terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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A
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E
T
I
O
P
Target IOP range
Target pressure
according to
risk
Fig. 3.2.1 - TARGET IOP
Diagrammatic evaluation of
the desired therapeutic outcome
in form of IOP-lowering.
The target pressure
should be situated within the
shaded area. The lower is
the initial IOP, the lower
will be the Target IOP and
viceversa. The percentage of
IOP reduction targeted (i.e.
20%, 30%, 40% respectively)
depends mainly on the
degree of VF damage at diagnosis
and on rate of progression
(RoP).
3.2.2 - THE QUALITY OF LIFE (QoL)
The quality of life (QoL) is hard to quantify as an outcome measure. For patients however it is one of the most
important. Individuals diagnosed with glaucoma can lose quality of life for several reasons 23-32 , alone or in combination
(see FC I):
a) Diagnosis of glaucoma. Being diagnosed as having a chronic and potentially blinding disease generates worries
and anxiety in patients and their families.
b) Functional loss due to the disease
c) Inconvenience of the treatment
d) Side effects of the treatment
e) Cost of the treatment
Each person should be approached by asking their own perceptions on their present status and on their course as
well as asked to describe their difficulties with daily tasks (see FC I).
When the disease is not likely to interfere with the QoL, not initiating or witholding treatment is an option to be
discussed with the patient.
In order to help our patients to maintain a “healthy” status, we need to focus not only on the treatment of the disease
process, but also on the effect of both our diagnosis and treatment on the individual.
Age-Related ganglion cells loss will continue: to reach target IOP is intended to prevent only glaucoma-related functional
loss.
REMEMBER:
* Assess each eye individually when deciding the most appropriate therapy.
* It is essential to involve patients as informed partners in decisions regarding the management of
their condition.
* The least amount of medication (and consequent inconvenience, costs and side effects) to achieve
the therapeutic response should be a consistent goal.
* A therapeutic medical trial on one eye first is useful, although not always logistically feasible.
* Usually there is no need to start treatment until all baseline diagnostic data are collected.
* A single IOP measurement, unless grossly abnormal, is an insufficient parameter upon which solely base the
diagnosis and future patient management.
Ch. 3 - 6 EGS