terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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$Refractiechirurgie - Nederlands Oogheelkundig Gezelschap$

No stratification for stage of disease was attempted in the associative analysis Patients with far advanced damage were excluded Despite the title “Advanced Glaucoma” early cases of glaucoma were also included II.5 - EARLY MANIFEST GLAUCOMA TREATMENT STUDY (EMGT) Prospective randomized trial of treatment vs no treatment to evaluate the effectiveness of IOP reduction in early, previously untreated open-angle glaucoma. Secondary aims were to assess factors related to glaucoma progression, and to determine the natural history of the disease. During a population-based screening among 44,243 residents in Sweden, 316 eyes of 255 patients were recruited. Over 400 glaucomatous patients either refused enrollment or did not meet the entry criteria. 82.3% of patients with newly detected glaucoma had IOP values of 30 mmHg or less. All subjects were randomized to IOP lowering treatment vs no treatment. Treated patients had laser trabeculoplasty and received topical betaxolol twice daily in eligible eyes. Follow-up visits included computerized perimetry and tonometry every 3 months, fundus photography every 6 months. Decisions to change or begin treatment were made jointly with the patient when EMGT progression occured and also later if clinically needed 14 . Primary outcome measure was progression of disease, defined by sustained increases of visual field loss in three consecutive C30-2 Humphrey tests, as determined from computer-based analyses, or by optic disc changes, as determined from flicker chronoscopy and side-by-side comparisons of fundus photographs performed by masked, independent graders. Summary of results 15,16 A 25% decrease of IOP from baseline and a maximum absolute level of 25mmHg reduced the risk of progression by 50%. Treatment had positive effects in all groups of patients; with higher and lower IOP, older and younger patients, patients with early and later stage of disease. Disease progression rates varied substantially between individual patients. Risk of progression was less with a larger initial IOP drop induced by treatment. The IOP level maintained throughout was related to initial IOP drop. The mean Rate of Progression (RoP) measured as MD in dB/month observed for this study was: No Treatment Treatment dB/Month 0.05 0.03 dB/Year 0.6 0.36 dB/10 Years 6.0 3.60 Risk of progression decreased 10% with each mmHg IOP reduction from baseline to the first follow-up visit. Subjects randomized to the study had a mean baseline IOP of 20.6 mmHg and the IOP was < 25 mmHg in 80%. Some patients did not show any disease progression even after several years without treatment. This study supports the idea that patients with lower risk for progression could be reasonably left untreated and followed closely as long as they remain unchanged, and that progression is related to disease stage. - Strengths Standardized protocol Recruitment through a population-based screening Strict crtiteria for examinations, independent observers. Examinations carried out without expensive technology Well designed assessment of VF progression. Initial power calculations were based on the suspected difference in progression between the two groups. Ch. Intro 9 EGS
- Weaknesses Limited IOP range Patients with advanced disease (≥16 Db) were excluded Limited treatment options High sensitivity of method for assessing progression may have reduced specificity II. 6 - CLINICALLY USEFUL POINTS FROM THESE STUDIES II. 6. 1 - from OHTS 1. 90% of OHT did not convert in 5 years, raising the ‘need to treat’ question. 2. Treatment is effective: of the approximately 10% that converted half could be prevented by the OHTS treatment. We do not know how much longer this treatment prevents further conversion. 3. It did not tell us what treatment would reduce the number of converters to close to zero. 4. The majority of conversion was based on ONH change: monitoring of the optic disc is essential for follow-up of OHT next to visual field. Will all disc changes eventually lead to significant visual field defects 5. Conversion based on optic disc / RNFL changes (OHTS) may come before white/white VF changes. 6. Results on alternative methods for discovery of earlier visual function disturbances have not - yet - been published by OHTS. Preliminary SWAP analysis suggested that a proporton had VF defects at entry; this plus the suggestion of pre-existing disc change says that many already could have had POAG. 7. At a mean treated IOP level of 19.3 mmHg, 4.4% reached the endpoint. Delta IOP was 4.6 mmHg (
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 10 and 11: INTRODUCTION The aim of the book is
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 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
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All forms of glaucoma should be cla
Page 74 and 75:
2.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
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2.2.4 - PRIMARY OPEN-ANGLE GLAUCOMA
Page 78 and 79:
2.3 - SECONDARY OPEN-ANGLE GLAUCOMA
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2.3.1.6 - Glaucoma due to intraocul
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2.4 - PRIMARY ANGLE-CLOSURE Primary
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Systemic Risk factors for primary a
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OCCLUDABLE ANGLE: “Occludable”
Page 88 and 89:
2.5.3 - SECONDARY ANGLE-CLOSURE GLA
Page 90 and 91:
CHAPTER 3 TREATMENT PRINCIPLES and
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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
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3.3.1.2 - Category: ADRENERGIC ANTA
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3.3.1.3 - Category: CARBONIC ANHYDR
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3.3.1.4 - Category: PARASYMPATHOMIM
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3.3.1.5 - Category: PROSTAGLANDIN D
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Drug interactions Precipitation occ
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COMBINATION THERAPY Starting* Addit
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3.3.2.2 - Category: ADRENERGIC ANTA
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Pregnancy and nursing mothers Only
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3.5 - LASER SURGERY 3.5.1 - LASER I
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3.5.2 - LASER TRABECULOPLASTY 77-89
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3.5.4 - CYCLOPHOTOCOAGULATION Indic
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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
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25) Janz NK, Wren PA, Lichter PR, M
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(Rescula TM ) in patients with glau
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in white patients with open-angle g
Page 134 and 135:
CHAPTER 4 TREATMENT GUIDELINES
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4.2 - PRIMARY OPEN-ANGLE GLAUCOMAS
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4.2.7 - OCULAR HYPERTENSION (OH) Al
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4.3.1.7 - Glaucoma associated with
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• Withdrawal of aqueous from vitr
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4.5 - SECONDARY ANGLE-CLOSURE GLAUC
Page 146 and 147:
4.5.3 - SECONDARY ANGLE-CLOSURE GLA
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NOTES
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NOTES
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NOTES
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