Example: confidence

ICO Guidelines for Glaucoma Eye Care

International Council of Ophthalmology Guidelines for Glaucoma Eye Care The International Council of Ophthalmology (ICO) Guidelines for Glaucoma Eye Care

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Text of ICO Guidelines for Glaucoma Eye Care

ICO Guidelines for Glaucoma Eye CareInternational Council of Ophthalmology Guidelines for Glaucoma Eye CareThe International Council of Ophthalmology (ICO) Guidelines for Glaucoma Eye Care have been developed as a supportive and educational resource for ophthalmologists and eye care providers worldwide. The goal is to improve the quality of eye care for patients and to reduce the risk of vision loss from the most common forms of open and closed angle glaucoma around the world. Core requirements for the appropriate care of open and closed angle glaucoma have been summarized, and consider low and intermediate to high resource settings. This is the first edition of the ICO Guidelines for Glaucoma Eye Care (February 2016). They are designed to be a working document to be adapted for local use, and we hope that the Guidelines are easy to read and Task Force for Glaucoma Eye CareNeeru Gupta, MD, PhD, MBA, ChairmanTin Aung, MBBS, PhDNathan Congdon, MD Tanuj Dada, MDFabian Lerner, MDSola Olawoye, MDSerge Resnikoff, MD, PhDNingli Wang, MD, PhD Richard Wormald, MDAcknowledgementsWe gratefully acknowledge Dr. Ivo Kocur, Medical Officer, Prevention of Blindness, World Health Organization (WHO), Geneva, Switzerland, for his invaluable input and participation in the discussions of the Task Force. We sincerely thank Professor Hugh Taylor, ICO President, Melbourne, Australia, for many helpful insights during the development of these Council of Ophthalmology | Guidelines for Glaucoma Eye Care International Council of Ophthalmology | Guidelines for Glaucoma Eye CareTable of ContentsIntroduction 2Initial Clinical Assessment of Glaucoma 4Glaucoma Assessment and Equipment Needs 5Glaucoma Assessment Checklist 6 Approach to Open Angle Glaucoma Care 10Ongoing Open Angle Glaucoma Care 13Approach to Closed Angle Glaucoma Care 15Ongoing Care for Closed Angle Glaucoma 16Indicators to Assess Glaucoma Care Programs 19ICO Guidelines for Glaucoma Eye Care 20 International Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 1IntroductionGlaucoma is the leading cause of world blindness after cataracts. Glaucoma refers to a group of diseases, in which optic nerve damage is the common pathology that leads to vision loss. The most common types of glaucoma are open angle and closed angle forms. Worldwide, open angle and closed angle glaucoma each account for about half of all glaucoma cases. Together, they are the major cause of irreversible vision loss globally. The burden of each of these diseases varies considerably among racial and ethnic groups worldwide. For example, in western countries, vision loss from open angle glaucoma is most common, in contrast to East Asia, where vision loss from closed angle glaucoma is most common. Patients with glaucoma are reported to have poorer quality of life, reduced levels of physical, emotional, and social well-being, and utilize more health care intraocular pressure (IOP) is a major risk factor for loss of sight from both open and closed angle glaucoma, and the only one that is modifiable. The risk of blindness depends on the height of the intraocular pressure, severity of disease, age of onset, and other determinants of susceptibility, such as family history of glaucoma. Epidemiological studies and clinical trials have shown that optimal control of IOP reduces the risk of optic nerve damage and slows disease progression. Lowering IOP is the only intervention proven to prevent the loss of sight from glaucoma. Glaucoma should be ruled out as part of every regular eye examination, since complaints of vision loss may not be present. Differentiating open from closed angle glaucoma is essential from a therapeutic standpoint, because each form of the disease has unique management considerations and interventions. Once the correct diagnosis of open or closed angle glaucoma has been made, appropriate steps can be taken through medications, laser, and microsurgery. This approach can prevent severe vision loss and disability from sight threatening low resource