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GROUP 6

GROUP 6. Dorina Cheles Alejandro Lichtinger Zohar Yehoshua Goldich Yakov Alexa Goz Ibrahim Ali. Dani Gaton Yaacov Rozenman. Case Presentation #3. 36 y.o male pt. BE: VA SC 6/6 IOP- 23mmHg C/D - 0.3 W/W HVF – normal SWAP - normal CCT – 482/480 µ

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GROUP 6

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  1. GROUP 6 Dorina Cheles Alejandro Lichtinger Zohar Yehoshua Goldich Yakov Alexa Goz Ibrahim Ali Dani GatonYaacov Rozenman

  2. Case Presentation #3 • 36 y.o male pt. • BE: VA SC 6/6 IOP- 23mmHg C/D - 0.3 • W/W HVF – normal • SWAP - normal • CCT – 482/480 µ • No FHx Glaucoma

  3. To treat or not to treat…? Not to treat

  4. We decided on some missing info: • IOP – 23mmHg highest measured IOP on repeated diurnal curves • C/D - 0.3 was vertical with normal rim shape

  5. “Classic” - Risk factors for Glaucoma • Age • Race • Family history • Level of IOP • C/D ratio • DM • HTN ? • Myopia • Migraine • Raynaud syndrome

  6. The Ocular Hypertension Treatment Study Baseline Factors That Predict the Onset of Primary Open-Angle Glaucoma Mae O. Gordon, et al. Arch Ophthalmol.2002;120:714-720.

  7. “New” - Risk factors • PSD • CCT

  8. OHTS – risk factors • Age • IOP • CCT • C/D • PSD • DM

  9. Subtotal 0

  10. Subtotal 32

  11. Total 32 Points = 6-10%

  12. Washington Univ. Risk Estimators

  13. Washington Univ. Risk Estimators

  14. Global Risk Threshold for Treatment Weinreb RN et al,Risk assesment in the management of patients with ocular hypertension Am J Ophthalmo 2004, 138,458-467

  15. Global Risk Threshold for Treatment Weinreb RN et al,Risk assesment in the management of patients with ocular hypertension Am J Ophthalmo 2004, 138,458-467

  16. Why Consider treatment ?

  17. Why Consider treatment ?

  18. Why Consider treatment ?

  19. Why Consider treatment ?

  20. Why Consider treatment ?

  21. Why Consider treatment ?

  22. Why Consider treatment ?

  23. Why Consider treatment ?

  24. Why Consider treatment ?

  25. Why Consider treatment ?

  26. Why Consider treatment ?

  27. Why Consider treatment ?

  28. Why Consider treatment ?

  29. Does the corneal thickness really have such a predictive power ?

  30. The European Glaucoma Prevention Study Risk ratio for CCT was only 1.3 vs. 1.7 in OHTS Apparently black population in USA (25%) contributes to role of CCT

  31. Corneal Biomechanical Properties (Hysteresis) Corneal Resistance Corneal Structure Corneal Elasticity More important to IOP measurement than just thickness

  32. CCT should be considered • In its appropriate clinical setting • Understanding its limitations • Using Clinical Common Sense

  33. The prediction derived using these methods is designed to aid but not to replace clinical judgment.

  34. “Consider treatment” Decided not to treat but…. Has to be followed up (IOP,C/D, VF, OCT etc.) X X X

  35. Glaucoma Continuum Adapted from Weinreb

  36. T h a n k Y o u

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