Ординатура / Офтальмология / Английские материалы / Terminology and Guidelines for Glaucoma 3rd edition_European Glaucoma Society_2008
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III. ABNORMAL THRESHOLD VISUAL FIELD
THE 1ST EXAM IS |
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REPEAT |
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NOT NORMAL |
AS SOON AS POSSIBLE TO ESTABLISH BASELINE |
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NORMAL |
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ABNORMAL |
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LEARNING EFFECT |
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BETTER |
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SAME OR WORSE |
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LOW RELIABILITY |
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CHECK RELIABILITY INDICES |
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NORMAL RELIABILITY |
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CAREFUL REINSTRUCTION |
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F/U |
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EARLY |
12 MONTHS |
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RUN A DEMO |
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OR EARLIER |
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CONSTANT SUPERVISION |
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STAGING |
MODERATE |
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CONSIDER GOLDMANN |
F/U |
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KINETIC PERIMETRY |
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ADVANCED |
6 MONTHS |
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OR EARLIER |
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DURING FOLLOW-UP
FLOWCHARTS
IDEALLY, OBTAIN 6 VFS IN 2 YEARS TO
IDENTIFY THE RATE OF PROGRESSION
PROGRESSION OF
CATARACT
BETTER |
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WORSE |
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RELIABILITY |
VERIFY AND |
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FLUCTUATION OF DAMAGE |
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CONSIDER QoL |
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LOW |
NORMAL |
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3 TO 12 MONTHS |
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REPEAT VF |
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SMALLER |
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PUPIL SIZE |
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NO CHANGE |
PROGRESSION OF DAMAGE - ASSESS RATE OF PROGRESSION
F/U AS NEEDED |
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CHANGE TREATMENT |
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BEFORE ACCEPTING VF DEFECTS AS REAL, THEY MUST BE CONFIRMED AT LEAST ON
TWO CONSECUTIVE EXAMS (EXCLUDING THE INITIAL ONE). FOLLOW-UP INTERVALS ARE JUST SUGGESTIONS. THE FREQUENCY OF TESTING IS TO BE ADAPTED TO THE SEVERITY OF DAMAGE AND ROP.
© EUROPEAN GLAUCOMA SOCIETY
IV. ASSESSMENT AND FOLLOW-UP
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OPTIC NERVE HEAD |
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IF ELEVATED IOP CONSIDER CCT |
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VISUAL FIELD |
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IF CONFIRMED IOP IN THE HIGH TWENTIES |
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OR |
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NORMAL |
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IF IOP VERY HIGH REPEAT ACCORDING TO IOP LEVEL |
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NORMAL |
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AFTER 1-12 MONTHS |
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NORMAL |
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ARTEFACT OR OTHER CAUSES |
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ABNORMAL |
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NORMAL |
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REPEAT TEST |
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SUSPICIOUS |
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––– |
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ABNORMAL |
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COUNSEL |
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NORMAL |
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SUSPICIOUS |
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REPEAT TEST |