settings, managing patients with glaucoma has unique challenges. Inability to pay, treatment rejection, poor compliance, and lack of education and awareness, are all barriers to good glaucoma care. Most patients are unaware of glaucoma disease, and by the time they present, many have lost significant vision. Long distances from healthcare facilities, and insufficient medical professionals and equipment, add to the difficulty in treating glaucoma. A diagnosis of open or closed angle glaucoma requires medical and surgical interventions to prevent vision loss and to preserve quality of life. Preventing glaucoma blindness in underserved regions requires heightened attention to local educational needs, availability of expertise, and basic infrastructure requirements. There is strong support to integrate glaucoma care within comprehensive eye care programs and to consider rehabilitation aspects of care. Persistent efforts to support effective and accessible care for glaucoma are Universal Eye Health: A Global Action Plan 2014-2019, WHO, 2013 Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 2Open Angle GlaucomaIn open angle glaucoma, there is characteristic optic nerve damage and loss of visual function in the presence of an open angle with no identifying pathology. The disease is chronic and progressive. Although elevated IOP is often associated with the disease, elevated IOP is not necessary to make the diagnosis. Risk factors for the disease include elevated intraocular pressure, increasing age, positive family history, racial background, myopia, thin corneas, hypertension, and diabetes. Patients with elevated IOP or other risk factors should be followed regularly for the development of patients with open and closed angle forms of glaucoma are unaware they have sight-threatening disease. Mass population screening is not currently recommended. However, all patients presenting for eye care should be reviewed for glaucoma risk factors and undergo clinical examination to rule out glaucoma. Patients with glaucoma should be told to alert brothers, sisters, parents, sons, and daughters that they have a higher risk of developing disease, and that they also need to be checked regularly for glaucoma. The ability to make an accurate diagnosis of glaucoma, to determine whether it is an open or closed form, and to assess disease severity and stability, are essential to glaucoma care strategies and blindness prevention. Open Angle Glaucomatous Optic Nerve Damage Elevated IOP Visual Field Damage Closed Angle Elevated IOP Glaucomatous Optic Nerve Damage Visual Field DamageClosed Angle GlaucomaIn closed angle glaucoma, optic nerve damage and vision loss may occur in the presence of an anatomical block of the anterior chamber angle by the iris. This may lead to elevated intraocular pressure and optic nerve damage. In acute angle closure glaucoma, the disease may be painful, needing emergency care. More often the disease is chronic, progressive, and without symptoms. Risk factors for the disease include racial background, increasing age, female gender, positive family history, and hyperopia. Patients with these risk factors should be followed regularly for the development of closed angle Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 3 Initial Clinical Assessment of GlaucomaHistory Assessment for glaucoma includes asking about complaints that may relate to glaucoma such as vision loss, pain, redness, and halos around lights. The onset, duration, location, and severity of symptoms should be noted. All patients should be asked about family members with glaucoma, and a detailed history should also be 1 - History ChecklistInitial Glaucoma AssessmentEvaluation for glaucoma is recommended as part of a comprehensive eye exam. The ability to diagnose glaucoma in its open or closed angle forms, and to evaluate its severity, are critical to glaucoma care approaches and the prevention of blindness. Core examination and equipment needs to diagnose and monitor glaucoma patients are listed in Table 2. Chief Complaint Age, Race, Occupation Social History Possibility of Pregnancy Family History of Glaucoma Past Eye Disease, Surgery, or Trauma Corticosteroid Use Eye Medications Systemic Medications Drug Allergies Tobacco, Alcohol, Drug Use Diabetes Lung Disease Heart Disease Cerebrovascular Disease