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1 General aspects (0)   1.1 Epidemiology (2)   1.2 Population genetics (1)   1.3 Pathogenesis (0)   1.4 Quality of life (4)   1.5 Glaucomas as cause of blindness (0)   1.6 Prevention and screening (3) 2 Anatomical structures in glaucoma (0)   2.1 Conjunctiva (0)   2.2 Cornea (3)   2.3 Sclera (0)   2.4 Anterior chamber angle (1)   2.5 Meshwork (0)     2.5.1 Trabecular meshwork (10)     2.5.2 Schlemms canal (0)     2.5.3 Scleral outlet channels (0)   2.6 Aqueous humor dynamics (1)     2.6.1 Production (0)     2.6.2 Outflow (1)       2.6.2.1 Trabecular meshwork (0)       2.6.2.2 Uveoscleral (0)     2.6.3 Compostion (2)   2.7 Episcleral veins and venous pressure (0)   2.8 Iris (0)   2.9 Ciliary body (0)   2.10 Lens (0)   2.11 Vitreous body (0)   2.12 Choroid, peripapillary choroid, peripapillary atrophy (0)   2.13 Retina and retinal nerve fibre layer (12)   2.14 Optic disc (9)   2.15 Optic nerve (4)   2.16 Chiasma and retrochiasmal central nervous system (2)   2.17 Stem cells (0)   2.20 Other (0) 3 Laboratory methods (5)   3.1 Microscopy (0)   3.2 Electron microscopy (2)   3.3 Immunohistochemistry (3)   3.4 Molecular genetics (1)     3.4.1 Linkage studies (9)     3.4.2 Gene studies (5)   3.5 Molecular biology incl. SiRNA (4)   3.6 Cellular biology (6)   3.7 Biochemistry (2)   3.8 Pharmacology (1)   3.9 Pathophysiology (3)   3.10 Immunobiology (0)   3.11 Pharmacogenetics (0)   3.12 Proteomics (0)   3.13 In vivo imaging (0)     3.13.1 Laser Scanning (0)       3.13.1.1 Confocal Scanning Laser Ophthalmoscopy (0)       3.13.1.2 Confocal Scanning Laser Polarimetry (0)     3.13.2 Optical Coherence Tomography (0)       3.13.2.1 Anterior Segment (0)       3.13.2.2 Posterior Segment (0)     3.13.3 RGC Imaging (0)     3.13.4 Other (0)   3.20 Other (0) 4 Tissue culture of ocular cells (0) 5 Experimental glaucoma; animal models (19)   5.1 Rodent (0)   5.2 Primates (0)   5.3 Other (0) 6 Clinical examination methods (1)   6.1 Intraocular pressure measurement; factors affecting IOP (12)     6.1.1 Devices, techniques (0)     6.1.2 Fluctuation, circadian rhythms (0)     6.1.3 Factors affecting IOP (0)   6.2 Tonography, aqueous flow measurement (see also 2.6) (0)   6.3 Biomicroscopy (slitlamp) (0)     6.3.1 Anterior segment (4)     6.3.2 Posterior segment (0)   6.4 Gonioscopy (1)   6.5 Ophthalmoscopy (0)   6.6 Visual field examination and other visual function tests (1)     6.6.1 Conventional manual (1)     6.6.2 Automated (3)     6.6.3 Special methods (e.g. color, contrast, SWAP etc.) (13)   6.7 Electro-ophthalmodiagnosis (4)   6.8 Photography (0)     6.8.1 Anterior segment (0)     6.8.2 Posterior segment (4)   6.9 Computerized image analysis (3)     6.9.1 Laser scanning (15)       6.9.1.1 Confocal Scanning Laser Ophthalmoscopy (0)       6.9.1.2 Confocal Scanning Laser Polarimetry (0)     6.9.2 Optical coherence tomography (13)       6.9.2.1 Anterior (0)       6.9.2.2 Posterior (0)     6.9.5 Other (1)   6.10 Fluorescein (ICG) angiography (0)     6.10.1 Anterior segment (0)     6.10.2 Posterior segment (0)   6.11 Bloodflow measurements (18)   6.12 Ultrasonography and ultrasound biomicroscopy (3)   6.13 Provocative tests (0)   6.19 Telemedicine (0)   6.20 Progression (2)   6.30 Other (0) 8 Refractive errors in relation to glaucoma (0)   8.1 Myopia (2)   8.2 Hypermetropia (0)   8.3 Contact lenses (0)   8.4 Refractive surgical procedures (0)   8.5 Other (0) 9 Clinical forms of glaucomas (0)   9.1 Developmental glaucomas (2)     9.1.1 Congenital glaucoma, Buphthalmos (2)     9.1.2 Juvenile glaucoma (1)     9.1.3 Syndromes of Axenfeld, Rieger, Peters, aniridia (3)     9.1.4 Other (0)   9.2 Primary open angle glaucomas (0)     9.2.1 Ocular hypertension (1)     9.2.2 Other risk factors for glaucoma (13)     9.2.3 Open angle glaucoma with elevated IOP (1)     9.2.4 Normal pressure glaucoma (7)   9.3 Primary angle closure glaucomas (2)     9.3.1 Acute primary angle closure glaucoma (pupillary block) (7)     9.3.2 Chronic primary angle closure glaucoma (pupillary block) (0)     9.3.3 Plateau iris syndrome (0)     