How Do I Know My Glaucoma Treatment is

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

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

What is glaucoma?

Treatment

What patients notice Black tunnel Blurred tunnel Black parts Blurred parts Missing parts Not aware Crabb et al. Ophthalmology 2013; 120: 1120– 6. Module 1

What patients notice Unmodified image Missing patches Crabb et al. Ophthalmology 2013; 120: 1120– 6. Slide courtesy of Allergan SSY Program

Blurred tunnel Blurred parts Pictures courtesy of Allergan SSY Program

Target IOP

Function

Frequency of Testing • Detect rate of progression sooner with more frequent fields MD change (d. B/year)* Years required to detect change 1 field/year 2 fields/year 3 fields/year 0. 25 19 9. 5 6. 3 0. 5 13 6. 5 4. 3 1. 0 9 4. 5 3 2. 0 6 3 2 *80% power in visual fields with moderate degrees of variability Chauhan et al. Br J Ophthalmol 2008; 92: 569– 73.

Objective progression analysis Rate of progression -3. 9 Slope significant P < 5%

Post-surgery 2008 Slope not significant

10 -2 2008 2012 2009 2013 2010 2014 2011 2015

Optic nerve photos 2007 2010

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