Definition of Glaucoma : Diagnosis & Screening

Source: Ministry of Health- Singapore

Maintaining quality of life at a sustainable cost ...

Management of glaucoma

The goal of treatment in glaucoma is to maintain useful visual function and the patient’s quality of life at a sustainable cost.

IOP lowering is the only clinically effective approach in the management of glaucoma.

The target IOP is an estimate of the mean IOP achieved with treatment that is expected to prevent further optic nerve damage. An individualised target IOP range should be set for every glaucoma patient.

The first line of treatment in Primary Open Angle Glaucoma is medical therapy and the choice of the drug depends on the target IOP, the safety profile of the drug, patient acceptance and cost.

The first line of treatment in Primary Angle Closure Glaucoma is a laser iridotomy. A laser iridotomy is also required for the fellow eye. Supplemental medical therapy may also be required.

In the emergency setting of acute angle closure glaucoma, additional systemic drugs like osmotic diuretics and oral/parenteral carbonic anhydrase inhibitors may be employed to rapidly reduce the IOP to avoid permanent, devastating nerve damage.

In Open Angle Glaucoma, laser trabeculoplasty may be used as an adjunct to medical therapy.

Surgery is indicated in patients who fail or are unable to comply with medical therapy and may be combined with cataract removal for enhanced visual rehabilitation.

Trabeculectomy is the primary surgery of choice in medically uncontrolled glaucoma.

Patients who have undergone glaucoma surgery should be advised that there is a lifelong need to be aware of symptoms of infection, which include blurring of vision, pain, redness, discharge and swelling.

Steroid eye drops are a frequently unrecognised cause of glaucoma. They should only be used as short-term therapy and IOP monitoring is vital in such patients.

Source: Ministry of Health (Singapore) : MOH Clinical Practice Guidelines 3/2005

World's highest incidence of acute angle closure glaucoma

Source: Ministry of Health (Singapore) : MOH Clinical Practice Guidelines 3/2005