Hypertension/Hypotension Renal Stones Migraine Raynaud's Disease Review of SystemsInternational Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 4Table 2 - Glaucoma Assessment and Equipment Needs - International Recommendations Clinical AssessmentMinimal Equipment (Low Resource Settings)Optional Equipment (Intermediate / High Resource Settings) Visual AcuityNear reading card or distance chart with 5 standard letters or symbolsPinhole 3- or 4-meter visual acuity lane with high contrast visual acuity chartRefractionTrial frame and lensesRetinoscope, Jackson cross-cylinderPhoropterAutorefractorPupi lsPen light or torch Anterior Segment Slit lamp biomicroscope KeratometerCorneal pachymeterIntraocular Pressure Goldmann applanation tonometer Portable handheld applanation t onometer Schiotz tonometerTonopenPneumotonometerAngle StructuresSlit lamp gonioscopy Goldmann, Zeiss/Posner goniolensesAnterior segment optical coherence tomography Ultrasound biomicroscopy Optic Nerve (dilated if angle open)Direct ophthalmoscopeSlit lamp biomicroscopy with hand held 78 or 90 diopter lensFundus photographyOptic nerve image analyzers Confocal scanning laser ophthalmoscopy Optical coherence tomography Scanning laser polarimetryFundus Direct ophthalmoscopeHead mounted indirect ophthalmoscope with 20 or 25 diopter lensSlit lamp biomicroscopy with 78 diopter lens12 and 30 diopter lenses60 and 90 diopter lensesVisual FieldManual perimetry or automated white on white perimetryFrequency doubling technologyShort wave automated perimetry International Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 5 Visual Acuity Vision should be tested (undilated), unaided, and with best correction at distance and near. Central vision may be affected in advanced glaucoma. Refractive Error The refractive error will help to understand the risk of open angle glaucoma (myopia) or closed angle glaucoma (hyperopia). Neutralizing the error is important to assessing visual acuity and visual fields. Pupils Pupils should be tested for reactivity and afferent pupillary defect. An afferent defect may signal asymmetric moderate to advanced glaucoma. Lids/Sclera/ Conjunctiva Evidence of inflammation, redness, ocular surface disease, or local pathology may point to uncontrolled IOP due to acute or chronic angle closure, or possible glaucoma drug allergy, or other disease. Cornea The cornea should be examined for edema, which may be seen in acute or chronic high IOP. Note that IOP readings are underestimated in the presence of corneal edema. Corneal precipitates may indicate inflammation. Glaucoma Assessment Checklist Corneal Thickness The thickness of the cornea is measured to help interpret IOP readings. Thick corneas tend to overestimate the IOP reading, and thin corneas tend to underestimate the reading. Intraocular Pressure IOP should be measured in each eye before gonioscopy and before dilation. Recording the time of IOP measurement is recommended to account for diurnal variation. Anterior Segment The anterior segment should be examined in the undilated state and after dilation (if the angle is open). Look for anterior chamber shallowing and peripheral depth, pseudoexfoliation, pigment dispersion, inflammation and neovascularization, or other causes of glaucoma. International Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 6 Angle Structures The angle should be examined for the presence of iris contact with the trabecular meshwork in a dark room setting. The location and extent, and whether it is due to appositional or synechial closure, should be determined by indentation gonioscopy. The presence of inflammation, pseudoexfoliation, neovascularization, and other pathology should be noted. Iris The iris should be examined for mobility and irregularity, the presence of anterior and posterior synechiae, and pseudoexfoliation at the pupil margin. Forward bowing, peripheral angle crowding, and iris insertion should be noted in addition to the presence of inflammation, neovascularization, and other pathology. Lens The lens should be examined for cataract, size, position, posterior synechiae, pseudoexfoliation material, and evidence of angle on gonioscopy with no structures visibleOpen angle on gonioscopyPseudoexfoliation deposits at the pupil marginGlaucoma Assessment Checklist (cont d) International Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 