9.3.4 Primary angle closure suspect (0)     9.3.5 Primary angle closure (0)     9.3.10 Other (1)   9.4 Glaucomas associated with other ocular and systemic disorders (1)     9.4.1 Steroid-induced glaucoma (3)     9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera (0)       9.4.2.1 Iridocorneal endothelial syndrome (ICE, incl. irisatrophy) (2)       9.4.2.2 Posterior polymorphous dystrophy (0)       9.4.2.3 Fuchs' endothelial dystrophy (0)       9.4.2.5 Other (0)     9.4.3 Glaucomas associated with disorders of the iris and ciliary body (0)       9.4.3.1 Pigmentary glaucoma (1)       9.4.3.5 Other (0)     9.4.4 Glaucomas associated with disorders of the lens (0)       9.4.4.1 Exfoliation syndrome (10)       9.4.4.2 Glaucomas associated with cataracts (1)       9.4.4.3 Glaucomas associated with lens dislocation (0)       9.4.4.5 Other (0)     9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous (1)       9.4.5.1 Neovascular glaucoma (2)       9.4.5.5 Other (0)     9.4.6 Glaucomas associated with inflammation, uveitis (3)     9.4.7 Glaucomas associated with ocular trauma (0)     9.4.8 Glaucomas associated with intraocular tumors (0)     9.4.9 Glaucomas associated with elevated episcleral venous pressure (0)       9.4.10 Glaucomas associated with hemorrhage (0)     9.4.11 Glaucomas following intraocular surgery (0)       9.4.11.1 Ciliary block (malignant) glaucoma (1)       9.4.11.2 Glaucomas in aphakia and pseudophakia (0)       9.4.11.3 Epithelial, fibrous, and endothelial proliferation (0)       9.4.11.4 Glaucomas associated with corneal surgery (2)       9.4.11.5 Glaucomas associated with vitreoretinal surgery (0)     9.4.15 Glaucoma in relation to systemic disease (9)     9.4.20 Other (0) 10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy (3) 11 Medical treatment (0)   11.1 General management, indication (9)   11.2 Cholinergic drugs (1)   11.3 Adrenergic drugs (0)     11.3.1 Epinephrine (0)     11.3.2 Thymoxamine, dapiprazole (0)     11.3.3 Apraclonidine, brimonidine (5)     11.3.4 Betablocker (10)     11.3.5 Other (0)   11.4 Prostaglandins (28)   11.5 Carbonic anhydrase inhibitors (4)     11.5.1 Systemic (2)     11.5.2 Topical (10)   11.6 Osmotic treatment (1)   11.7 Treatment of bloodflow (3)   11.8 Neuroprotection (8)   11.9 Gene therapy (3)   11.13 Combination therapy (0)     11.13.1 Betablocker and pilocarpine (0)     11.13.2 Betablocker and carbon anhydrase inhibitor (0)     11.13.3 Betablocker and brimonidine (0)     11.13.4 Betablocker and prostaglandin (0)     11.13.5 Other (0)   11.14 Investigational drugs; pharmacological experiments (14)   11.15 Other drugs in relation to glaucoma (2)   11.16 Vehicles, delivery systems, pharmacokinetics, formulation (2)   11.17 Cooperation with medical therapy e.g. persistency, compliance, adherence (0)   11.20 Other (1) 12 Surgical treatment (0)   12.1 General management, indication (3)   12.2 Laser iridotomy (3)   12.3 Laser iridoplasty (1)   12.4 Laser trabeculoplasty and other laser treatment of the angle (1)   12.7 Surgical iridectomy (0)   12.8 Filtering surgery (0)     12.8.1 Without tube implant (4)     12.8.2 With tube implant or other drainage devices (11)     12.8.3 Non-perforating (11)     12.8.4 Using laser (0)     12.8.5 Other (0)     12.8.10 Woundhealing antifibrosis (9)     12.8.11 Complications, endophthalmitis (10)   12.9 Trabeculotomy, goniotomy (3)   12.10 Cyclodestruction (8)   12.11 Cyclodialysis (0)   12.12 Cataract extraction (0)     12.12.1 Intracapsular (0)     12.12.2 Extracapsular (1)     12.12.3 Phacoemulsification (5)   12.14 Combined cataract extraction and glaucoma surgery (1)     12.14.1 Intracapsular (0)     12.14.2 Extracapsular (0)     12.14.3 Phacoemulsification (3)   12.15 Capsulotomy (1)   12.16 Vitrectomy (1)   12.17 Anesthesia (1)   12.20 Other (2) 13 Therapeutic prognosis and outcome (0)   13.1 Prognostic factors (0)   13.2 Outcome (0)     13.2.1 IOP (0)     13.2.2 Visual field (0)       13.2.2.1 Progression (0)       13.2.2.2 Improvement (0)     13.2.3 Other (0) 14 Costing studies; pharmacoeconomics (2) 15 Miscellaneous (3)

