Podcast
Questions and Answers
What is the recommended method for intraocular pressure measurement before referral for further investigation of COAG and related conditions?
What is the recommended method for intraocular pressure measurement before referral for further investigation of COAG and related conditions?
- Dynamic contour tonometry
- Rebound tonometry
- Goldmann-type applanation tonometry (correct)
- Non-contact tonometry
Which of the following tests is NOT recommended for assessing peripheral anterior chamber configuration and depth?
Which of the following tests is NOT recommended for assessing peripheral anterior chamber configuration and depth?
- Pachymetry (correct)
- Van Herick test
- Gonioscopy
- Optical coherence tomography (OCT)
What is the purpose of pupil dilatation during fundus examination using stereoscopic slit lamp biomicroscopy?
What is the purpose of pupil dilatation during fundus examination using stereoscopic slit lamp biomicroscopy?
- To enhance the accuracy of IOP measurement
- To facilitate gonioscopy
- To improve visualization of the optic nerve (correct)
- To allow for better imaging of the retinal periphery
What is the recommended approach for central visual field assessment before referral for further investigation of COAG and related conditions?
What is the recommended approach for central visual field assessment before referral for further investigation of COAG and related conditions?
What should NOT be the sole basis for referring a patient for further investigation of COAG and related conditions?
What should NOT be the sole basis for referring a patient for further investigation of COAG and related conditions?
What should a professional do if a person with IOP below 24 mmHg is referred to?
What should a professional do if a person with IOP below 24 mmHg is referred to?
What is recommended for people planning and providing eye care services?
What is recommended for people planning and providing eye care services?
What should be offered to diagnose COAG and related conditions?
What should be offered to diagnose COAG and related conditions?
What should be considered when assessing the risk of future visual impairment in people with ocular hypertension?
What should be considered when assessing the risk of future visual impairment in people with ocular hypertension?
What should be repeated if necessary to establish severity at diagnosis?
What should be repeated if necessary to establish severity at diagnosis?
What should be used if gonioscopy is not possible?
What should be used if gonioscopy is not possible?
What should be obtained at diagnosis for baseline documentation?
What should be obtained at diagnosis for baseline documentation?
When should a referral be made?
When should a referral be made?
What should be adopted to reduce the risk of transmitting infective agents?
What should be adopted to reduce the risk of transmitting infective agents?
What should be considered for people with physical or learning disabilities?
What should be considered for people with physical or learning disabilities?
What records should be available at each clinical episode to all healthcare professionals involved in a person's care?
What records should be available at each clinical episode to all healthcare professionals involved in a person's care?
What should be calibrated regularly according to the manufacturers' instructions?
What should be calibrated regularly according to the manufacturers' instructions?
What should be taken into account when making decisions about management and treatment?
What should be taken into account when making decisions about management and treatment?
What should be checked before offering pharmacological treatment?
What should be checked before offering pharmacological treatment?
Who should not be offered treatment?
Who should not be offered treatment?
What should people be advised to do?
What should people be advised to do?
What is offered to people with newly diagnosed OHT with IOP of 24 mmHg or more?
What is offered to people with newly diagnosed OHT with IOP of 24 mmHg or more?
What is considered for people with OHT if the effect of an initial successful SLT has subsequently reduced over time?
What is considered for people with OHT if the effect of an initial successful SLT has subsequently reduced over time?
What is offered to people with OHT with IOP of 24 mmHg or more if they choose not to have 360° SLT?
What is offered to people with OHT with IOP of 24 mmHg or more if they choose not to have 360° SLT?
Why should correct eye drop installation technique be demonstrated and observed?
Why should correct eye drop installation technique be demonstrated and observed?
What should be offered to people with an IOP of 24 mmHg or more who cannot tolerate their current treatment?
What should be offered to people with an IOP of 24 mmHg or more who cannot tolerate their current treatment?
What should be offered to people with an IOP of 24 mmHg or more whose current treatment is not reducing IOP sufficiently?
What should be offered to people with an IOP of 24 mmHg or more whose current treatment is not reducing IOP sufficiently?