7Plateau iris with peripheral iris rollGlaucoma Assessment Checklist (cont d) Optic Nerve The optic nerve should be evaluated for characteristic signs of glaucoma. The degree of optic nerve damage helps to guide initial treatment goals. Early optic nerve damage may include a cup , focal retinal nerve fiber layer defects, focal rim thinning, vertical cupping, cup/disc asymmetry, focal excavation, disc hemorrhage, and departure from the ISNT rule (rim thickest inferiorly, then superiorly, nasally and temporally). Moderate to advanced optic nerve damage may include a large cup , diffuse retinal nerve fiber defects, diffuse rim thinning, optic nerve excavation, acquired pit of the optic nerve, and disc nerve fiber layer defectThinning of the inferior rim Disc hemorrhage at 5 o clockAdvanced glaucoma with vertical cupInternational Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 8Glaucoma Assessment Checklist (cont d) Fundus The posterior pole should be evaluated for the presence of diabetic retinopathy, macular degeneration, and other retinal disorders. See the ICO Guidelines for Diabetic Eye Care at: The Visual Field Preserving visual function is the goal of all glaucoma management. The visual field is a measure of visual function that is not captured by the visual acuity test. Visual field testing identifies, locates, and quantifies the extent of field loss. The presence of visual field damage may indicate moderate to advanced disease. Monitoring the visual field is important to determine disease instability as seen below. Progressive vision loss over timeInternational Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 9Approach to Open Angle Glaucoma CareA diagnosis of open angle glaucoma requires medical and possible surgical intervention to prevent vision loss and to preserve quality of life. Once a diagnosis of open angle glaucoma is made, patient education should begin regarding the nature of the disease, the need to lower IOP, along with discussions of treatment options. Patients should be informed of the need to alert first degree relatives for the need of a glaucoma examination. The financial, physical, social, emotional, and occupational burdens of glaucoma treatment options should be carefully considered for each patient. Recommendations, risks, options, and consequences of no treatment, should be discussed with all patients in language that is understandable to the patient or caregiver. Classifying glaucoma disease as early, or moderate to advanced, can help to guide IOP treatment goals and approaches. A simplified approach to initiating care in glaucoma patients is summarized below in Table 3 - Initiating Open Angle Glaucoma Care - International RecommendationsLow resource settings pose unique challenges depending on the region. Particular attention should be given to compliance with treatments and the capacity of the patient to obtain and use medication. If a patient cannot afford the cost of drugs, initial laser trabeculoplasty would be favored wherever equipment and expertise are available. If resources to manage glaucoma are insufficient, referral is SeverityFindingsSuggested IOP ReductionTreatment ConsiderationsEarlyOptic Nerve Damage Visual Field LossLower IOP 25%Medication or Laser trabeculoplasty Moderate/ AdvancedOptic Nerve Damage+Visual Field LossLower IOP 25 50%Medication or Laser trabeculoplasty or Trabeculectomy Mitomycin C or Tube ( cataract removal and intraocular lens [IOL]) and/orCyclophotocoagulation (or cryotherapy)End-stage (Refractory glaucoma)Blind Eye PainLower IOP 25 50%(If painful)Medication and/or Cyclophotocoagulation (or cryotherapy) andRehabilitation ServicesInternational Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 10Table 4 - Medicines for Glaucoma Care: International Recommendations Eye DropsEssential Medicines (Low Resource Settings)Optional Medicines (Intermediate / High Resource Settings)Anesthetic Tetracaine Fluorescein 1% Tropicamide Constricting Pilocarpine 2% or 4%Pupil Dilating Atropine , , or 1%Homatropine or cyclopentolateAnti-Inflammatory Prednisolone or 1%Anti-Infectives Ofloxacin , gentamycin or azithromycin Pressure Lowering (Topical)Latanoprost 50 g/mLTimolol or analogs Other beta blockersCarbonic anhydrase inhibitors Alpha agonistsFixed combination drops Intraocular Pressure