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Abstract #10895 Published in IGR 6-2

Eye care in the skilled nursing facility: A pilot study of prevalence and treatment patterns of glaucoma

Voytas JJ; Kowalski D; Wagner S; Carlson AM; Maddens M
Journal of the American Medical Directors Association 2004; 5: 156-160

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OBJECTIVE: The objective of this study was to determine the rates of ophthalmic examinations for glaucoma, prevalence rates of glaucoma, ongoing evaluation (follow-up) rates and rates of treatment for a population of residents in a skilled nursing facility. DESIGN: We conducted a retrospective evaluation and chart review of glaucoma-related ophthalmology services. Setting: This study was conducted in a skilled nursing facility located in a large metropolitan area located in the Midwest. PARTICIPANTS: We studied all nursing home residents of the facility on October 1, 2002 (n = 160). METHODS: We conducted a retrospective evaluation and chart review of glaucoma-related ophthalmology services for 160 patients. The medical records used for review included admission records, physician history and physical records, hospital notes, nursing assessments, consultation notes, and medication reviews (including medications administered during hospital stays). Minimum data set (MDS) data and individual patient interviews were used to supplement and verify chart abstraction findings. RESULTS: Eighty-three residents (52%) had evidence of assessment for glaucoma. Thirty-three of these residents (40%) had documentation of a diagnosis of glaucoma; 25 (76%) had current treatment orders for a topical ophthalmic agent. Nine patients were using combination therapy; four used topical and oral beta-adrenergic-blocking agents. CONCLUSIONS: Visual impairment remains a serious problem for nursing facility residents. Assessment of visual abilities is infrequent or nonexistent. Education for nursing home personnel, discussion and activation among nursing home thought leaders, and guidelines for the evaluation and management of glaucoma in this care environment are needed.

Dr. J.J. Voytas, Woodward Hills Nursing Center, 39312 Woodward Avenue, Bloomfield Hills, MI 48304

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Classification:

1.6 Prevention and screening (Part of: 1 General aspects)

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