ICO International Clinical Guidelines:
Primary Open-Angle Glaucoma (Initial Evaluation)
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(You can also download this Guideline as a PDF file - 103 KB)
On this page:
- Initial exam history
- Initial physical exam
- Management plan for patients in whom therapy is indicated
- Surgery and postoperative care for laser trabeculoplasty patients
- Surgery and postoperative care for filtering surgery patients
- Patient education for patients with medical therapy
Initial Exam History (Key elements)
- Ocular history [A:III]
- Systemic history [A:III]
- Family history [A:II]
- Assessment of impact of visual function on daily living and activities [A:III]
- Review of pertinent records [A:III]
Initial Physical Exam (Key elements)
- Visual acuity [A:III]
- Pupils [B:II]
- Slit-lamp biomicroscopy of anterior segment [A:III]
- Measurement of IOP [A:I]
- Time of day recorded because of diurnal variation [B:III]
- Time of day recorded because of diurnal variation [B:III]
- Central corneal thickness [A:II]
- Gonioscopy [A:III]
- Evaluation of optic nerve head and retinal nerve fiber layer with magnified stereoscopic visualization [A:III]
- Documentation of the optic disc morphology, best performed by color stereophotography or computer-based image analysis [A:II]
- Evaluation of the fundus (through a dilated pupil whenever feasible) [A:III]
- Visual field evaluation, preferably by automated static threshold perimetry [A:III]
Management Plan for Patients in Whom Therapy is Indicated
- Set an initial target pressure of at least 20% lower than pretreatment IOP, assuming that the measured pretreatment pressure range contributed to optic nerve damage. [A:I] The more advanced the damage, the lower the initial target pressure should be. [A:III]
- In many instances, topical medications constitute effective initial therapy. [A:III]
- Laser trabeculoplasty is an appropriate initial therapeutic alternative. [A:I]
- Filtering surgery may sometimes be an appropriate initial therapeutic alternative. [A:I]
- Choose a regimen of maximal effectiveness and tolerance to achieve desired therapeutic response. [A:III]
Surgery and Postoperative Care for Laser Trabeculoplasty Patients
- Ensure the patient receives adequate postoperative care. [A:III] Plan prior to and after surgery includes:
Surgery and Postoperative Care for Filtering Surgery Patients
- Ensure the patient receives adequate postoperative care. [A:III] Plan prior to and after surgery includes:
- Informed consent. [A:III ]
- At least one preoperative evaluation by the surgeon. [A:III]
- Follow-up on first day (12-36 hours after surgery) and at least once from the second to tenth postoperative day. [A:II]
- In absence of complications, additional routine postoperative visits during a 6-week period. [A:III]
- Use topical corticosteroids in the postoperative period, unless contraindicated. [A:II]
- Add more frequent visits, if needed, for patients with postoperative complications. [A:III]
- Additional treatments as necessary to maximize chances for long-term success. [A:III]
- Informed consent. [A:III ]
Patient Education for Patients with Medical Therapy
- Discuss diagnosis, severity of the disease, prognosis and management plan, and likelihood that therapy will be lifelong. [A:III]
- Educate about eyelid closure or nasolacrimal occlusion when applying topical medications to reduce systemic absorption. [B:II]
- Encourage patients to alert their ophthalmologist to physical or emotional changes that occur when taking glaucoma medications. [A:III]
- Educate about the disease process, rationale and goals of intervention, status of their condition, and relative benefits and risks of alternative interventions so that patients can participate meaningfully in developing an appropriate plan of action. [A:III]
* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2006 (www.aao.org)
(You can also download this Guideline as a PDF file - 103 KB)
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