Page 102 - NAME OF CONDITION: REFRACTIVE ERRORS

Once the blindness of glaucoma has occurred there is no treatment that will

restore the lost vision. In nearly all cases blindness from glaucoma is preventable,

which requires early diagnosis and proper treatment. Detection depends on the

ability to recognize the early clinical manifestations of various glaucomas.
Appropriate treatment requires an understanding of the pathogenic mechanisms

involved, detailed knowledge of drugs and operations that control IOP. Infact

sometimes, a patient needs to be followed up for an extended period of time
before a decision to treat can be made. Retinal nerve fiber layer loss precedes

measurable optic nerve head and conventional white on white perimetry

changes in early glaucoma.Hence patients should be counseled regarding the

asymptomatic nature of the disease, importance of treatment, correct technique

of eye drop application and regular follow up. Each patient should be educated
about different modalities of treatment.

V. OPTIMAL DIAGNOSTIC CRITERIA, INVESTIGATIONS,
TREATMENT & REFERRAL CRITERIA

*Situation 1: At Secondary Hospital/ Non-Metro situation: Optimal Standards of
Treatment in Situations where technology and resources are limited

Clinical Diagnosis:
Diagnosis: based on comprehensive initial ophthalmic evaluation-
 History (ocular and systemic)
 Family history of Glaucoma ( Severity and Outcome)

 IOP recording by applanation tonometer.
 Larger diurnal variation in IOP either by daytime phasing or 24 hour diurnal phasing.
 Gonioscopy to exclude angle closure disease and causes of secondary open angle
glaucoma
 Steroscopic ONH evaluation (Preferably through dilated pupil) with pictoric fundus
diagram.

Investigations:

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