terminology and guidelines for glaucoma ii - Kwaliteitskoepel

3.1 - GENERAL PRINCIPLES OF GLAUCOMA TREATMENT
• The purpose of this chapter is to give a summary overview and it is not meant to be all-inclusive
• When more than one active compound or drug category is referred to under any heading, these are listed in alphabetical
order
NORMAL
FUNCTION
WHOM TO TREAT
RATE OF PROGRESSION
SIGNIFICANT
FUNCTIONAL
IMPAIRMENT
BLINDNESS
TIME FROM DIAGNOSIS
DEATH
Fig. 3.1 - THE “WHOM TO TREAT” GRAPH
The rate of ganglion cell loss and consequent functional decay is different in different individuals and can vary within the
same eye due to changes in time of the risk factors. To preserve the quality of life, patients must remain above the threshold of
significant functional impairment. Line A represents the effect of aging alone. The patient identified by line B is worsening due
to disease, but does not need treatment while those following lines C, D and E will be disabled within their lifetime unless successfully
treated. To assess the likely Rate of Progression (RoP) is an important part of patient management.
The goal of glaucoma treatment is to maintain the patient’s quality of life at a sustainable cost. The cost of treatment
in terms of inconvenience and side effects as well as financial implications for the individual and society requires
careful evaluation. The quality of life is closely linked with visual function. The treatment side effects, the dosing
schedule and the constant worry about losing eye sight are all detrimental to the quality of life (see also Ch.
Introduction).
Among the potential treatment options in glaucoma, reduction of IOP, improvement of ocular blood flow, and direct neuroprotectionhave
been identified. Presently, the only approach proven to be efficient in preserving visual function is to lower
the IOP 1-2 (see Ch. Introduction II). Current evidence indicates that alteration in blood flow may be relevant in openangle
glaucoma patients, independent of intraocular pressure 3-13 . However, because of the lack of an adequate methodology,
no study that is capable of assessing the value of ocular blood flow treatment in glaucoma, has yet been designed
(see also Ch. 1.6). Nevertheless, ocular blood flow is an important parameter to be considered when evaluating
the direct and indirect effects of any treatment for glaucoma 5-13, , as is the concept of neuroprotection.
Ch. 3 - 3 EGS