ICO International Clinical Guidelines:
Primary Open-Angle Glaucoma (Follow-up evaluation)
More on the Guidelines:
(You can also download this Guideline as a PDF file - 108 KB)
On this page:
- Exam history
- Physical exam
- Management plan for patients on medical therapy
- Follow-up
- Patient education for patients with medical therapy
Exam History
- Interval ocular history [A:III]
- Interval systemic medical history [B:III]
- Side effects of ocular medication [A:III]
- Frequency and time of last IOP-lowering medications, and review of use of medications [B:III]
Physical Exam
- Visual acuity [A:III]
- Slit-lamp biomicroscopy [A:III]
- Measurement of IOP and time of day of measurement [A:III]
- Evaluation of optic nerve and visual fields (see table below) [A:III]
- Pachymetry should be repeated after any event that may alter central corneal thickness [A:II]
Management Plan for Patients on Medical Therapy
- Reconsider current IOP and its relationship to the target IOP at each visit. [A:III]
- At each exam, record dosage and frequency of use, discuss adherence to the therapeutic regimen and patient's response to recommendations for therapeutic alternatives or diagnostic procedures. [A:III]
- Perform gonioscopy if there is a suspicion of angle closure, anterior-chamber shallowing or anterior-chamber angle abnormalities or if there is an unexplained change in IOP. [A:III] Perform gonioscopy periodically (e.g., 1-5 years). [A:III]
- Assess treatment regimen if target IOP is not achieved and maintained in light of potential risks and benefits of additional or alternative treatment. [A:III]
- If a drug fails to reduce IOP, replace with an alternate agent until effective medical treatment is established. [A:III]
- Adjust target pressure downward if disc or visual field change is progressive. [A:III]
- Within each of the recommended intervals, factors that determine frequency of evaluation include the severity of damage, the stage of disease, the rate of progression, the extent to which the IOP exceeds the target pressure and the number and significance of other risk factors for damage to the optic nerve. [A:III]
- Deleting or adding medication justifies a follow-up visit at an interval appropriate for washout or maximal effect of medication withdrawn or added. [A:III]
Follow-up:
Recommended Guidelines for Follow-up:
|
Target IOP Achieved |
Progression of Damage |
Duration of Control (months) |
Follow-up Interval [B:III] |
Optic Nerve Head Evaluation [A:III] |
Visual Field Evaluation [A:III] |
|
Yes |
No |
< 6 |
Within 6 months |
3-12 months |
3-12 months |
|
Yes |
No |
> 6 |
Within 12 months |
3-12 months |
3-12 months |
|
Yes |
Yes |
(n/a) |
Within 4 months |
1-12 months |
12 months |
|
No |
Yes or No |
(n/a) |
Within 4 months |
1-12 months |
12 months |
Patient Education for Patients with Medical Therapy:
- Encourage patients to alert their ophthalmologist to physical or emotional changes that occur when taking glaucoma medications. [A:III]
- Refer for or encourage patients with significant visual impairment or blindness to use appropriate vision rehabilitation and social services. [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 - 108 KB)
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