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S. Jungkim, F. Ahmed, J. Levy, D. Johnston, P. Bloom, C. Migdal, M. F. Cordeiro; A Novel Way of Identifying Stable Glaucoma and Ocular Hypertension Using an Electronic Medical Record System (Medisoft®ERS). Invest. Ophthalmol. Vis. Sci. 2010;51(13):182.
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Recent NICE guidelines have led to a review of the role of primary healthcare in glaucoma management. In the UK, glaucoma clinics are continually expanding and the ability to identify the "stable" glaucoma patient who may be monitored in the community has become a priority. In this study, we have devised a new glaucoma summary chart as part of the Medisoft Ophthalmology ERS incorporating all the currently acceptable individually measured parameters to identify non-progressing, stable glaucoma patients.
Standard methods of monitoring glaucoma include the assessment of IOP, the vertical cup-to-disc ratio (CDR) and Humphrey visual field (HVF) analysis. Most clinics now also use confocal laser scanning ophthalmoscopy (HRT II) and scanning laser polarimetry (GDx-VCC). We incorporated into a summary chart the following parameters: IOP, HVF mean deviation (MD) and pattern standard deviation (PSD), HRT II CDR ratio, rim area and volume, and the GDx nerve fiber index (NFI). Medical and surgical intervention were also recorded.
Of the 50 glaucoma patients followed up on average for 8.43 years (+/- 3.36 years SD), 25 patients were non-progressive. These were defined as stable according to whether on average a flat line was apparent. Although fluctuations in individual parameters were seen, it was possible to show agreement between several parameters over time. Rim volume changes, as calculated by HRT II, was found to be the correlate best with HVF MD.
We believe the newly devised glaucoma summary sheet provides an easily interpretable multifactorial trend analysis . Furthermore we have shown that it can be readily applied to identifying stability in glaucoma patients who would therefore require less frequent follow-up and be appropriate for monitoring in a primary care setting.
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