HIGHLIGHTS OF THE SAGS CONGRESS

26 - 28 May 2006, DRAKENSBERG, SOUTH AFRICA

GUEST SPEAKER: JOHN THYGESEN - DENMARK

 

IMPACT OF GLAUCOMA:

  • 53% of glaucoma patients have concominant disease: 27% cardiovascular, 16% respiratory: 10% arthritis.
  • The average lifetime of a glaucoma patient is 13.5 years because of late diagnosis.
  • 16% of glaucoma patients with advanced VF damage have a history of hip or wrist fracture. only 10% of blind people are still working.
  • Savings in estimated costs of treatment of a POAG patient of 3% per 1 mmHg additional IOP lowering from about 17000 dollars per patient per year.

RISK FACTORS:

  • Risk factors need to be established for every patient individually at the time of the diagnosis and need periodical re-evaluation.
  • The star-scoring tool for assessing risk is not evidence based, a physician's experience is still necessary.
  • Diurnal IOP is not an independant risk factor in OHT.

ONH EVALUATION:

  • Applying the ISNT rule helps to systematically evaluate the optic nerve head in glaucoma and ocular hypertension patients.
  • Look for position of the vessle trunk and notching when evaluating the ONH for progression.
  • ONH needs documentation with stereo colour photos or sequential stereo photos or digital imaging.
  • Measuring optic disc size if macro or micro disc.
  • It normally takes about 5 years from visable retinal nerve fibre layer changes until significant visual field changes are seen.

TREATMENT:

  • 15% of glaucoma patients miss more than 50% of their drug dosage.
  • In 40% of glaucoma patients mono therapy is not enough. When adjunctive therapy is needed use therapies with complimentary modes of action, ie. on inflow and outflow pathways.

GENERAL: 

  • An acute attack of angle-closure is not glaucoma; if the optic nerve and visual field are normal, it is only an acute angle closure.
  • Technique of laser trabeculoplasty: start at 6 oclock, always rotate clockwise, burn at trabecular meshwork, take IOP six hours later, treat with CIA alpha-agonists and topical steroids for one week.
  • Concider ALT as a primary proceedure in pigmentary glaucoma, pseudo-exfoliation, and above 60 years of age.
  • The first morphological changes of bilateral optic neuropathy take place in lateral geniculate nucleus.
  • Early agression treatment in glaucoma may be indicated when:              

1. presenting IOP is high                                                                     

2. there is advanced rate of glaucomatous damage at presentation           

3. there is an advanced rate of glaucomatous damage progression                

4. central vision loss is expected with lifetime                                        

5. there are risk factors, such as advanced glaucoma in second eye.

 

2006 REGISTRAR WINNER - DARSHANA SOMA

prize sponsored by MSD

 

Dr Darshana Soma is from the Division of Ophthalmology,Department of Neurosciences,University of the Witwatersrand.She is currently at St John Eye Hospital,Chris Hani Baragwanath. Her talk was on macrodiscs in glaucoma patients and how they pose diagnostic problems in diagnosing glaucoma.Exact title will be in theprogramme of last years meeting.She attended the European Cataract and Refractive Society Congress in London last September.She is currently doing her M.Med thesis on the diagnostic problems posed by Macrodiscs in Glaucoma.