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By The National Collaborating Centre for Acute Care

ISBN-10: 0954976061

ISBN-13: 9780954976064

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Additional resources for Diagnosis and management of chronic open angle glaucoma and ocular hypertension:Methods, Evidence & Guidance

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D For people started on treatment for the first time check IOP 1 to 4 months after start of medication. e No = not detected or not assessed if IOP check only following treatment change. a b (Selection criteria: A, B, E. Implementation support: W, X, Y, Z) ¾ Offer people with OHT or suspected COAG with high IOP treatment based on estimated risk of conversion to COAG using IOP, CCT and age as illustrated by the following table: Table: Treatment of people with OHT or suspected COAG CCT More than 590 micrometres 555 to 590 micrometres Less than 555 micrometres Any Untreated IOP (mmHg) >21 to 25 >25 tp 32 >21 to 25 >25 to 32 >21 to 25 >25 to 32 >32 Age (years) a Any Any Any Treat until 60 Treat until 65 Treat until 80 Any BB b PGA PGA PGA Treatment No Treatment No Treatment No Treatment Treatment should not be routinely offered to people over the age threshold unless there are likely to be benefits from the treatment over an appropriate timescale.

In addition there exist a number of laser and surgical procedures which may be used to reduce IOP and arrest or slow progression of vision loss. There are wide variations across the NHS in terms of management of COAG, a reflection of the uncertainties and sometimes conflicting reports in the scattered literature. Recent evidence indicates that treating elevated IOP prior to the onset of glaucoma reduces by half the risk of conversion from OHT to COAG. Whether such preventative treatment is cost effective in terms of long term avoidance of blindness has been unclear.

Informed consent should be obtained and documented. Both drugs should be handled with caution and in accordance with guidance issued by the Health and Safety Executive. (Selection criteria: A, B, C, E. Implementation support: W, Z) ¾ Refer people with suspected optic nerve damage or repeatable visual field defect, or both, to a consultant ophthalmologist for consideration of a definitive diagnosis and formulation of a management plan. (Selection criteria: A, B, E. Implementation support: Z) ¾ People with a diagnosis of OHT, suspected COAG or COAG should be monitored and treated by a trained healthcare professional who has all of the following: • a specialist qualification (when not working under the supervision of a consultant ophthalmologist) • relevant experience • ability to detect a change in clinical status.

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Diagnosis and management of chronic open angle glaucoma and ocular hypertension:Methods, Evidence & Guidance by The National Collaborating Centre for Acute Care


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