NHMRC Glaucoma Guidelines - ANZGIG

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA
Chapter 8 – Monitoring: long-term care
Figure 8.1: The monitoring cycle
SET
TARGET
IOP
Establish
baselines
Consider
need to alter
targets or
intervention
DIAGNOSIS
Commence
intervention
Monitor
response to
intervention
Medical history
The collection of information from patients being monitored for glaucoma progression should include
an adequate history of the patient’s health since last visit, as well as questions regarding ocular
history, new systemic medications, and any side effects from ocular medications since last assessment.
Frequency and time of the last IOP-lowering medication administration and review of use of systemic
medications should also be included (American Optometric Association [AOA] 2002).
Assessing a patient’s capacity to adhere to a medication regimen is essential, otherwise medication
management may need to be escalated, on an assumption of medically unresponsive glaucoma.
Health care providers should thus develop a patient-by-patient understanding of the factors
associated with individual adherence to glaucoma management strategies. Health care providers
should then develop strategies in partnership with the patient to assist in addressing barriers to
ongoing adherence with management programs. Understanding the patient’s social and behavioural
responses to a diagnosis of a chronic eye condition such as glaucoma is essential. This enables
health care providers to assist the patient to manage their condition in the best possible manner
for them. This optimises the patient’s quality of life, and reduces complications and the likelihood
of deterioration of their condition. Accurate and timely information on the patient’s use of
prescription and over-the-counter medications for other health conditions is essential, as is an
understanding of the patient’s capacity to self-administer and to pay for glaucoma medications.
This guideline provides ideas regarding Questions to Ask Your Patient at the end of this chapter.
Evidence Statement
• Evidence strongly supports taking a comprehensive history at each review. This should include information
on what has occurred in the intervening period, and the patient’s ability to adhere to the prescribed
medication regimen.
92 National Health and Medical Research Council