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Abstract #46501 Published in IGR 13-3
Treating patients presenting with advanced glaucoma - Should we reconsider current practice?
King AJ; Stead RE; Rotchford APBritish Journal of Ophthalmology 2011; 95: 1185-1192
See also comment(s) by Keith Barton • George Spaeth • Chris Leung • Franz Grehn • Felipe Medeiros • Jeffrey Liebmann •
The management of patients presenting with advanced glaucoma presents a challenge to glaucoma clinicians. Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (IOP) control in such situations is likely to minimise the risk of further visual field deterioration thus either preventing or slowing progression to blindness. Currently most patients presenting with advanced disease in the UK are managed on an escalating regime of medical treatment. Should this fail glaucoma surgery is usually employed to further lower IOP. Although glaucoma surgery is generally a safe and successful intervention it carries a small risk of severe visual loss and is considered by many clinicians as an intervention only to be used following failure of medical treatment. Recently however the National Institute for Clinical Excellence has suggested in its clinical guidelines for management of ocular hypertension and glaucoma that primary surgery should be offered to patients presenting with advanced glaucomatous visual field loss. This is contrary to the practice of most UK ophthalmologists. In this review the current available evidence underlying the management of presentation with advanced disease is examined.
A.J. King. Department of Ophthalmology, Queen's Medical Centre Campus, Nottingham University NHS Hospital, Nottingham NG7 2UH, United Kingdom.
Classification:
11.1 General management, indication (Part of: 11 Medical treatment)
12.1 General management, indication (Part of: 12 Surgical treatment)