When should people with suspected COAG and IOP less than 24 mmHg be offered treatment?
When should people with suspected COAG and IOP less than 24 mmHg be offered treatment?
What should be discussed with people with OHT or suspected COAG who have both a low risk of developing visual impairment within their lifetime and an acceptable IOP?
What should be discussed with people with OHT or suspected COAG who have both a low risk of developing visual impairment within their lifetime and an acceptable IOP?
What should be offered to people who present with advanced COAG and who are listed for glaucoma surgery?
What should be offered to people who present with advanced COAG and who are listed for glaucoma surgery?
What should be offered to people with advanced COAG?
What should be offered to people with advanced COAG?
What should be offered to people with newly diagnosed COAG?
What should be offered to people with newly diagnosed COAG?
What should healthcare professionals discuss with patients about 360° SLT?
What should healthcare professionals discuss with patients about 360° SLT?
When should preservative-free eye drops be offered?
When should preservative-free eye drops be offered?
When should a second 360° SLT be considered for people with COAG?
When should a second 360° SLT be considered for people with COAG?
What should be referred to a consultant ophthalmologist?
What should be referred to a consultant ophthalmologist?
What is the purpose of demonstrating correct eye drop installation technique?
What is the purpose of demonstrating correct eye drop installation technique?
Why should healthcare professionals ask about adherence to treatment in people with COAG?
Why should healthcare professionals ask about adherence to treatment in people with COAG?
What should be given to people with advanced COAG who are listed for glaucoma surgery?
What should be given to people with advanced COAG who are listed for glaucoma surgery?
What should healthcare professionals offer to people with COAG who are at risk of progressing to sight loss despite treatment with medicines from 2 therapeutic classes?
What should healthcare professionals offer to people with COAG who are at risk of progressing to sight loss despite treatment with medicines from 2 therapeutic classes?
What should healthcare professionals provide to people with COAG who are considering glaucoma surgery?
What should healthcare professionals provide to people with COAG who are considering glaucoma surgery?
Why should healthcare professionals encourage people to continue with the same pharmacological treatment for COAG?
Why should healthcare professionals encourage people to continue with the same pharmacological treatment for COAG?
What should healthcare professionals offer to people with COAG who have satisfactory adherence to treatment and eye drop instillation technique but whose IOP has not been reduced sufficiently to prevent the risk of progression to sight loss?
What should healthcare professionals offer to people with COAG who have satisfactory adherence to treatment and eye drop instillation technique but whose IOP has not been reduced sufficiently to prevent the risk of progression to sight loss?
What should healthcare professionals consider for people with COAG who are waiting for an 360° SLT and need an interim treatment?
What should healthcare professionals consider for people with COAG who are waiting for an 360° SLT and need an interim treatment?
Why should healthcare professionals offer 360° SLT to people with COAG who choose not to have a generic PGA?
Why should healthcare professionals offer 360° SLT to people with COAG who choose not to have a generic PGA?
What is the recommended treatment for people with COAG who cannot tolerate a pharmacological treatment?
What is the recommended treatment for people with COAG who cannot tolerate a pharmacological treatment?
What should be considered after treatment with medicines from 2 therapeutic classes?
What should be considered after treatment with medicines from 2 therapeutic classes?
What is recommended for people with COAG whose IOP has not been reduced sufficiently to prevent the risk of progression to sight loss after glaucoma surgery?
What is recommended for people with COAG whose IOP has not been reduced sufficiently to prevent the risk of progression to sight loss after glaucoma surgery?
What is recommended for people with COAG who prefer not to have glaucoma surgery or for whom glaucoma surgery is not suitable?
What is recommended for people with COAG who prefer not to have glaucoma surgery or for whom glaucoma surgery is not suitable?
What tests are recommended at each assessment for people with COAG, people with suspected COAG, and people with OHT?
What tests are recommended at each assessment for people with COAG, people with suspected COAG, and people with OHT?
When is repeat gonioscopy recommended?
When is repeat gonioscopy recommended?
What is the recommended approach for visual field testing in people with COAG?
