ASIA PACIFIC GLAUCOMA GUIDELINES
The Asia Pacific Glaucoma Guidelines
(APGG) were first released in 2003. The third and latest edition was unveiled
in 2016 during the Asia Pacific Glaucoma Congress at Chiang Mai.
The guidelines follow the “easy-to-read” format seen in previous editions. Information is provided in the form of “why”, “what”, “when” and “how” questions and answers.
The guidelines consist of
an Introduction as a prologue, 3 main sections and an epilogue of appendices,
definition of terms, abbreviations and references.
The main sections consist of:
1. Assessment
2. Treatment
3. Follow-up
Section 1 on patient assessment broadly deals
with evaluation of a glaucoma suspect. There are also short notes on gonioscopy;
optic nerve head and retinal nerve fiber layer assessments; optic disc
photography and imaging; and finally visual field examination. This section
also deals with risk categories and treatment targets.
According to the APGG, intraocular
pressure should be reduced by 40%, 30% and 20% from baseline in glaucoma with
high risk, moderate risk and glaucoma suspects with moderate risk of visual
loss respectively.
Regarding central corneal thickness
(CCT), the APGG provides the following statement: “While correction nomograms
based solely on corneal thickness are neither valid nor useful in individual
patients, the clinician needs to put the measured IOP into context”.
Section 2 starts with initiation of
treatment. An important recommendation here is to treat the mechanism causing
glaucoma (page 33). Another highlight is the emphasis on choosing the most
appropriate medication with respect to the patient. Section 2.3 deals with
laser treatments in glaucoma. While, Section 2.4 is on surgical techniques;
touching on trabeculectomy, non-penetrating glaucoma surgery, glaucoma drainage
devices and minimally invasive glaucoma surgery.
Section 3 is on follow-up. This
section deals with reasons why follow-up is required; the points to be looked
at during follow-up and timing of the follow-ups. Section 3.2 highlights
screening for glaucoma and other relevant issues.
The appendix provides concise
information on a number of topics such as: medical treatment of childhood
glaucoma; treatment in pregnancy and lactation; systemic medications that may
induce angle closure; calibration of Goldmann tonometers; tonometer mires;
gonioscopy; goniogram/gonioscopic chart; modified Van Hedrick grading; how to
optimize patient performance in subjective perimetry; common artifacts for
visual field measurements; principles of management of secondary glaucomas;
side-effects of glaucoma medications; laser trabeculoplasty; trans-scleral
cyclophotocoagulation; glaucomatous optic neuropathy; imaging devices; field
progression; glaucoma quality of life-15 questionnaire; and other topics.
The APGG 3rd edition is available
for download from the following link:
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