terminology and guidelines for glaucoma ii - Kwaliteitskoepel

More documents

Recommendations

Info

$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

INTRODUCTION The aim of the book is to present in two main sections the view of the EGS on the management and diagnosis of glaucoma. The first part is devoted to the results of recent trials, flow charts, patient examination, terminology and classification. The second part is a reference section which tabulates available medical therapy, laser and surgical techniques. Our treatment guidelines are intended to support the general ophthalmologist in managing patients affected by or suspected of having glaucoma.The clinical guidelines are to be considered as recommendations. This work is based on glaucoma literature, conferences and clinical experience. Our purpose is not to offer strict treatment protocols. Clinical care must be individualized to the patient, the treating ophthalmologist and the socioeconomic milieu. The availability of Randomized Controlled Trials (RCTs) makes it possible to apply scientific evidence to clinical recommendations. The European Glaucoma Society (EGS), all contributors and sponsors disclaim responsibility and liability for any and all adverse medical or legal effects resulting directly or indirectly from the use of the guidelines. I - TERMINOLOGY, CLASSIFICATION AND DEFINITIONS Classification and disease definitions are arbitrary, and a consensus can be reached only if they are acceptable to most ophthalmologists on both theoretical and practical grounds. The scope of terminology, classifications and definitions varies, however. As examples, prospective clinical trials, health planning, coding for third party payers, the review of existing clinical data and the classification of individuals for individualized treatment have somewhat different needs, and the level of detail and differentiation is not the same for all. The following factors are to be considered in order to identify and separate the diagnostic groups. 1. Anatomy (see Ch. 1) Open-angle, closed-angle, exfoliation, pigment dispersion etc. 2. Function (see Ch. 1) Stage of ganglion cell damage, rate of decay etc. Visual field examination, disc and nerve fiber layer assesment, rate of progression. Techniques for imaging of the disc/RNFL are now available and still being developed and standardized (See ch. 1). 3. IOP level (see Ch. 1) 3.1 At which diagnosis is made (See Ch. 2) 3.2 At which damage occurred (See Ch. 1) 3.3 Target IOP (See Ch. 3.2) Treatment principles Once the type of disease is identified, the treatment goals appropriate for the specific individual are to be pursued. A. Treatment Goals (See Ch. 3.1 and 3.2) A.1. Quality of life A.2. Quality of vision A.3. Cost containment Ch. Intro 1 EGS
In general, the goal of glaucoma treatment can be summarized as follows: preservation of visual function adequate to the individual needs with minimal or no side effects, for the expected lifetime of the patient, without any disruption of his/her normal activities, at a sustainable cost. B. Suggested ways to obtain the goal (see Ch. 3 and 4) B.1. B.1.1. B.1.2. B.1.3. Selection of patients to be treated Identification of patients with disease Identification of patients at risk of developing the disease Treatment of the above when actual or expected rate of decay is likely to interfere with quality of life B.2. Decreasing the risk of ganglion cell loss B.2.1. Determine the target IOP for the individual In general, when there is more advanced damage, lower IOPs are needed to prevent decrease in quality of life B.2.2. IOP lowering B.2.2.1. Drugs Verify the short term effect on the stated endpoint in each individual i.e. IOP, blood flow etc. Confirm such effect in long term. When not effective, withdraw and substitute before adding a further drug Avoid combining drugs aimed at the same or similarly acting receptors Consider drug combinations which combine additive, different mechanism B.2.2.2. Surgery Compared with pharmacological treatment, surgery to achieves and maintains lower IOPs, with less diurnal variations, regardless of pre-treatment levels. Primary surgery, supported by large prospective studies, should be considered in selected individuals and/or specific environments B.2.2.3. Laser Verify the short term effect on the stated target IOP in each individual Confirm the above effect in long term When not effective, proceed to the next step to achieve the target IOP B.2.2.4. Verify the target IOP and the trends in the visual fields/disc. B.2.3. Enhancement of optic nerve blood flow (Ch. 1.5) B.2.4. Neuroprotection, neurorescue, neuroregeneration B.3. Incorporation of a quality of life measure in the outcome of treatment C. On-going quality control with independent evaluation of efficacy, safety, cost C.1. Failures include patients suffering from the consequences of insufficient IOP lowering, unnecessary treatment, surgical complications, and progression of disease. Ch. Intro 2 EGS
