European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and optionsSupported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options
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The goal of glaucoma treatment is to maintain the patient’s visual function and related quality of life, and to assess the likely Rate of Progression (RoP) is an important part of patient management.Abstract:
### 3.1 - General Principles of Glaucoma Treatment
The purpose of this chapter is to give a summary overview and it is not meant to be an all-inclusive text
Figure 3.1.
THE WHOM -TO -TREAT GRAPH The rate of ganglion cell loss and resulting functional decay is very different among different glaucoma eyes. Quality of life is clearly reduced when visual field defects become severe, cf. the severe functional impairment. Line A represents the effect of aging alone. In glaucoma loss of visual function is often much more rapid. An older patient, diagnosed late in life, with a moderate rate of progression (B) has a much lower risk of developing severe functional impairment than a younger patient with the same amount of field loss at diagnosis and rate of progression (C). A very slow rate of progression may be tolerated by the patient and treatment left unchanged (D), while a rapid rate of progression (E) needs a considerably lower target pressure .
It needs to be remembered that it is the extent of binocular visual field or the field of the better eye that largely determines the patient’s quality of life, while the rates of progression of each eye separately are needed to determine treatment .
To assess the likely Rate of Progression (RoP) is an important part of patient management and the measured rate is a very important factor that should determine target pressure and treatment intensity (See Ch. Introduction) [I.D]. Many studies have found that progression is usually linear1-4, but the goal of intensifying treatment is to decrease rate of progression.
Please observe that perimetric printouts of progression using the MD or VFI indices are age-corrected, so that a normal eye would not show any age-related deterioration over time.
The goal of glaucoma treatment is to maintain the patient’s visual function and related quality of life, …read more
Citations
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Optical Coherence Tomography Angiography in Glaucoma: A Review.
TL;DR: OCTA has a high repeatability and reproducibility, has good discriminatory power to differentiate normal eyes from glaucoma eyes, is more strongly correlated with visual function than conventional OCT, and reaches a floor effect at a more advanced disease stage than OCT.
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A New SITA Perimetric Threshold Testing Algorithm : Construction and a Multicenter Clinical Study
Anders Heijl,Vincent Michael Patella,Luke X. Chong,Aiko Iwase,Christopher Kai-Shun Leung,Anja Tuulonen,Gary C Lee,Thomas Callan,Boel Bengtsson +8 more
TL;DR: A new time-saving threshold visual field-testing strategy-Swedish Interactive Thresholding Algorithm (SITA) Faster, which is intended to replace SITA Fast, is described and a clinical evaluation of this new strategy is reported on.
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Omidenepag Isopropyl Versus Latanoprost in Primary Open-Angle Glaucoma and Ocular Hypertension: The Phase 3 AYAME Study
TL;DR: OMDI 0.002% was non-inferior to latanoprost 0.005% in reducing IOP in patients with OHT or POAG and was well tolerated.
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Simultaneous co-delivery of neuroprotective drugs from multi-loaded PLGA microspheres for the treatment of glaucoma
Alicia Arranz-Romera,Benjamin M. Davis,Irene Bravo-Osuna,Sergio Esteban-Pérez,I.T. Molina-Martínez,Ehtesham Shamsher,Nivedita Ravindran,Li Guo,Maria Francesca Cordeiro,Maria Francesca Cordeiro,Rocío Herrero-Vanrell +10 more
TL;DR: The development of multi‐loaded PLGA‐microspheres (MSs) incorporating three recognised neuroprotective agents in a single formulation to create a novel sustained‐release intraocular drug delivery system (IODDS) for the treatment of glaucoma is described.
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Fundus-controlled perimetry (microperimetry): Application as outcome measure in clinical trials.
Maximilian Pfau,Jasleen K Jolly,Zhichao Wu,Jonathan Denniss,Eleonora M. Lad,Robyn H. Guymer,Monika Fleckenstein,Frank G. Holz,Steffen Schmitz-Valckenberg,Steffen Schmitz-Valckenberg +9 more
TL;DR: This review describes the theoretical and technical background of FCP, its prior application in clinical and research settings, data that qualify the application of F CP as an outcome measure in clinical trials as well as ongoing and future developments.
References
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The Ocular Hypertension Treatment Study: A Randomized Trial Determines That Topical Ocular Hypotensive Medication Delays or Prevents the Onset of Primary Open-Angle Glaucoma
Michael A. Kass,Dale K. Heuer,Eve J. Higginbotham,Chris A. Johnson,John L. Keltner,J. Philip Miller,Richard K. Parrish,M. Roy Wilson,Mae O. Gordon +8 more
TL;DR: Topical ocular hypotensive medication was effective in delaying or preventing the onset of POAG in individuals with elevated IOP, and clinicians should consider initiating treatment for individuals with ocular hypertension who are at moderate or high risk for developing POAG.
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Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial.
TL;DR: The first adequately powered randomized trial with an untreated control arm to evaluate the effects of IOP reduction in patients with open-angle glaucoma who have elevated and normal IOP showed considerable beneficial effects of treatment that significantly delayed progression.
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The advanced glaucoma intervention study (AGIS): 7. the relationship between control of intraocular pressure and visual field deterioration
Fred Ederer,Ma,Douglas E. Gaasterland,E. Kenneth Sullivan,Allen D. Beck,Bruce E. Prum,Marshall N. Cyrlin,Howard S. Weiss +7 more
TL;DR: In both analyses low intraocular pressure is associated with reduced progression of visual field defect, supporting evidence from earlier studies of a protective role for low intracular pressure in visual field deterioration.
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Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial.
TL;DR: Patients treated in the EMGT had half of the progression risk of control patients, including the effect of EMGT treatment, and the magnitude of initial IOP reduction was a major factor influencing outcome.
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