1. Glaucoma New Zealand - A Charitable Trust

2. Glaucoma New Zealand’s objectives are to: Eliminate blindness and visual disability from glaucoma in our community Inform and educate people about how best to live with glaucoma and prevent further visual disability.

3. Glaucoma NZ and General Practice The aim of this presentation is: To raise awareness about glaucoma in General Practice To place glaucoma amongst diseases that require detection when asymptomatic To emphasise Risk Factors for glaucoma in the process of detecting glaucoma early This presentation will require 10 minutes of your time. We encourage you to participate.

4. Understanding Glaucoma in General Practice Topics addressed in this presentation are: The importance of visual loss from glaucoma in our community The Risk Factors for developing glaucoma The complexity of detecting glaucoma –implications for early diagnosis The opportunities for shared care of patients with glaucoma

5. Visual loss and quality of life. A true and typical glaucoma presentation : A 68 yr old single lady who runs a 650 acre farm, on which she was born, has no family or close relatives, finally admits to herself that her sight is slipping and seeks an eye check. Diagnosis: Primary open angle glaucoma with extensive optic disc cupping and visual field loss - it will limit her enjoyment of life, force a change of residence, and yet it is her only major medical problem.

6. Visual loss and quality of life. Another glaucoma patient : A 48 yr old man, wife died of cancer 4 yrs ago, bringing up 2 teenage children, runs own small business and domestic life. Presents with visual difficulties. Primary open angle glaucoma with severe visual field loss and his driver’s licence is threatened. Diagnosis: Primary open angle glaucoma It will severely limit his quality of life, ability to drive, maintain his business and care for his children.

7. Visual loss from glaucoma Glaucoma is the leading cause of preventable blindness in western communities. Prevalence is 2 % of adults over 40 yrs of age, increasing to near 10 % adults over 80 yrs Symptomatic presentation is very late, usually with advanced optic disc cupping Relatively young adults also develop glaucoma Only a heightened awareness with attention to risk factors and regular eye checks can reduce blindness from glaucoma in NZ

8. Open Angle Glaucoma Risk Factors: 1. Identified without an eye examination Age Family history High myopia Previous eye trauma Steroid use Take a history to detect these risk factors

9. Open Angle Glaucoma Risk Factors 2. Identified with an eye examination Intra-ocular pressure Central corneal thickness Optic disc structure Intra-ocular pathology

10. Angle Closure Glaucoma Risk Factors: Age Family history Females (x3 risk) Hypermetropia (long sightedness) Anterior chamber (AC) morphology : shallow AC, narrow AC angles Race : especially Asian ethnicity

11. The Complexity of Detecting Early Glaucoma There is no single “screening” test for glaucoma Intra-ocular pressure lacks sensitivity Optic disc assessment is not a screening test Visual field testing produces false positives An eye examination is required to : Detect and assess eye risk factors Make a diagnosis of glaucoma

12. Early diagnosis of glaucoma Glaucoma is a chronic, progressive optic neuropathy with characteristic optic disc damage that leads to a corresponding visual field defect. A diagnosis of “glaucoma” requires detection of damage to the optic disc. Damage maybe detected by: 1 Structural assessment of the optic disc by examination and, if necessary, by imaging the optic disc 2Functional assessment with a visual field test Risk assessment guides appropriate clinical decisions including the frequency of examinations

13. Glaucoma testing : “45 plus 5” Glaucoma NZ recommends that every adult have an eye examination at age 45 years and every 5 years there-after. Individuals with glaucoma risk factors require more frequent assessment. Optic discs suspicious of glaucoma definitely require visual field assessment. By aged 80 yrs all will need a 2 yearly examination

14. The General Practitioner and preventing glaucoma blindness Promote the “45 + 5” glaucoma eye test Identify glaucoma risk factors so that patients at risk receive more frequent re-assessment Incorporate glaucoma awareness and testing recommendations into every day clinical practice.

