Glaucoma New Zealand

- A Charitable Trust

Glaucoma New Zealand’sobjectives are to:

Eliminate blindness and visual disability from glaucoma in our community

Inform and educate people about how best to live with glaucoma and prevent further visual disability.

Glaucoma NZ and General PracticeThe aim of this presentation is:

To raise awareness about glaucoma in

General Practice

To place glaucoma amongst diseases that require detection when asymptomatic

To emphasise Risk Factors for glaucoma in the process of detecting glaucoma early

This presentation will require 10 minutes of your time. We encourage you to participate.

Understanding Glaucoma in General Practice

Topics addressed in this presentation are:

The importance of visual loss from glaucoma in our

community

The Risk Factors for developing glaucoma

The complexity of detecting glaucoma

– implications for early diagnosis

The opportunities for shared care of patients with glaucoma

Visual loss and quality of life.

A true and typical glaucoma presentation :

A 68 yr old single lady who runs a 650 acre farm, on which she was born, has no family or close relatives, finally admits to herself that her sight is slipping and seeks an eye check.

Diagnosis:

Primary open angle glaucoma with extensive optic disc cupping and visual field loss - it will limit her enjoyment of life, force a change of residence, and yet it is her only major medical problem.

Visual loss and quality of life.

Another glaucoma patient :

A 48 yr old man, wife died of cancer 4 yrs ago, bringing up 2 teenage children, runs own small business and domestic life.

Presents with visual difficulties. Primary open angle glaucoma with severe visual field loss and his driver’s licence is threatened.

Diagnosis: Primary open angle glaucoma It will severely limit his quality of life, ability to drive, maintain his business and care for his children.

Visual loss from glaucoma

Glaucoma is the leading cause of preventable blindness in western communities.

Prevalence is 2 % of adults over 40 yrs of age,increasing to near 10 % adults over 80 yrs

Symptomatic presentation is very late, usually with advanced optic disc cupping

Relatively young adults also develop glaucoma

Only a heightened awareness with attention to risk factors and regular eye checks can reduce blindness from glaucoma in NZ

Open Angle GlaucomaRisk Factors:

1. Identified without an eye examination

Age

Family history

High myopia

Previous eye trauma

Steroid use

Take a history to detect these risk factors

Open Angle GlaucomaRisk Factors

2. Identified with an eye examination

Intra-ocular pressure

Central corneal thickness

Optic disc structure

Intra-ocular pathology

Angle Closure GlaucomaRisk Factors:

Age

Family history

Females (x3 risk)

Hypermetropia (long sightedness)

Anterior chamber (AC) morphology :

shallow AC, narrow AC angles

Race : especially Asian ethnicity

The Complexity of Detecting Early Glaucoma

There is no single “screening” test for glaucoma

Intra-ocular pressure lacks sensitivity

Optic disc assessment is not a screening test

Visual field testing produces false positives

An eye examination is required to :

Detect and assess eye risk factorsMake a diagnosis of glaucoma

Early diagnosis of glaucoma

Glaucoma is a chronic, progressive optic neuropathy with characteristic optic disc damage that leads to a corresponding visual field defect.

A diagnosis of “glaucoma” requires detection of damage to the optic disc. Damage maybe detected by:

1 Structural assessment of the optic disc by examination and, if necessary, by imaging the optic disc

2 Functional assessment with a visual field test

Risk assessment guides appropriate clinical decisions including the frequency of examinations

Glaucoma testing : “45 plus 5”

Glaucoma NZ recommends that every adult have an eye examination at age 45 years and every 5 years there-after.

Individuals with glaucoma risk factors require more frequent assessment.

Optic discs suspicious of glaucoma definitely require visual field assessment.

By aged 80 yrs all will need a 2 yearly examination

The General Practitioner and preventing glaucoma blindness

Promote the “45 + 5” glaucoma eye test

Identify glaucoma risk factors so that patients at risk receive more frequent re-assessment

Incorporate glaucoma awareness and testing recommendations into every day clinical practice.

