Treating patients presenting with advanced glaucoma—should we reconsider current practice?
The management of patients presenting with advanced glaucoma presents a challenge to glaucoma clinicians. Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (...
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| Veröffentlicht in: | British journal of ophthalmology 2011-09, Vol.95 (9), p.1185-1192 |
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| container_title | British journal of ophthalmology |
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| creator | King, Anthony J Stead, Richard E Rotchford, Alan P |
| description | The management of patients presenting with advanced glaucoma presents a challenge to glaucoma clinicians. Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (IOP) control in such situations is likely to minimise the risk of further visual field deterioration thus either preventing or slowing progression to blindness. Currently most patients presenting with advanced disease in the UK are managed on an escalating regime of medical treatment. Should this fail glaucoma surgery is usually employed to further lower IOP. Although glaucoma surgery is generally a safe and successful intervention it carries a small risk of severe visual loss and is considered by many clinicians as an intervention only to be used following failure of medical treatment. Recently however the National Institute for Clinical Excellence has suggested in its clinical guidelines for management of ocular hypertension and glaucoma that primary surgery should be offered to patients presenting with advanced glaucomatous visual field loss. This is contrary to the practice of most UK ophthalmologists. In this review the current available evidence underlying the management of presentation with advanced disease is examined. |
| doi_str_mv | 10.1136/bjo.2010.188128 |
| format | Article |
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Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (IOP) control in such situations is likely to minimise the risk of further visual field deterioration thus either preventing or slowing progression to blindness. Currently most patients presenting with advanced disease in the UK are managed on an escalating regime of medical treatment. Should this fail glaucoma surgery is usually employed to further lower IOP. Although glaucoma surgery is generally a safe and successful intervention it carries a small risk of severe visual loss and is considered by many clinicians as an intervention only to be used following failure of medical treatment. Recently however the National Institute for Clinical Excellence has suggested in its clinical guidelines for management of ocular hypertension and glaucoma that primary surgery should be offered to patients presenting with advanced glaucomatous visual field loss. This is contrary to the practice of most UK ophthalmologists. In this review the current available evidence underlying the management of presentation with advanced disease is examined.</description><identifier>ISSN: 0007-1161</identifier><identifier>EISSN: 1468-2079</identifier><identifier>DOI: 10.1136/bjo.2010.188128</identifier><identifier>PMID: 21097788</identifier><identifier>CODEN: BJOPAL</identifier><language>eng</language><publisher>BMA House, Tavistock Square, London, WC1H 9JR: BMJ Publishing Group Ltd</publisher><subject>Advanced glaucoma ; Antihypertensive Agents - therapeutic use ; Biological and medical sciences ; Blindness ; Blindness - epidemiology ; Blindness - etiology ; Blindness - prevention & control ; Decision Making ; Disease Progression ; Filtering Surgery ; Glaucoma ; Glaucoma - complications ; Glaucoma - epidemiology ; Glaucoma - therapy ; Glaucoma and intraocular pressure ; Humans ; Incidence ; Intervention ; Intraocular Pressure - physiology ; Medical sciences ; medical treatment ; Miscellaneous ; Ophthalmology ; Quality of life ; Risk Factors ; Surgery ; Surgical outcomes ; trabeculectomy ; treatment medical ; treatment surgery ; United Kingdom - epidemiology ; Visual impairment</subject><ispartof>British journal of ophthalmology, 2011-09, Vol.95 (9), p.1185-1192</ispartof><rights>2011, Published by the BMJ Publishing Group Limited. 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Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (IOP) control in such situations is likely to minimise the risk of further visual field deterioration thus either preventing or slowing progression to blindness. Currently most patients presenting with advanced disease in the UK are managed on an escalating regime of medical treatment. Should this fail glaucoma surgery is usually employed to further lower IOP. Although glaucoma surgery is generally a safe and successful intervention it carries a small risk of severe visual loss and is considered by many clinicians as an intervention only to be used following failure of medical treatment. Recently however the National Institute for Clinical Excellence has suggested in its clinical guidelines for management of ocular hypertension and glaucoma that primary surgery should be offered to patients presenting with advanced glaucomatous visual field loss. This is contrary to the practice of most UK ophthalmologists. In this review the current available evidence underlying the management of presentation with advanced disease is examined.