ALPINE HEATH RESORT, DRAKENSBERG 3-5 AUGUST 2007
GUEST SPEAKER – CLIVE MIGDAL, WESTERN EYE HOSPITAL, LONDON
∙ 5 Rules for Glaucoma Follow-up: SMARRT: Severity of damage, MArkers for progression,
Risk factors, Rate progression, Testing frequency.
∙ Risk factors for POAG progression: age, baseline IOP, PEX, disc haemorrhage, mean
∙ Strategies to enhance compliance: educate the patient about the disease and treatment, teach the patient how and when to apply eye drops, fit the medications into the patient’s daily routine, use minimal amount of drops, frequency and concentration, discuss potential side effects, use aids (literature, tapes, videos).
∙ OHT conversion to early POAG does not equal reduced quality of vision.
∙ OHT initiation of treatment is based on probability of reduced quality of vision, which is
based on risk or evidence of progression.
∙ OHT management questions: natural course of disease? How does treatment alter the
disease course? Effect of the disease versus treatment on QoL? costs of treatment and
∙ Risk factors of OHT for conversion to POAG in 6y: CCT per 40micron, CD ratio per 0.1,
PSD per 0.2DB, age per decade, IOP per mmHg.
∙ Contra-indications for trabeculoplasty: uveitic and traumatic glaucoma, narrow angles,
neovascular, congenital or juvenile glaucoma.
∙ Always make sure the disc and visual field fit when making the diagnosis of glaucoma.
∙ Know your drugs: indications and contra-indications, mechanism of action: inflow
suppressants, outflow enhancement, select combination drugs carefully, variable individual
drug response, evaluate drug compliance versus quality of life issues.
∙ Antimetabolite regime with trabeculectomy surgery:
low risk - none or 25mg/ml 5FU
intermediate risk - 25mg/ml 5FU or 0.2mg/ml MMC/3 minutes
high risk - 0.4mg/ml MMC/3 minutes
∙ OHT in thyroid eye diseases TAO (thyroid associated orbitopathy is due to increased episcleral venous pressure (orbital congestion, increased MPS deposits in TM, direct-toxic
effect, genetically linked predisposition of thyroid disease and glaucoma) and unexplained eyelid retraction with lagophthalmos (+/- clinical signs of inflammation, +/- evidence of thyroid dysfunction).
∙ Criteria for TAO: unexplained proptosis, EOM enlargement, orbital congestion, inflammation, plus: lid retraction with lagophthalmos or thyroid dysfunction.
Malignant glaucoma ( agreous misdirection syndrome) can follow intraocular surgery and presents as secondary angle-closure glaucoma with a centrally shallow/flat ac, normal/elevated IOP, patent PIDY, absence of choroidal effusion/haemorrhage, or misdirection of aqueous into the vitreous cavity leading to forward displacement of the iris/lens diagram and occlusion of the angle.
Dr Roelof Van Wyk - Registrar in the Ophthalmology Department, University of the Orange Free State
This prize was sponsored by Alcon on the 7th August 2007 (second time this prize has been awarded)