What is the recommended approach for visual field testing in people with COAG?
What should be done when a change in optic nerve head status is detected by stereoscopic slit lamp biomicroscopy?
What should be done when a change in optic nerve head status is detected by stereoscopic slit lamp biomicroscopy?
Why should pupils be dilated before stereoscopic slit lamp biomicroscopy or optic nerve head imaging?
Why should pupils be dilated before stereoscopic slit lamp biomicroscopy or optic nerve head imaging?
What should be repeated when clinically indicated in people with COAG?
What should be repeated when clinically indicated in people with COAG?
What should be evaluated at each assessment for people with COAG, suspected COAG, and OHT?
What should be evaluated at each assessment for people with COAG, suspected COAG, and OHT?
What should be asked about at each assessment for people with COAG, suspected COAG, and OHT?
What should be asked about at each assessment for people with COAG, suspected COAG, and OHT?
What is the recommended time to next assessment for people with treated OHT and a normal optic nerve head and visual field?
What is the recommended time to next assessment for people with treated OHT and a normal optic nerve head and visual field?
What should be used to decide when the next appointment should take place within the recommended interval?
What should be used to decide when the next appointment should take place within the recommended interval?
What is included in uncertain conversion?
What is included in uncertain conversion?
What is the recommended time to next assessment for people with suspected COAG and uncertain conversion?
What is the recommended time to next assessment for people with suspected COAG and uncertain conversion?
What should be assessed at each assessment for people with COAG?
What should be assessed at each assessment for people with COAG?
What is the recommended time to next assessment for people with COAG and uncertain progression?
What is the recommended time to next assessment for people with COAG and uncertain progression?
What should be reviewed at each assessment for people with COAG and no progression detected?
What should be reviewed at each assessment for people with COAG and no progression detected?
What is the recommended time to next assessment for people with COAG, no progression detected, and low clinical risk?
What is the recommended time to next assessment for people with COAG, no progression detected, and low clinical risk?
What is the reason for discharge back to primary care for people referred for OHT?
What is the reason for discharge back to primary care for people referred for OHT?
What should be given to people who have been assessed and discharged to primary care?
What should be given to people who have been assessed and discharged to primary care?
Who should refer people to a consultant ophthalmologist for consideration of a definitive diagnosis and formulation of a management plan?
Who should refer people to a consultant ophthalmologist for consideration of a definitive diagnosis and formulation of a management plan?
What is essential for healthcare professionals involved in the diagnosis of OHT and suspected COAG?
What is essential for healthcare professionals involved in the diagnosis of OHT and suspected COAG?
What is necessary for people with OHT, suspected COAG or COAG?
What is necessary for people with OHT, suspected COAG or COAG?
What should healthcare professionals involved in monitoring and treating OHT, suspected COAG and established COAG be trained to do?
What should healthcare professionals involved in monitoring and treating OHT, suspected COAG and established COAG be trained to do?
What is not sufficient for managing glaucoma and related conditions?
What is not sufficient for managing glaucoma and related conditions?
What should people be advised to take with them when attending future sight tests?
What should people be advised to take with them when attending future sight tests?
Where should a copy of the discharge summary be sent?
Where should a copy of the discharge summary be sent?
What should be considered when managing OHT, suspected COAG and COAG?
What should be considered when managing OHT, suspected COAG and COAG?
