How Do I Know My Glaucoma Treatment is Working? Dr Catherine Green Head: 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 Black tunnel Blurred tunnel Black parts Blurred parts Missing parts Not aware 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 change 1 field/year2 fields/year3 fields/year *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 -3.9 Slope significant P < 5%

Post-surgery 2008 Slope not significant

Optic nerve photos

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