1. How Do I Know My Glaucoma Treatment is Working? Dr Catherine Green Head: Glaucoma Unit RVEEH

2. Outline What is glaucoma? What do glaucoma patients notice? Intraocular pressure Functional testing Structural testing Frequency of testing

3. What is glaucoma?

4. Treatment

5. 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.

6. Missing patchesUnmodified image Slide courtesy of Allergan SSY Program What patients notice

7. Blurred parts Blurred tunnel Pictures courtesy of Allergan SSY Program

8. Target IOP

9. Function

10. 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 0.25199.56.3 0.5136.54.3 1.094.53 2.0632 *80% power in visual fields with moderate degrees of variability Chauhan et al. Br J Ophthalmol 2008;92:569–73.

11. Objective progression analysis Rate of progression -3.9 Slope significant P < 5%

12. Post-surgery 2008 Slope not significant

13. 10-2 2008200920102011 2012 20132014 2015

16. Optic nerve photos 20072010

19. 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