Glaucoma Referral and Safe Discharge. A National Clinical Guideline

Following are the major excerpts from the National Clinical guidelines issued by SIGN, Scotland on Glaucoma Referral and Safe Discharge

Following are the recommendations of the guidelines:-

Primary-Care Examination and Assessment of Patients with Ocular Hypertension or Suspected Glaucoma

Measurement of Intraocular Pressure

For patients with ocular hypertension or suspected glaucoma a reliable baseline measure of intraocular pressure is required. A minimum of two intraocular pressure readings on a single occasion using the same tonometer is recommended. The type of tonometer and the time of measurement should be specified in any referral to secondary-eye-care services.

Measurement of Central Corneal Thickness

Central corneal thickness should be measured in patients with ocular hypertension or suspected glaucoma and reported alongside the measured intraocular pressure results when referring to secondary-eye-care services.

Assessment of Anterior Chamber Angle

Depending on practitioner's preference and clinical competence, either the Van Herick method or gonioscopy may be used to detect narrow anterior chamber angles in patients with ocular hypertension or suspected angle closure.

Optic Disc Assessment

For patients with suspected glaucoma the optic discs should be examined by slit-lamp biomicroscopy. The vertical optic disc diameter should be measured using the slit beam height. This should be corrected for the magnification of the condensing lens, and the disc categorised as small, medium or large.

The narrowest rim/disc ratio and disc size should be recorded and considered alongside additional indicators of glaucoma, such as optic disc nerve fibre layer haemorrhage and cup/disc ratio asymmetry, when assessing the need for referral to secondary-eye-care services.

The optic discs should be photographed and the images transmitted with the electronic referral letter.

Visual Field Assessment

For patients with ocular hypertension or suspected glaucoma, standard automated perimetry is recommended for visual field testing. Frequency doubling technology is also acceptable.

Monitoring At-Risk Groups

Patients with Ocular Hypertension

For patients with ocular hypertension, treated or untreated, a reliable baseline based on repeated measurement of intraocular pressure and perimetry should be established. Repeat glaucoma testing every two years is recommended.





For full guidelines click on the following link:

Artical Source: Scottish Intercollegiate Guidelines Network (SIGN). Glaucoma referral and safe discharge. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2015 Mar. 38 p. (SIGN publication; no. 144). [72 references]