15. The General Practitioner and a glaucoma eye examination Without a slit-lamp, an eye examination cannot assess risk or make a diagnosis. Intra-ocular pressure measurement assesses only one risk factor for glaucoma. It is frequently NOT elevated at diagnosis. Optic disc evaluation with new types of ophthalmoscopes, may detect a suspicious optic disc but cannot “screen” for glaucoma. Automated visual field testing will detect moderately advanced glaucoma. Early glaucoma and risk factors will be missed. An eye examination at a slit-lamp is essential

16. Glaucoma assessment report: An eye examination for glaucoma should assess: –Diagnosis and/or risk assessment for both open angle and closed angle glaucoma –IOP and, ideally, also the central corneal thickness –Anterior chamber angle: the Risk of Angle Closure –Other eye pathology: especially pseudo-exfoliation in the older patient and pigment dispersion in the younger patient –Optic nerve head assessment: the key to early diagnosis –Visual field testing if the optic disc is at all suspicious for glaucomatous cupping or other risk factors are present

17. Eye examination report An eye examination for glaucoma risk assessment can be requested from: A Public Hospital Eye Department An optometrist An ophthalmologist

18. General Practice in shared care for glaucoma patients Roles the General Practitioner may consider are: Maintain glaucoma awareness for all your patients and assure adequate assessment for glaucoma risk factors and early diagnosis of glaucoma Monitor compliance with treatment and continue prescriptions Monitor for side-effects of glaucoma treatments

19. Management Expectations Diagnosed Glaucoma: –Monitor compliance with treatment –Monitor for side effects of treatment –Monitor regular specialist review At-risk not-yet-glaucoma: –Monitor compliance with follow-up reviews –Re-evaluation of risk factors for glaucoma Early and appropriate glaucoma treatment is effective in the prevention of visual disability

20. Glaucoma in General Practice A successful outcome of this initiative would be: That you promote “glaucoma screening”, the 45 + 5 glaucoma eye test, as part of your routine practice especially in “well care” clinics and all patients seeking a routine check-up. That you are aware of the Risk Factors for glaucoma and the need to monitor eye examinations That you incorporate glaucoma treatments for monitoring in the care of your patients

21. General Practice and Glaucoma NZ Glaucoma New Zealand welcomes your participation in our mission to eliminate glaucoma blindness from our community. Glaucoma New Zealand acknowledges that this is our first initiative into General Practice and we are open to all constructive suggestions. The Glaucoma NZ GP Education programme is free to all GPs who have registered for it. Glaucoma NZ also provides an in depth education package for professionals involved in glaucoma care. The fee in 2007 was $220 including GST. Full details available on request.

22. Public education about glaucoma Glaucoma New Zealand provides information to the public who enrol with us. There is no fee. We publish “Eyelights” a regular newsletter, maintain a web site, and produce additional educational materials. Enrolment forms and pamphlets are available to you on request. Samples will be sent to you shortly. Contact details are at the end of this presentation. Please encourage your patients with glaucoma to enrol with us

23. Benefits of patient enrolment Instructive and educational information for patients with glaucoma Invitation to local Glaucoma NZ activities and public meetings Voluntary participation with Glaucoma NZ to help us achieve our aim : to eliminate blindness and visual disability from glaucoma in our community

24. Glaucoma New Zealand provides: Information and education for glaucoma patients Awareness about glaucoma in our community Professional education Research into glaucoma in New Zealand

25. Glaucoma NZ sponsors Glaucoma New Zealand wishes to thank our sponsors without whose help we could not undertake our activities

28. General Practice and Glaucoma NZ Glaucoma New Zealand thanks you for your time and consideration with this presentation We welcome feedback from you

29. Glaucoma New Zealand Glaucoma NZ Department of Ophthalmology The University of Auckland Private Bag 92019 Auckland Tel 09 373 8779 Fax 09 373 7947 www.glaucoma.org.nz Email: info@glaucoma.org.nz