Page 2 and 3: ISBN: 88-87434-13-1 Editrice DOGMA
Page 4 and 5: ACKNOWLEDGEMENT This work was made
Page 6 and 7: 2.2.5 - Primary Open-Angle Glaucoma
Page 8 and 9: Foreword These Definitions and Guid
Page 12 and 13: Since resources are limited worldwi
Page 14 and 15: II - RANDOMIZED CONTROLLED TRIALS F
Page 16 and 17: II.3 - COLLABORATIVE NORMAL TENSION
Page 18 and 19: No stratification for stage of dise
Page 20 and 21: II. 6. 3 - from CNTG 1. Therapy tha
Page 22 and 23: References 1) The Ocular Hypertensi
Page 24 and 25: I - QUESTIONS TO ASK TO YOUR GLAUCO
Page 26 and 27: III - ABNORMAL THRESHOLD VISUAL FIE
Page 28 and 29: V - GONIOSCOPIC OPEN ANGLES SOME DI
Page 30 and 31: VII - TREATMENT STEPLADDER JUVENILE
Page 32 and 33: IX - MONOTHERAPY (in alphabetic ord
Page 34 and 35: XI - MANAGEMENT ACUTE ANGLE CLOSURE
Page 36 and 37: XIII - ANTIMETABOLITES FOR WOUND MO
Page 38 and 39: CHAPTER 1 PATIENT EXAMINATION
Page 40 and 41: Other methods 22-25 : Air-puff tono
Page 42 and 43: References 1) Martin XD. Normal int
Page 44 and 45: 1.2 - GONIOSCOPY Gonioscopy is a fu
Page 46 and 47: 1 2 3 4 Fig. 1 Dynamic indentation
Page 48 and 49: The Spaeth classification Insertion
Page 50 and 51: References 1) Palmberg P. Gonioscop
Page 52 and 53: small - size mid - size large - siz
Page 54 and 55: Fig. 5 A) Cirumlinear vessel, B) Ba
Page 56 and 57: 1.3.4.3 - OCT The Optical Coherence
Page 58 and 59: 31) Carpineto P, Ciancaglini M, Zup
Page 60 and 61:
central 24 or 30 central degrees re
Page 62 and 63:
A retinal sensitivity value worse t
Page 64 and 65:
HODAPP CLASSIFICATION 31 EARLY GLAU
Page 66 and 67:
References 1) Bengtsson B, Heijl A,
Page 68 and 69:
1.5 - BLOOD FLOW 1.5.1 - VASCULAR F
Page 70 and 71:
28) Flammer J, Orgul S, Costa VP, O
Page 72 and 73:
All forms of glaucoma should be cla
Page 74 and 75:
2.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
Page 76 and 77:
2.2.4 - PRIMARY OPEN-ANGLE GLAUCOMA
Page 78 and 79:
2.3 - SECONDARY OPEN-ANGLE GLAUCOMA
Page 80 and 81:
2.3.1.6 - Glaucoma due to intraocul
Page 82 and 83:
2.4 - PRIMARY ANGLE-CLOSURE Primary
Page 84 and 85:
Systemic Risk factors for primary a
Page 86 and 87:
OCCLUDABLE ANGLE: “Occludable”
Page 88 and 89:
2.5.3 - SECONDARY ANGLE-CLOSURE GLA
Page 90 and 91:
CHAPTER 3 TREATMENT PRINCIPLES and
Page 92 and 93:
Furthermore, blindness may occur de
Page 94 and 95:
T A R G E T I O P Target IOP range
Page 96 and 97:
Practical points for topical medica
Page 98 and 99:
3.3.1.1 - Category: ADRENERGIC AGON
Page 100 and 101:
3.3.1.2 - Category: ADRENERGIC ANTA
Page 102 and 103:
3.3.1.3 - Category: CARBONIC ANHYDR
Page 104 and 105:
3.3.1.4 - Category: PARASYMPATHOMIM
Page 106 and 107:
3.3.1.5 - Category: PROSTAGLANDIN D
Page 108 and 109:
Drug interactions Precipitation occ
Page 110 and 111:
COMBINATION THERAPY Starting* Addit
Page 112 and 113:
3.3.2.2 - Category: ADRENERGIC ANTA
Page 114 and 115:
Pregnancy and nursing mothers Only
Page 116 and 117:
3.5 - LASER SURGERY 3.5.1 - LASER I
Page 118 and 119:
3.5.2 - LASER TRABECULOPLASTY 77-89
Page 120 and 121:
3.5.4 - CYCLOPHOTOCOAGULATION Indic
Page 122 and 123:
Although medical therapy is still t
Page 124 and 125:
3.6.4 - COMPLEX CASES Complicated g
Page 126 and 127:
Post-operative use Concentration: 0
Page 128 and 129:
25) Janz NK, Wren PA, Lichter PR, M
Page 130 and 131:
(Rescula TM ) in patients with glau
Page 132 and 133:
in white patients with open-angle g
Page 134 and 135:
CHAPTER 4 TREATMENT GUIDELINES
Page 136 and 137:
4.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
Page 138 and 139:
4.2.7 - OCULAR HYPERTENSION (OH) Al
Page 140 and 141:
4.3.1.7 - Glaucoma associated with
Page 142 and 143:
• Withdrawal of aqueous from vitr
Page 144 and 145:
4.5 - SECONDARY ANGLE-CLOSURE GLAUC
Page 146 and 147:
4.5.3 - SECONDARY ANGLE-CLOSURE GLA
Page 148 and 149:
NOTES
Page 150 and 151:
NOTES
Page 152:
NOTES
show all

terminology and guidelines for glaucoma ii - Kwaliteitskoepel

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?