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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

12. Glaucoma

Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

Glaucomas are a group of relatively common optic neuropathies, in which there is pathological loss of retinal ganglion cells, progressive loss of sight and associated alteration in the retinal nerve fibre layer and optic nerve head.

Evidence supports screening people at higher risk for glaucoma (A). General practitioners (GPs) have an important role in identifying those at increased risk for glaucoma and referring them for testing. There is no consensus on the recommended frequency of screening for at-risk groups.1,2

Table 12.1. Glaucoma: Identifying risk
Who is at risk?What should be done?How often?
Increased risk1, 2
  • Family history of glaucoma (first-degree relatives)
  • Caucasian and Asian patients aged ≥50 years
  • Patients of African descent aged ≥40 years
Refer for ocular examination 5–10 years earlier than the age of onset of glaucoma in the affected relative (A) Frequency of follow up determined by the individual patient’s eye assessment
Higher risk1, 2
Patients aged >50 years with:
  • diabetes
  • myopia
  • long-term steroid use
  • migraine and peripheral vasospasm
  • abnormal blood pressure (BP)
  • history of eye trauma
Refer for examination of the optic nerve head (ophthalmoscopy), measurement of intraocular pressure (tonometry) and assessment of visual fields (perimetry)* Frequency of follow up determined by the individual patient’s eye assessment1, 2
*This may be by an ophthalmologist or optometrist

BP, blood pressure
Table 12.2. Glaucoma: Preventive interventions
TestTechnique
Patient education Educate patients about glaucoma and alert them to associated risk factors, with advice to attend regular, fully comprehensive eye examinations1, 2
Tonometry Applanation or puff tonometry has poor sensitivity and specificity for early detection of glaucoma. Tonometry alone is an inadequate screening tool as it overestimates the prevalence of glaucoma
Perimetry (visual fields) Not advisable in general practice as only automated perimetry is sensitive for detecting loss of visual field due to glaucoma
Assessment of eye structure (ophthalmoscopy) Indirect ophthalmoscopy performed with a slit lamp is the examination of choice1, 2

References

  1. National Health and Medical Research Council. A guide to glaucoma for primary health care providers – A companion document to NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma. Canberra: NHMRC, 2010.
  2. National Health and Medical Research Council. Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma. Canberra: NHMRC, 2010.
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