By R.N. Weinreb, P.R. Healey, F. Topouzis
Eleven tables and fifty seven figures, of with 1 in complete color
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Extra resources for Glaucoma Screening
The main disadvantage of analyzing the disc with the direct ophthalmoscope is the absence of a stereoscopic view. The examiner has to use indirect tips to allow the interpretation of the disc as a tri-dimensional structure. Furthermore, direct ophthalmoscopy does not yield a permanent record, and the examiner is required to draw the disc to allow subsequent comparisons. indb 35 6-10-2008 12:04:05 36 A. Azuara Blanco and L. Zangwill tri-dimensional observation of the optic disc. Current practice consists of the use of a standard slit-lamp biomicroscope associated with non-contact lenses (60D or 78D).
25 However, opportunistic glaucoma screening is marginal to the core activities of these healthcare providers. In some regions of the world, a pyramidal delivery system for eye care exists, under which symptomatic evaluation and screening are carried out by trained technicians who then refer to a multi-layered ophthalmic medical system. Alternative strategies involve referral from non-ophthalmic medical or technician screening to optometric screening prior to referral for diagnosis. Opticians also play a role in glaucoma screening in some regions.
The treatment for OAG consists of lowering intraocular (IOP) sufficiently to alter the natural history. After IOP reduction, monitoring of the glaucomatous neuropathy, rate of change and risk factors for progression is an essential part of treatment. The degree of risk factor reduction is limited by cost and the possible harm of treatment. Medical knowledge and cultural imperatives of individual doctors and institutions play a major role in determining glaucoma treatment. Like diagnosis, decisions about what is acceptable treatment are also societal and patient dependent.
Glaucoma Screening by R.N. Weinreb, P.R. Healey, F. Topouzis