</description><subject>Advanced glaucoma</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blindness</subject><subject>Blindness - epidemiology</subject><subject>Blindness - etiology</subject><subject>Blindness - prevention & control</subject><subject>Decision Making</subject><subject>Disease Progression</subject><subject>Filtering Surgery</subject><subject>Glaucoma</subject><subject>Glaucoma - complications</subject><subject>Glaucoma - epidemiology</subject><subject>Glaucoma - therapy</subject><subject>Glaucoma and intraocular pressure</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intervention</subject><subject>Intraocular Pressure - physiology</subject><subject>Medical sciences</subject><subject>medical treatment</subject><subject>Miscellaneous</subject><subject>Ophthalmology</subject><subject>Quality of life</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>trabeculectomy</subject><subject>treatment medical</subject><subject>treatment surgery</subject><subject>United Kingdom - epidemiology</subject><subject>Visual impairment</subject><issn>0007-1161</issn><issn>1468-2079</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkMtq3DAUhkVpaKbTrrMLhhIKBSeWLOuyKmGa5sKQwjDtKiB0OU488WUq2U2660PkCfMk0eBJCt10dXSk7_wcfQjt4ewQ45wdmVV3SLJNJwQm4hWaYMpESjIuX6NJlmU8xZjhXfQ2hFVsCcP8DdolOJOcCzFBV0sPuq_a62QdC7R9SNYeQjxs7u6q_ibR7pduLbjkutaD7Rr9-Och3HRD7ZI7SDzYrg2VA5_Ywfs4GAO07SsLn9-hnVLXAd5v6xR9_3qynJ2l82-n57PjeWpySvqUC1OCzQkxThYgOaW0yMGRglAphOCFkCXQkpXOOjCW4AIzU2hsgTKjHcmn6OOYu_bdzwFCr5oqWKhr3UI3BCUEFZTKmDpFH_4hV93g27icwlGIpBznMlJHI2V9F4KHUq191Wj_W-FMbbyr6F1tvKvRe5zY3-YOpgH3wj-LjsDBFtDB6rr0UWkV_nLxz1JSFrl05KrQw_3Lu_a3ivGcF-ryx0xdXpBFsVicqS-R_zTypln9d8snj4mpPQ</recordid><startdate>201109</startdate><enddate>201109</enddate><creator>King, Anthony J</creator><creator>Stead, Richard E</creator><creator>Rotchford, Alan P</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201109</creationdate><title>Treating patients presenting with advanced glaucoma—should we reconsider current practice?</title><author>King, Anthony J ; Stead, Richard E ; Rotchford, Alan P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b342t-78bfec322bd95e9744453ed252498887589fe4f6fdcdebc21516b5a1ce46bad23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Advanced glaucoma</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Blindness</topic><topic>Blindness - epidemiology</topic><topic>Blindness - etiology</topic><topic>Blindness - prevention & control</topic><topic>Decision Making</topic><topic>Disease Progression</topic><topic>Filtering Surgery</topic><topic>Glaucoma</topic><topic>Glaucoma - complications</topic><topic>Glaucoma - epidemiology</topic><topic>Glaucoma - therapy</topic><topic>Glaucoma and intraocular pressure</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intervention</topic><topic>Intraocular Pressure - physiology</topic><topic>Medical sciences</topic><topic>medical treatment</topic><topic>Miscellaneous</topic><topic>Ophthalmology</topic><topic>Quality of life</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>trabeculectomy</topic><topic>treatment medical</topic><topic>treatment surgery</topic><topic>United Kingdom - epidemiology</topic><topic>Visual impairment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>King, Anthony J</creatorcontrib><creatorcontrib>Stead, Richard E</creatorcontrib><creatorcontrib>Rotchford, Alan P</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>King, Anthony J</au><au>Stead, Richard E</au><au>Rotchford, Alan P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treating patients presenting with advanced glaucoma—should we reconsider current practice?</atitle><jtitle>British journal of ophthalmology</jtitle><addtitle>Br J Ophthalmol</addtitle><date>2011-09</date><risdate>2011</risdate><volume>95</volume><issue>9</issue><spage>1185</spage><epage>1192</epage><pages>1185-1192</pages><issn>0007-1161</issn><eissn>1468-2079</eissn><coden>BJOPAL</coden><abstract>The management of patients presenting with advanced glaucoma presents a challenge to glaucoma clinicians. Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (IOP) control in such situations is likely to minimise the risk of further visual field deterioration thus either preventing or slowing progression to blindness. Currently most patients presenting with advanced disease in the UK are managed on an escalating regime of medical treatment. Should this fail glaucoma surgery is usually employed to further lower IOP. Although glaucoma surgery is generally a safe and successful intervention it carries a small risk of severe visual loss and is considered by many clinicians as an intervention only to be used following failure of medical treatment. Recently however the National Institute for Clinical Excellence has suggested in its clinical guidelines for management of ocular hypertension and glaucoma that primary surgery should be offered to patients presenting with advanced glaucomatous visual field loss. This is contrary to the practice of most UK ophthalmologists. In this review the current available evidence underlying the management of presentation with advanced disease is examined.</abstract><cop>BMA House, Tavistock Square, London, WC1H 9JR</cop><pub>BMJ Publishing Group Ltd</pub><pmid>21097788</pmid><doi>10.1136/bjo.2010.188128</doi><tpages>8</tpages></addata></record> |
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| subjects | Advanced glaucoma Antihypertensive Agents - therapeutic use Biological and medical sciences Blindness Blindness - epidemiology Blindness - etiology Blindness - prevention & control Decision Making Disease Progression Filtering Surgery Glaucoma Glaucoma - complications Glaucoma - epidemiology Glaucoma - therapy Glaucoma and intraocular pressure Humans Incidence Intervention Intraocular Pressure - physiology Medical sciences medical treatment Miscellaneous Ophthalmology Quality of life Risk Factors Surgery Surgical outcomes trabeculectomy treatment medical treatment surgery United Kingdom - epidemiology Visual impairment |
| title | Treating patients presenting with advanced glaucoma—should we reconsider current practice? |
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