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NORMAL |
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––– |
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SUSPICIOUS |
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COUNSEL |
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SUSPICIOUS |
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SUSPICIOUS |
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EARLY GLAUCOMA/GLAUCOMA SUSPECT |
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ABNORMAL |
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REPEAT TEST 3-12 MONTHS |
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ABNORMAL |
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SUSPICIOUS |
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ABNORMAL |
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GLAUCOMA DAMAGE |
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ABNORMAL |
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GLAUCOMA DAMAGE
ESTABLISH RATE OF PROGRESSION
ESTABLISH TARGET IOP RANGE AS A
SURROGATE ENDPOINT
RE-EVALUATE 3-12 MONTHS
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PROGRESSION |
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NO PROGRESSION |
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NEW TARGET IOP |
FOLLOW-UP 6 MONTHS |
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FLOWCHARTS
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STABLE |
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PROGRESSION |
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RE-EVALUATE |
NEW TARGET IOP |
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3-12 MONTHS |
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MODIFY RX |
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FOLLOW-UP INTERVALS ARE JUST RECOMMENDATIONS |
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© EUROPEAN GLAUCOMA SOCIETY
V. GONIOSCOPICALLY OPEN ANGLE
SOME DIAGNOSTIC CLUES
POAG
CONGENITAL GLAUCOMA CHILDHOOD GLAUCOMA
EXFOLIATIVE GLAUCOMA
PIGMENTARY GLAUCOMA
OPEN ANGLE GLAUCOMA SECONDARY TO UVEITIS
POST-TRAUMATIC
GLAUCOMA
OPEN ANGLE GLAUCOMA
SECONDARY TO
NEOVASCULARIZATION
NORMAL ANGLE
ANGLE POORLY DIFFERENTIATED 
TRABECULODYSGENESIS BARKAN S “MEMBRANE”
ANTERIOR INSERTION OF THE IRIS
BLACK PIGMENTED UNDULATING LINE ON ANTERIOR TO 
SCHWALBE S LINE (SAMPAOLESI S LINE)
HEAVILY PIGMENTED TRABECULUM
MID TRABECULAR BAND OF BROWN PIGMENT
PIGMENT ON SCWALBE S LINE
SCATTERED PIGMENT, NEW VESSELS,
PERIPHERAL ANTERIOR SYNECHIA
ANGLE RECESSION, IRREGULAR IRIS INSERTION
POSSIBLE INCREASE OF PIGMENT
NEOVASCULAR MEMBRANE
© EUROPEAN GLAUCOMA SOCIETY
FLOWCHARTS
VI. TARGET IOP
HIGHER
TARGET
IOP
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EARLY |
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SHORT |
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HIGH |
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SLOW |
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GLAUCOMA DAMAGE LIFE EXPECTANCY UNTREATED IOP
RATE OF
PROGRESSION
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ADVANCED |
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LONG |
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LOW |
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FAST |
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LOWER TARGET IOP
THE ABOVE FACTORS NEED TO BE CONSIDERED AS A WHOLE IN DECIDING THE INDIVIDUAL TARGET PRESSURE REQUIRED
© EUROPEAN GLAUCOMA SOCIETY
FLOWCHARTS
VII. TREATMENT STEPLADDER FOR OAG AND OH
JUVENILE |
POAG/EXFOL/PIGM |
SEE CHAPTERS INTRO, 2 AND 3
MEDICAL RX 2 |
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MEDICAL RX 2 |
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LASER TRABECULOPLASTY 1
FILTRATION SURGERY 3
FILTRATION SURGERY 3
TRABECULOTOMY
OCULAR
HYPERTENSION
SEE CHAPTERS INTRO, 2 AND 3
CONSIDER TREATMENT
IN PATIENT WITH REPEATED IOPs IN THE HIGH 20s EVEN WITHOUT ADDITIONAL RISK FACTORS. ALWAYS CONSIDER CORNEAL THICKNESS MEASUREMENT
MEDICAL RX 2
IF THE ABOVE NOT SUCCESSFUL, CONSIDER REPEAT FILTRATION SURGERY+ANTIMETABOLITES OR
LONG-TUBE DRAINAGE IMPLANT/CYCLO DESTRUCTIVE PROCEDURE
1 LASER TRABECULOPLASTY CAN ALSO BE CONSIDERED AS PRIMARY TREATMENT
2 UP TO 2-3 DIFFERENT DRUGS. DO NOT ADD A DRUG TO A NON-EFFECTIVE ONE; CONSIDER SWITCHING
3 IN CERTAINS CASES, IT MAY BE NECESSARY TO CONSIDER FILTRATION SURGERY WITHOUT RESORTING TO MEDICAL TREATMENT OR LASER TRABECULOPLASTY
OAG = Open Angle Glaucoma, OH = Ocular Hypertension
© EUROPEAN GLAUCOMA SOCIETY
FLOWCHARTS