terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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HODAPP CLASSIFICATION 31 EARLY GLAUCOMATOUS LOSS a) MD > - 6 dB b) Fewer than 18 points depressed below the 5% probability level and fewer than 10 points below the p < 1% level c) No point in the central 5 degrees with a sensitivity of less than 15 dB MODERATE GLAUCOMATOUS LOSS a) -6 > MD > -12 dB b) Fewer than 37 points depressed below the 5% probability level and fewer than 20 points below the p < 1% level c) No absolute deficit (0 dB) in the 5 central degrees d) Only one hemifield with sensitivity of < 15 dB in the 5 central degrees ADVANCED GLAUCOMATOUS LOSS a) MD < -12 dB b) More than 37 points depressed below the 5% probability level or more than 20 points below the p < 1% level c) Absolute deficit ( 0 dB) in the 5 central degrees d) Sensitivity < 15 dB in the 5 central degrees in both hemifields 1.4.5 - WORSENING OF THE VISUAL FIELD Looking for visual field progression is the most important part of clinical management in chronic glaucoma because this is the outcome that affects the patients quality of life. Changes in the visual field will make the Physician consider a change in clinical management The identification of visual field progression requires a series of fields, usually more than three, and often 5 or 6. Diagnosing visual field progession on a shorter visual field series is risky, because of the inherent variability in patient responses. The exception would be a dramatic change that was associated with corresponding symptoms suggesting visual loss and confirmed by unquestionable changes in ONH/RNFL. In many instances of such sudden change, the cause will not be glaucoma, but either vascular in origin, or due to changes in the visual pathways. Recent Treatment/No Treatment trials (see Introduction) have shown that glaucomatous field progression is usually slow, and that it will rarely be detected within one year of followup, even with a strict test/retest regime. In clinical practice there will be an individual approach, with stricter follow up being indicated in cases with advanced disease or with VF defects close to fixation. A practical scheme is to perform 2-3 tests that ‘train’ the patient, and provide mean values for a baseline, and then to repeat testing twice a year. A clinical routine that involves less frequent testing will reduce the chances of identifying change. Reduced sensitivity in a cluster of test points on the same hemifield, and outside the periphery by >=5db, or a single test point by > 10 db needs confirmation. This confirmation needs to be obtained on 2 subsequent field tests before deemed a permanent change. As an example, when using the Glaucoma Change Probability Maps in the Humphrey perimeter, at least three points flagged as significantly progressing that occur in the same location in three consecutive examinations can be used to define ‘confirmed’ glaucomatous field progression; the same pattern occurring in two consecutive fields can be used to denote ‘tentative’ field progression. Ch. 1 - 29 EGS
SUMMARY OF SUGGESTED CRITERIA FOR VISUAL FIELD DEFECT PROGRESSION * For a new defect in a previous normal area • A cluster of three or more non-edge points, each of which declines ≥ 5 dB compared to baseline on two consecutive fields. or • A single non-edge point that declines ≥10 dB compared to baseline on two consecutive fields. or • A cluster of three or more non-edge points, each of which declines at a p < 5% level compared to baseline on two consecutive fields. For deepening of a preexisting defect • A cluster of three non-edge points, each of which declines ≥ 10 dB compared to baseline on two consecutive fields. The confirming points may differ if they are part of a contiguous cluster. or • A cluster of three non-edge points or three points that are part of the same scotoma, each of which worsens at least 5 dB and is depressed compared to baseline at a p < 5% level on two consecutive fields. The confirming points may differ if they are part of a contiguous cluster or are separated by points not in the data base. For expansion of preexisting scotoma into contiguous points • At least two previously normal points within the central 15° or three additional previously normal points outside at the central 15°, each of which declines ≥ 10 dB each on two consecutive fields. or • At least two previously normal points within the central 15° or three previously normal points outside 15°, each of which is depressed at a p < 5% level compared to baseline on two consecutive fields. For generalized depression • A decline in the mean deviation that is significant at the p < 1% level and is not explained by media opacity or pupil size. or • A CPSD that shows an obvious trend based on the last five consecutive fields. or • A decline of ≥ 3 dB at all points on two consecutive fields that is not explained by media opacity or pupil size. PROGRESSION MUST BE CONFIRMED * Modified from Hodapp et Al 31 Ch. 1 - 30 EGS
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ISBN: 88-87434-13-1 Editrice DOGMA
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ACKNOWLEDGEMENT This work was made
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2.2.5 - Primary Open-Angle Glaucoma
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Foreword These Definitions and Guid
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INTRODUCTION The aim of the book is
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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 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
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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
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3.6.4 - COMPLEX CASES Complicated g
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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
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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
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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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