, Vale L, Fraser C, Azuara-Blanco A, Deeks J, Cairns J, Wormald R, McPherson S, Rabindranath K, Grant A (2007): The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technology Assessments; 11(41): 1-206. Canadian Glaucoma Study Group (2006): Canadian glaucoma study: 1. Study design, baseline characteristics and preliminary analyses. Canadian Journal of Ophthalmology; 41:566-75. Dueker DK, Singh K, Lin SC, Fechtner RD, Minckler DS, Samples JR, Schuman JS (2007): Corneal Thickness Measurement in the Management of Primary Open-angle Glaucoma. A Report by the American Academy of Ophthalmology. Ophthalmology; 114(9):1779-1787. European Glaucoma Society [EGS] (2003): Terminology and guidelines for glaucoma (2nd edn.). Savona, Italy: European Glaucoma Society. Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish II RK, Wilson MR, Kass MA (2002): The Ocular Hypertension Treatment Study: Baseline factors that predict the onset of primary open-angle glaucoma. Archives of Ophthalmology; 120: 714-720. Heigl A, Leske C, Bengtsson B, Hyman L, Bengtsson B, Hussien M (2002): Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Archives of Ophthalmology; 120:1268-1279. 88 National Health and Medical Research Council
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