Glaucoma New Zealand - A Charitable Trust

1. Glaucoma New Zealand- A Charitable Trust

2. 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.

3. 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.

4. 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

5. 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.

6. 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.

7. 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

8. 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

9. Open Angle GlaucomaRisk Factors • 2. Identified with an eye examination • Intra-ocular pressure • Central corneal thickness • Optic disc structure • Intra-ocular pathology

10. 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

11. 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

12. 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 • Functional assessment with a visual field test • Risk assessment guides appropriate clinical decisions including the frequency of examinations

13. 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

14. 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.

15. 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

16. 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

17. Eye examination report • An eye examination for glaucoma risk assessment can be requested from: • A Public Hospital Eye Department • An optometrist • An ophthalmologist

18. 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

19. 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

20. 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

21. 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.

22. 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

23. Benefits of patient enrolment • Instructive and educational information for patients with glaucoma • Invitation to local Glaucoma NZ activities and public meetings • Voluntary participationwith Glaucoma NZ to help us achieve our aim : • to eliminate blindness and visual disability from glaucoma in our community

24. Glaucoma New Zealand provides: • Information and education for glaucoma patients • Awareness about glaucoma in our community • Professional education • Research into glaucoma in New Zealand

25. Glaucoma NZ sponsors • Glaucoma New Zealand wishes to thank our sponsors • without whose help we could not • undertake our activities

28. General Practice and Glaucoma NZ • Glaucoma New Zealand thanks you for your time and consideration with this presentation • We welcome feedback from you

29. 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