Lowering (Systemic)Oral and IV acetazolamide IV mannitol 10% or 20% MethazolamideGlycerolSee the 19th WHO Model List of Essential Medicines (April 2015), by going to: Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 11An ethical approach is indispensable to quality clinical care. Download the ICO Code of Ethics at: 5 - Laser Trabeculoplasty for Glaucoma: International RecommendationsTreatment ParametersArgon Laser Trabeculoplasty (ALT) Selective Laser Trabeculoplasty (SLT)Laser TypeArgon green or blue-green / Diode LaserFrequency doubled Q-Switched Nd: Yag Laser (532 nm)Spot Size50 microns (Argon) or 75 microns (diode)400 micronsPower300 to 1000 to 2 mJApplication SiteTM junction non-pigmented/pigmentedTrabecular meshwork (TM)Handheld LensGoldmann gonioscopy lens or Ritch lensGoldmann or SLT lensTreated Circumference180 360 degrees180 360 degreesNumber of Burns~ 50 spots per 180 degrees~ 50 spots per 180 degreesNumber of Sittings1 or 21 or 2EndpointBlanching at junction of anterior non-pigmented and pigmented TMBubble formationTreatment ParametersTransscleral Nd: YAG LaserTransscleral Diode LaserLaser TypeNd: YAG LaserDiode LaserPower4 to 7 to WExposure to to secondsApplication to mm from to mm from limbusHandheld ProbeTransscleral contactTransscleral contactTreated Circumference180 360 degrees180 360 degreesNumber of Burns~ 15 20 spots per 180 degrees~ 12 20 spots per 180 degreesNumber of Sittings1 or 21 or 2Table 6 - Cyclophotocoagulation for Glaucoma: International Recommendations International Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 12Ongoing Open Angle Glaucoma CareOngoing management of glaucoma depends on the ability to evaluate response to treatment, and to detect disease progression and instability. Follow-up examinations are similar to the initial assessment and should include history and clinical evaluation. History: Ask about changes to general health and medications, visual changes, glaucoma drug compliance, difficulty with drops, and possible side effects. Clinical Assessment: Assess for changes in visual acuity or refractive error, IOP, new anterior segment pathology, and changes to the angle anatomy, changes to the optic nerve, and changes to the visual of Unstable Open Angle GlaucomaElevated Intraocular Pressure May be due to poor compliance, drug intolerance, or worsening Optic Nerve Changes Expanding nerve fiber layer defect, enlarging cup, new disc hemorrhage, and rim thinning. Progressive visual field changes Expanding visual field defect in size and depth, confirmed by repeat inferior rim lossProgressive superior field lossInternational Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 13Ongoing Open Angle Glaucoma Care A rise in IOP, progressive optic nerve damage, or progressive visual field loss, signal the need for additional medical or surgical intervention to prevent sight loss. A simplified approach to monitor and follow patients with glaucoma is summarized FindingsTreatment Follow-upStable GlaucomaNo Change to IOP and Optic Nerve and Visual FieldContinue~ 4 months 1 yearUnstable GlaucomaIncreased IOP and/or Increased Optic Nerve Damageand/orIncreased Visual Field DamageAdditional IOP lowering needed by 25%(Refer to Table 3) 1 4 months(depending on disease severity, risk factors and resources) More frequent follow-up is suggested in the presence of advanced disease, multiple risk factors, or progression within a short period. In low resource settings, compliance with treatment and the capacity of the patient to obtain and use medication should be considered. Surgical options may be favored earlier, wherever equipment and expertise are available. If resources to manage glaucoma are insufficient, referral is 7 - Ongoing Open Angle Glaucoma Care - International Recommendations International Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 14Approach to Closed Angle Glaucoma CareA diagnosis of closed angle glaucoma requires medical and surgical intervention to prevent vision loss. If expertise and resources to manage glaucoma are insufficient, referral is a diagnosis of closed angle glaucoma is made, patients should be educated regarding the nature of the disease and required treatment to help prevent vision loss. The cause of angle closure will determine the clinical care pathway, and as pupil block is the most common