Operieren wir die Glaukome zu spät?

Abstract

As glaucoma specialists, we often ask ourselves why patients are referred so late for surgery. Usually the patient is referred in a far advanced stage of the disease after long-term conventional treatment with topical medications. By that time, substantial morphologic damage is present and the patient is disabled by far advanced visual field defects. In addition, decompensated intraocular pressure, despite maximal tolerated medical treatment, is seen. Delayed surgery due to late diagnosis is rather a rare event. Various reasons may be responsible for this late referral. Improved IOP-lowering medications (i.e., fixed combinations), personal aversion (fear and knowledge of lack of improvement in visual acuity) against surgery, and imperfect glaucoma procedures may play an important role. A retrospective review of the last 274 cases referred for filtering glaucoma surgery is used to describe and analyze criteria for adequate timing of glaucoma surgery. This study reveals that almost ¾ of patients are referred rather late for glaucoma surgery. Criteria for adequate timing of glaucoma surgery are given for non-glaucoma specialists in particular. They apply for all types of glaucoma surgery, and the pros and cons are discussed in detail. Trabeculectomy is still regarded as the gold standard of glaucoma surgery. Because trabeculectomy may not be an ideal glaucoma procedure, there is hope that the modern less-invasive glaucoma procedures (MIGS) will be able to extend indications for glaucoma surgery. This may also lower the hurdle of referral for glaucoma surgery for both patients and non-glaucoma specialist doctors.

Differences in Tertiary Glaucoma Care in the Veterans Affairs Health Care System

“…This would suggest that these conditions are either not present in rural communities or, more likely, underdiagnosed. Underreferring or referring patients too late for tertiary glaucoma care has been reported for both the VA and non-VA eye care professionals . Marks et al reported that there may be a significant difference in the management of glaucoma between optometrists and ophthalmologists.…”

Impact of COVID-19 on glaucoma management: A review

“…As of 2010, 1 in 15 blind people was blind due to glaucoma highlighting the increasing global burden of glaucoma ( 17 ). The correct management of patients with glaucoma requires scheduled monitoring of IOP and visual field so that prompt intervention can be made in case of progression of damage ( 18 ). There is a reduction in 81% of medical visits during the first few months of the pandemic, including cataracts (-97%), sleep apnea (-91%) and osteoarthrosis (-88%), and glaucoma (-88%) ( 19 , 20 ).…”