The General Practitioner and a glaucoma eye examination

Without a slit-lamp, an eye examination cannot assess risk or make a diagnosis.

Intra-ocular pressure measurement assesses only one risk factor for glaucoma. It is frequently NOT elevated at diagnosis.

Optic disc evaluation with new types of ophthalmoscopes, may detect a suspicious optic disc but cannot “screen” for glaucoma.

Automated visual field testing will detect moderately advanced glaucoma. Early glaucoma and risk factors will be missed.

An eye examination at a slit-lamp is essential

Glaucoma assessment report:

An eye examination for glaucoma should assess:

– Diagnosis and/or risk assessment for both open angle and

closed angle glaucoma

– IOP and, ideally, also the central corneal thickness

– Anterior chamber angle: the Risk of Angle Closure

– Other eye pathology: especially pseudo-exfoliation in the

older patient and pigment dispersion in the younger patient

– Optic nerve head assessment: the key to early diagnosis

– Visual field testing if the optic disc is at all suspicious for

glaucomatous cupping or other risk factors are present

Eye examination report

An eye examination for glaucoma risk assessment can be requested from:

A Public Hospital Eye Department

An optometrist

An ophthalmologist

General Practice in shared care for glaucoma patients

Roles the General Practitioner may consider are:

Maintain glaucoma awareness for all your patients and assure adequate assessment for glaucoma risk factors and early diagnosis of glaucoma

Monitor compliance with treatment and continue prescriptions

Monitor for side-effects of glaucoma treatments

Management Expectations

Diagnosed Glaucoma:–Monitor compliance with treatment–Monitor for side effects of treatment–Monitor regular specialist review

At-risk not-yet-glaucoma: –Monitor compliance with follow-up reviews–Re-evaluation of risk factors for glaucoma

Early and appropriate glaucoma treatment is effective in the prevention of visual disability

Glaucoma in General Practice

A successful outcome of this initiative would be:

That you promote “glaucoma screening”, the 45 + 5 glaucoma eye test, as part of your routine practice especially in “well care” clinics and all patients seeking a routine check-up.

That you are aware of the Risk Factors for glaucoma and the need to monitor eye examinations

That you incorporate glaucoma treatments for monitoring in the care of your patients

General Practice and Glaucoma NZ

Glaucoma New Zealand welcomes your participation in our mission to eliminate glaucoma blindness from our community.

Glaucoma New Zealand acknowledges that this is our first initiative into General Practice and we are open to all constructive suggestions.

The Glaucoma NZ GP Education programme is free to all GPs who have registered for it.

Glaucoma NZ also provides an in depth education package for professionals involved in glaucoma care. The fee in 2007 was $220 including GST. Full details available on request.

Public education about glaucoma

Glaucoma New Zealand provides information to the public who enrol with us. There is no fee.

We publish “Eyelights” a regular newsletter, maintain a web site, and produce additional educational materials.

Enrolment forms and pamphlets are available to you on request. Samples will be sent to you shortly. Contact details are at the end of this presentation.

Please encourage your patients with glaucoma to enrol with us

Benefits of patient enrolment

Instructive and educational information for patients with glaucoma

Invitation to local Glaucoma NZ activities and public meetings

Voluntary participation with Glaucoma NZ to help us achieve our aim :

to eliminate blindness and visual disability from glaucoma in our community

Glaucoma New Zealand provides:

Information and education for glaucoma patients

Awareness about glaucoma in our community

Professional education

Research into glaucoma in New Zealand

Glaucoma NZ sponsors

Glaucoma New Zealand wishes to thank our sponsors

without whose help we could not

undertake our activities

General Practice and Glaucoma NZ

Glaucoma New Zealand thanks you for your time and consideration with this presentation

We welcome feedback from you

Glaucoma New Zealand

Glaucoma NZ

Department of Ophthalmology

The University of Auckland

Private Bag 92019

Auckland

Tel 09 373 8779

Fax 09 373 7947

www.glaucoma.org.nz

Email: info@glaucoma.org.nz