cause, laser iridotomy is recommended as the first line treatment for all patients. A simplified approach to initiating care in closed angle glaucoma patients is summarized angle closure with red eye and forward iris bowingSlit lamp beam shows very shallow anterior chamber depthIn addition to pupil block, progressive and irreversible angle closure may be due to plateau iris and other causes. The chamber angle should be carefully reviewed after laser iridotomy to look for other mechanisms of a closed angle needing treatment. Table 8 - Initiating Closed Angle Care - International RecommendationsDiagnosis Clinical FindingsEssential TreatmentSurgical Options Acute or Chronic Closed Angle(Pupil Block)Iris-trabecular contact Iris bowingConstrict pupil and lower IOP Laser iridotomy (desirable)orSurgical iridectomy (laser to fellow eye)Lens extraction/IOL Trabeculectomy Mitomycin CClosed Angle(Plateau Iris) Iris-trabecular contact Flat IrisConstrict pupil and lower IOPLaser iridotomy (desirable)or Surgical iridectomy (laser to fellow eye)andLaser iridoplastyLens extraction/IOL Trabeculectomy Mitomycin CInternational Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 15Ongoing Closed Angle Glaucoma Care Ongoing management of angle closure glaucoma relies on the ability to evaluate response to treatment and to detect disease progression and instability. Follow-up examinations are similar to the initial assessment and should include history and clinical evaluation. History: Ask about changes to general health and medications, visual changes, glaucoma drug compliance, difficult with drops, and possible side effects. Clinical Assessment: Assess for changes in visual acuity or refractive error, assess IOP, with careful attention to the angle and changes to angle closure status, changes to the optic nerve, and the visual of Unstable Closed Angle GlaucomaPersistent Angle Closure Synechiae formation, failed iridotomyElevated Intraocular Pressure Inadequate aqueous drainageProgressive Optic Nerve Changes Expanding nerve fiber layer defect, enlarging cup, new disc hemorrhage, rim thinning Progressive Visual Field Changes Expanding visual field defect in size and depth, confirmed by repeat testingTreatment ParametersLaser IridotomyLaser Iridoplasty Laser TypeQ-Switched Nd: Yag Argon green or blue-green Spot Size 200 500 micronsPower2mJ to 8mJ200 400 mWApplication SitePeripheral iris Peripheral irisHandheld LensLaser iridotomy lensGoldmann gonioscopy lens or Ritch lensTreated Circumference 180 360 degreesNumber of Burns 20 40 spots per 180 degreesNumber of Sittings1 1 or 2EndpointFull thickness iris openingContraction burnTable 9 - Laser Iridotomy and Iridoplasty for Glaucoma: International RecommendationsInternational Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 16Table 10 - Ongoing Closed Angle Glaucoma Care - International Recommendations ClassificationExam FindingsTreatment Follow-upStable GlaucomaNo Change to Angle, IOP, Optic Nerve, and Visual FieldContinue~ 6 months 1 year(depending on disease severity, risk factors, and resources)Unstable GlaucomaPersistent Angle ClosureandIncreased IOP Increased Optic Nerve Damage Increased Visual Field DamageAdditional IOP lowering needed by 25%(Refer to Table 11) 1 4 months(depending on disease severity, risk factors, and resources) Ongoing Closed Angle Glaucoma Care Persistent angle closure with a rise in IOP, progressive optic nerve damage, or progressive visual field loss, all signal the need for additional medical or surgical intervention to prevent sight loss. A simplified approach to monitor and follow patients with glaucoma is summarized Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 17More frequent follow-up is suggested in the presence of advanced disease, multiple risk factors, or progression within a short period. In low resource settings, compliance with treatment and the capacity of the patient to obtain and use medication should be considered. Surgical options may be favored earlier, wherever equipment and expertise are available. If resources to manage glaucoma are insufficient, referral is Closed Angle Glaucoma Once closed angle glaucoma is deemed unstable, classifying the disease as early, or moderate to advanced, helps to guide IOP treatment goals and approaches. The treatment options for a closed angle differ from