how do i know my glaucoma treatment is working? dr catherine green head: glaucoma unit rveeh

How Do I Know My Glaucoma Treatment is

Working?

Dr Catherine GreenHead: Glaucoma Unit

RVEEH

Outline

• What is glaucoma?• What do glaucoma patients notice?• Intraocular pressure• Functional testing• Structural testing• Frequency of testing

What is glaucoma?

Treatment

What patients notice

Module 1

Blacktunnel

Blurredtunnel

Blackparts

Blurredparts

Missingparts

Notaware

Crabb et al. Ophthalmology 2013;120:1120–6.

Crabb et al. Ophthalmology 2013;120:1120–6.

Missing patchesUnmodified image

Slide courtesy of Allergan SSY Program

What patients notice

Blurred parts

Blurred tunnel

Pictures courtesy of Allergan SSY Program

Target IOP

Function

Frequency of Testing

• Detect rate of progression sooner with more frequent fields

MD change (dB/year)*

Years required to detect change1

field/year2

fields/year3

fields/year

0.25 19 9.5 6.3

0.5 13 6.5 4.3

1.0 9 4.5 3

2.0 6 3 2*80% power in visual fields with moderate degrees of variability

Chauhan et al. Br J Ophthalmol 2008;92:569–73.

Objective progression analysis

Rate of progression -3.9Slope significant P < 5%

Post-surgery 2008

Slope not significant

10-2

2008 2009 2010 2011

2012 2013 2014 2015

Optic nerve photos2007 2010

Conclusions

• Glaucoma patients usually don’t have symptoms

• Glaucoma is treatable• Regular monitoring is essential• Need to consider IOP, structure and function• Frequency of testing tailored to individual –

based on risk and response to treatment