Glaucoma | Eye Biz Australia

Dr. Colin Clement and Professor Ivan Goldberg

Research in Australia proves 50% of Glaucoma patients remain undiagnosed ( 1. Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of Open-angle Glaucoma in Australia: The Blue Mountains Eye Study. Ophthalmology 1996: 103; 1661–1669.)

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Despite the many advances in recent years, health care professionals who treat patients with glaucoma still face a difficult task on several fronts. In Australia there are still a large number of people with undiagnosed Glaucoma. Regular eye examinations & early detection still remain our #1 means of finding those people and saving them from this potentially blinding disease.

Even though we now have many different ways to treat glaucoma (drug & surgical methods) finding the right one to meet the needs of each patient remains critical to long term success.

Initially glaucoma is usually asymptomatic. That means you will probably never know you have Glaucoma until you have severe, wide spread damage to both eyes or it is picked up during an eye examination. Glaucoma damage is irreversible, earlier detection and early detection is vital to a long term, successful outcome.

Regardless of the reason apatient Waiting for symptoms is a lost opportunity; detection and intervention before this time is far preferable. Effective screening would not only serve to diagnose and treat patients with glaucoma earlier but also reduce the number of patients presenting with advanced damage and/or symptomatic disease.

We do not yet have a broadly applicable community screening program for glaucoma. No single or combination of tests meets requirements:

a. The condition being screened is an important health problem;
b. An effective treatment for the condition is available;
c. There are facilities and personnel available for diagnosis and treatment;
d. The screening test is appropriate, cost effective and accurate;
e. The natural history of the condition is well known.

Recommendations from the ‘NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma’ include the following recommendations:

a. Perform regular eye health checks for Caucasians over the age of 50, and for African-descended people over the age of 40;
b. Perform regular eye health checks for all first-degree relatives of glaucoma patients, commencing 5–10 years earlier than the age of onset of glaucoma in their affected relative;
c. Remind all glaucoma patients to alert first-degree relatives of the benefits of early and regular eye checks;
d. Survey for glaucoma particularly in patients greater than 50 years old, any myopia, abnormal blood pressure, a history of migraine, diabetes, peripheral vasospasm, eye injury and ongoing steroid use;
e. Monitor for glaucoma particularly in patients greater than 70-years old, with IOP >21 mmHg, large and/or asymmetric cup-to-disc ratio (accounting for disc size), disc haemorrhage, and thin central corneal thickness.

Australian Researches are asking people to ’spread the word’ need increased the awareness of Glaucoma in the wider community. Hoping people will come in for a Glaucoma Check is failing dismally. We all need to encourage our loved ones to Get Their Eyes Checked.

How Often Should a Glaucoma Patient Be Checked?

A Glaucoma Patient progressing at -1 dB per year who is only checked once a year, with moderate variability between tests, will take an estimated nine years to detect progression confidently.

In contrast:

The same patient;
Tested 3 times a year,
Progressing at the same rate;
May be detected in two years if the variability between tests is low.

Hence we now know that it is important to use the same equipment, under circumstances, more often to ensure no one slips under the radar.

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OCT’s & What they are so Important in Glaucoma Detection & Monitoring

OCT’s use Infra-Red lasers to scan the Retina of the eye. They then compare the thickness of the nerve layers with data collected from all over the world. By comparing the thickness of your Nerve Fibre Layer to that of a ‘normal’ eye for someone of your age we are able to accurately see the very first signs of Glaucoma. In fact this technology is so accurate that some experts believe we are seeing changes some 6 years earlier then traditional tests. In short we are able to monitor suspicious changes way before your eyesight is damaged or destroyed.

Treatment Options:

Since 2010, there has been a switch away from medications that contain Benzalkonium Chloride (BAK). The reason for the switch is an increased awareness that ocular surface disease occurs more commonly in individuals receiving glaucoma treatment and that BAK may be contributing this.

Currently in Australia, patients may be treated with Travoprost and Travoprost / Timolol with Polyquad preservative, brimonidine with Purite preservative. The preservative free option currently is Bimatoprost or Bimatoprost / Timolol or Tafluprost preservative free.

The other major change is the availability of a fixed combination treatment that does not contain a beta-blocker: brimonidine-brinzolamide. This offers a distinct advantage for patients with contra-indications to beta-blockers.

Laser & Surgery options may also be recommended where the condition is not responding to drug treatment or in cases where non-compliance is an issue.