(IGR: 8-2) | International Glaucoma Review #

Highlights of the Annual South African Glaucoma Society Meeting

53% of glaucoma patients have concomitant disease; 27% cardiovascular, 16% respiratory; 10% arthritis.
The average lifetime of a glaucoma patient is 13.5 years because of the late diagnosis.
16 % of glaucoma patients with advanced VF damage have a history of hip or wrist fracture; only 10% of blind people are still working.
Savings in estimated costs of treatment of a POAG patient of 3% per 1 mmHg additional IOP lowering from about $17,000 per patient per year.

Risk factors need to be established for every patient individually at the time of diagnosis and need periodical re-evaluation.
The Star-Scoring Tool for Assessing Risk is not evidence based, a physician's experience is still necessary.
Diurnal IOP is not an independent risk factor in OHT.

Applying the ISNT rule helps to systematically evaluate the optic nerve head in glaucoma and ocular hypertension patients.
Look for position of the vessel trunk and notching when evaluating the ONH for progression.
ONH needs documentation with stereo colour photos or sequential stereo photos or digital imaging.
Measure optic disc size if macro or micro disc.
It normally takes about five years from visible retinal nerve fibre layer changes until significant visual field changes are seen.

15% of glaucoma patients miss more than 50% of their drug dosage.
In 40% of glaucoma patients mono therapy is not enough. When adjunctive therapy is needed use therapies with complimentary modes of action, i.e. on inflow and outflow pathways.

An acute attack of angle-closure is not glaucoma; if the optic nerve and visual field are normal, it is only an acute angle-closure.
Technique of laser trabeculoplasty: start at six o'clock, always rotate clockwise, burn at trabecular meshwork, take IOP six hours later, treat with CAI alpha-agonists and topical steroids for one week.
Consider ALT as a primary procedure in pigmentary glaucoma, pseudo-exfoliation, and above 60 years of age.
The first morphological changes of bilateral optic neuropathy take place in the lateral geniculate nucleus.
Early aggressive treatment in glaucoma may be indicated when:
1. presenting IOP is high;
2. there is advanced glaucomatous damage at presentation;
3. there is an advanced rate of glaucomatous damage progression;
4. central vision loss is expected within lifetime;
5. there are risk factors, such as advanced glaucoma in second eye.