open angle care, and are summarized 11 - Unstable Closed Angle Glaucoma - International Recommendations Glaucoma SeverityFindingsSuggested IOP ReductionTreatment ConsiderationsEarlyPersistent Angle Closure+Optic Nerve Damage Visual Field LossLower IOP 25%Medication Lens extraction/IOLModerate / AdvancedPersistent Angle Closure +Optic Nerve Damage+Visual Field LossLower IOP 25 50%Medication and/or Trabeculectomy or tube (with or without goniosynechiolysis, cataract removal, and IOL) and/orCyclophotocoagulation (or cryotherapy)Rehabilitation ServicesEnd-stage (Refractory glaucoma)Blind Eye PainLower IOP 25 50%(If painful)Medication and/or Cyclophotocoagulation (or cryotherapy) Rehabilitation ServicesIntraocular pressure goals should be adjusted according to individual risk factors. Financial, physical, and psychosocial burdens of each treatment option should also be considered. In low resource settings, surgical options may be favored. End-stage disease treatment is similar to that of open angle glaucoma. If resources or expertise to manage angle closure glaucoma are insufficient, referral is Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 18Indicators to Assess Glaucoma Care Programsa. Prevalence of glaucoma-related blindness and visual Proportion of blindness and visual impairment due to Last eye examination for glaucoma among known persons with glaucoma (males/females). 0 12 months ago 13 24 months ago >24 months ago Could be simplified as: 0-12 months ago, or >12 months ago d. Number of patients who were examined for glaucoma during last Number of patients who received laser trabeculoplasty, iridotomy, trabeculectomy, or tube surgery during last year. Define ratios such as:f. Number of patients who received laser or trabeculectomy per million general population per year (equivalent to cataract surgical rate [CSR]).g. Number of patients who received laser, trabeculectomy, or tube treatments per number of patients with glaucoma in a given area (hospital catchment area, health district, region, country). Numerator: number of laser, trabeculectomy, or tube treatments during the last year Denominator: number of patients with glaucoma (population x prevalence of glaucoma)h. Number of patients who received laser, trabeculectomy, or tube treatments per number of persons with vision-threatening glaucoma in a given area (hospital catchment area, health district, region, country). Numerator: number of laser, trabeculectomy, or tube treatments during the last year Denominator: number of patients with vision-threatening glaucoma (population x prevalence of glaucoma)International Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 19ICO Guidelines for Glaucoma Eye CareThe ICO Guidelines for Glaucoma Eye Care were created as part of a new initiative to reduce worldwide vision loss related to glaucoma. The ICO collected guidelines for glaucoma management from around the world. View the collected guidelines at: addition to creating a consensus on technical guidelines, this resource will also be used to: Stimulate improved training and continuing professional development to meet public needs. Develop a framework to evaluate, stimulate, and to monitor relevant public health Credit The ICO Guidelines for Glaucoma Eye Care were designed in collaboration with Marcelo Silles and Yuri Markarov (photo, page 1), Medical Media, St. Michael s Hospital, Toronto, Canada. Learn more at: Credit All photos that appear in the ICO Guidelines for Glaucoma Eye Care were provided by Prof. Neeru Gupta, St. Michael s Hospital, Li Ka Shing Knowledge Institute, Ophthalmology & Vision Sciences, University of Toronto, with the exception of the images on page 7, provided by Prof. Ningli Wang, Beijing Institute of Ophthalmology. These may not be used for commercial purposes. If the photos are used, appropriate credit must be the ICOThe ICO is composed of 140 national and subspecialty Member societies from around the globe. ICO Member Societies are part of an international ophthalmic community working together to preserve and restore vision. Learn more at: ICO welcomes any feedback, comments, or suggestions. Please email us at Headquarters:San Francisco, CaliforniaUnited StatesFax: +1 (415) 409-8411Email: Council of Ophthalmology | Guidelines for Glaucoma Eye Care | Page 20NotesNotes

Related search results