Treatment Principal and Option (GLAUCOMA)

Br J Ophthalmol: first published as 10.1136/bjophthalmol-2016-EGSguideline.003 on 30 May 2017. Downloaded from http://bjo.bmj.com/ on May 15, 2021 by guest.
Protected by copyright.
The “Terminology and Guidelines” project was entirely supported by the EGS Foundation
The “Terminology and Guidelines”
project was entirely supported
by the EGS Foundation
Fast rate of
progression
Advanced initial
Long life
glaucoma
expectancy
damage
Likelihood of
Adverse symptomatic
Additional risk
consequences of vision loss factors
intervention
Status of other Target IOP Patient

eye preferences
The treatment target is a compromise between reducing the risk of symptomatic vision
loss and the consequences of therapy. Patient preferences should be taken into account.
o
o
o
o
•
•
•
•
•
•
•
HIGHER
TARGET
IOP
EARLY SHORT HIGH NO SLOW
LIF E
GLAUCOMA UNTREATED ADDITIONAL RATE OF
DAMAGE EXPECTANCY IOP* RISK FACTORS PROGRESSION
ADVANCED LONG LOW Yes FAST
LOWER
TARGET The above factors need to be considered as a whole in
IOP deciding the individual target pressure required
* Consider central corneal thickness
(See FC X)
Determine Individualized Target IOP
Prescribe treatment accordingly

and re-evaluate for progression
Progression Stable
Follow-up 6 months
Consider Lower Target

Progression Stable
IOP
Target IOP reached Target IOP not-reached
Re-evaluate after Consider accepting higher

Follow-up intervals are just recommendations
6-12 months target IOP
Re-Evaluate
PATIENT DRUG
CHARACTERISTICS PROPERTIES
Mechanism of
Clinical picture
action
Safety Efficacy
- Systemic First choice
Target IOP
- Ocular treatment
Preserved /
Adherence
unpreserved
Quality of life Cost
A first choice treatment is considered a drug that the treating physician prefers to use as initial IOP
lowering therapy as opposed to the first line treatment, which is one that has been approved by an
official controlling body, like EMEA, FDA or National Agencies.
Systemic Contra-indications
Exclude allergies
Ask for specific diseases: asthma, arrhythmia,...
Note concomitant medications
Ocular Characteristics
Ocular Surface Concomitant Eye Diseases
In selected patients,
consider preservative-free options
Prostaglandins
-blockers
2-agonists
CAIs
others
FIRST CHOICE MONOTERAPY
PGAs, -Blockers, CAIs, -agonists, others
Well tolerated Not tolerated

Effective on IOP Not effective on IOP
Target IOP
Switch monotherapy
not reached Consider laser
Add 2nd drug

Target IOP
reached
Target IOP
not reached
PERIODICALLY VERIFY
ENDPOINTS
Substitute
•Visual field Other therapeutic options
the 2nd drug and verify
•Optic disc efficacy/tolerability e.g. Surgery, Laser
•IOP
•Quality of life If poor response to several different medications, consider non-compliance
•
•
•
•
•
•
•
•
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
•
•
-
-
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
-
-
-
-
-
-
•
•
•
•
•
•

Treatment Principal and Option (GLAUCOMA)

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Treatment Principal and Option (GLAUCOMA)

Uploaded by

Copyright:

Available Formats

Br J Ophthalmol: first published as 10.1136/bjophthalmol-2016-EGSguideline.003 on 30 May 2017. Downloaded from http://bjo.bmj.com/ on May 15, 2021 by guest.

Status of other Target IOP Patient

EARLY SHORT HIGH NO SLOW

ADVANCED LONG LOW Yes FAST

Prescribe treatment accordingly

Consider Lower Target

Target IOP reached Target IOP not-reached

Re-evaluate after Consider accepting higher

Quality of life Cost

Ocular Surface Concomitant Eye Diseases

Well tolerated Not tolerated

Add 2nd drug

You might also like