Flashcards are hidden until you start studying
Study Notes
Referral and Diagnosis
- Before referral, offer all of the following tests:
- Central visual field assessment using standard automated perimetry
- Optic nerve assessment and fundus examination using stereoscopic slit lamp biomicroscopy
- Optical coherence tomography (OCT) or optic nerve head image
- Intraocular pressure (IOP) measurement using Goldmann-type applanation tonometry
- Peripheral anterior chamber configuration and depth assessments using gonioscopy or the van Herick test or OCT
- Do not base a decision to refer solely on IOP measurement using noncontact tonometry
- Consider repeating visual field assessment and IOP measurement on another occasion to confirm a visual field defect or IOP of 24 mmHg or more
Diagnosis
- To diagnose COAG and related conditions, offer all of the following tests:
- Visual field assessment using standard automated perimetry (central thresholding test)
- Optic nerve assessment and fundus examination using stereoscopic slit lamp biomicroscopy
- IOP measurement using Goldmann applanation tonometry
- Peripheral anterior chamber configuration and depth assessments using gonioscopy
- Central corneal thickness (CCT) measurement
- Adopt professional or Department of Health and Social Care guidance to reduce the risk of transmitting infective agents via contact tonometry or gonioscopy
Treatment
- For people with OHT, offer 360° selective laser trabeculoplasty (SLT) if they are at risk of visual impairment within their lifetime
- Offer a generic prostaglandin analogue (PGA) to people with OHT with IOP of 24 mmHg or more
- Consider a second 360° SLT for people with OHT if the effect of an initial successful SLT has subsequently reduced over time
- For people with COAG, offer 360° SLT or a generic PGA, and consider glaucoma surgery with pharmacological augmentation (MMC) as indicated
Ongoing Treatment
- Offer another pharmacological treatment to people with an IOP of 24 mmHg or more who cannot tolerate their current treatment
- Offer a medicine from another therapeutic class to people with an IOP of 24 mmHg or more whose current treatment is not reducing IOP sufficiently
- Refer people to a consultant ophthalmologist to discuss other options if their IOP cannot be reduced sufficiently with 360° SLT or pharmacological treatment or both
Stopping Treatment
- Discuss the benefits and risks of stopping treatment with people with OHT or suspected COAG who have both a low risk of developing visual impairment within their lifetime and an acceptable IOP
Reassessment
- At each assessment, offer the following tests:
- Goldmann applanation tonometry
- Anterior segment slit lamp examination with van Herick peripheral anterior chamber depth assessment
- Repeat visual field testing using standard automated perimetry (central thresholding test) or supra-threshold test
- Repeat assessment of the optic nerve head (stereoscopic slit lamp biomicroscopy or imaging)### Reassessment and Discharge
- Reassess people with COAG, suspected COAG, and OHT at each assessment to evaluate the risk of conversion to COAG and sight loss, and set a time for the next assessment.
- Consider general health, factors affecting adherence to treatment, cognitive impairment, and treatment side effects during reassessment.
Treated OHT with Normal Optic Nerve Head and Visual Field
- Reassess people with treated OHT (baseline IOP ≥ 24 mmHg) and normal optic nerve head and visual field at the most recent assessment based on clinical judgement.
- Use Table 1 to determine the time to the next assessment based on control of IOP and risk of conversion to COAG.
Suspected COAG
- Reassess people with suspected COAG based on clinical judgement, considering control of IOP and risk of conversion to COAG.
- Use Table 2 to determine the time to the next assessment.
Confirmed COAG
- Reassess people with COAG based on clinical judgement, considering the risk of COAG progression to sight loss.
- Use Table 3 to determine the time to the next assessment.
Discharge to Primary Care
- Discharge people back to primary eye care services if they were referred for OHT but do not need treatment or if they were referred for suspected COAG but it is no longer suspected.
- Provide a discharge summary to people being discharged, and send a copy to their GP and primary eye care professional with patient consent.
Organisation of Care
- Refer people to a consultant ophthalmologist for a definitive diagnosis and management plan if they have suspected optic nerve damage or repeatable visual field defect, or if SLT treatment is suitable.
- Diagnosis and management of OHT and suspected COAG should be made by a suitably trained healthcare professional with a specialist qualification and relevant experience.
- Healthcare professionals involved in diagnosis and management should be trained in case detection and referral refinement, and be able to perform and interpret relevant clinical tests and assessments.
- Monitoring and treatment of OHT, suspected COAG, and COAG should be done by a trained healthcare professional with a specialist qualification, relevant experience, and ability to detect changes in clinical status.
- Healthcare professionals involved in monitoring and treating OHT, suspected COAG, and COAG should be trained to make management decisions on risk factors, coexisting pathology, and risk of sight loss.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
