EUROPEAN GLAUCOMA SOCIETY TERMINOLOGY AND GUIDELINES FOR GLAUCOMA 3rd Edition

Foreword

It gives me great pleasure to introduce thus, the third edition of the European Glaucoma Society ‘Guidelines’. In the 5 years since the last edition the Guidelines have been accepted as one of the standard texts in glaucoma, widely distributed and adopted across Europe. Since the last edition significant changes have taken place in the diagnosis and management of glaucoma: we have a much clearer understanding of the pathogenesis of open angle glaucoma, and have seen a revision of the terminology and mechanisms for angle closure. There have been advances in both diagnosis and method of followup of chronic glaucoma. Treatment both medical and surgical has improved with new drug combinations and new surgical techniques entering the mainstream of practice. More importantly, there have been improvements in measuring the affect that glaucoma has on the patient, how it affects Quality of life. All these changes and more appear in the third edition. The Guidelines owe much to the enthusiasm and effort put in by the writing team, headed by Carlo Traverso with Anders Heijl, and the many co-opted helpers. Without them this edition would not have been possible. The new ‘Guidelines’ build on the reputation established by the earlier versions, and should take forward the understanding of glaucoma in Europe.

Roger Hitchings
EGS President

The Guidelines Task Force Anders Heijl (Editor) Carlo E. Traverso (Editor) Augusto Azuara-Blanco Stefano Gandolfi Franz Grehn Gabor Hollo Anton Hommer Michele Iester Clive Migdal John Thygesen Fotis Topouzis

Contributors and Reviewers Alfonso Anton Alessandro Bagnis Keith Barton Boel Bengtsson Graziano Bricola Howard Cohn Francesca Cordeiro Fabio De Feo Paul Foster David Garway Heath Peng Khaw Yves Lachkar Hans Lemij Selim Orgul Marina Papadia Leopold Schmetterer Riccardo Scotto Ingeborg Stalmans Anja Tuulonen Thierry Zeyen

Production Team Roberta Bertagno Laura Guazzi Maria Musolino Stefania Rela Valentina Scanarotti Executive Committee Roger Hitchings (President) Franz Grehn Anders Heijl Gabor Hollo Yves Lachkar Clive Migdal Norbert Pfeiffer John Thygesen Carlo E. Traverso Anja Tuulonen

The European Glaucoma Society website is: www.eugs.org



BLOOD FLOW

Vascular factors are probably involved in the pathogenesis of glaucoma. Recent epidemiological studies have shown an association between low systemic diastolic blood pressure and low ocularperfusion pressure and the incidence, prevalence and progression of glaucoma(1-4).
Conventionally ocular perfusion pressure is estimated as the difference between the systemic arterial blood pressure and intraocular pressure.

Several methods have been developed to measure ocular blood fl ow. Their value in clinical practice has not yet been determined(5-15).
At the present time the clinical role of blood flow measurements in glaucoma management is unclear.
Clinical vascular risk factors should be taken into account in glaucoma management especially when the IOP is low over 24 hours with normal CCT and visual fields show severe and progressive alteration [II,D].

References

1) Bonomi, L., Marchini, G., Marraffa, M., Bernardi, P., Morbio, R., and Varotto, A. 2000. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology 107:1287-1293.
2) Leske, M.C., Wu, S.Y., Hennis, A., Honkanen, R., and Nemesure, B. 2008. Risk factors for incident open-angle glaucoma: the Barbados Eye Studies. Ophthalmology 115:85-93.
3) Leske, M.C., Heijl, A., Hyman, L., Bengtsson, B., Dong, L., and Yang, Z. 2007. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology 114:1965-1972.
4) Nemesure, B., Honkanen, R., Hennis, A., Wu, S.Y., and Leske, M.C. 2007. Incident openangle glaucoma and intraocular pressure. Ophthalmology 114:1810-1815.
5) Galassi, F., Sodi, A., Ucci, F., Renieri, G., Pieri, B., and Baccini, M. 2003. Ocular hemodynamics and glaucoma prognosis: a color Doppler imaging study. Arch Ophthalmol 121:1711-1715.
6) Zeitz, O., Galambos, P., Wagenfeld, L., Wiermann, A., Wlodarsch, P., Praga, R., Matthiessen, E.T., Richard, G., and Klemm, M. 2006. Glaucoma progression is associated with decreased blood fl ow velocities in the short posterior ciliary artery. Br J Ophthalmol 90:1245-1248.
7) Satilmis, M., Orgul, S., Doubler, B., and Flammer, J. 2003. Rate of progression of glaucoma correlates with retrobulbar circulation and intraocular pressure. Am J Ophthalmol 135:664-669.
8) Gherghel, D., Orgul, S., Gugleta, K., Gekkieva, M., and Flammer, J. 2000. Relationship between ocular perfusion pressure and retrobulbar blood fl ow in patients with glaucoma with progressive damage. Am J Ophthalmol 130:597-605.
9) Henry, E., Newby, D.E., Webb, D.J., Hadoke, P.W., and O’Brien, C.J. 2006. Altered endothelin-1 vasoreactivity in patients with untreated normal-pressure glaucoma. Invest Ophthalmol Vis Sci 47:2528-2532.
10) Polak, K., Luksch, A., Berisha, F., Fuchsjaeger-Mayrl, G., Dallinger, S., and Schmetterer, L. 2007. Altered nitric oxide system in patients with open-angle glaucoma. Arch Ophthalmol 125:494-498.
11) Fuchsjager-Mayrl, G., Wally, B., Georgopoulos, M., Rainer, G., Kircher, K., Buehl, W., Amoako-Mensah, T., Eichler, H.G., Vass, C., and Schmetterer, L. 2004. Ocular blood fl ow and systemic blood pressure in patients with primary open-angle glaucoma and ocular hypertension. Invest Ophthalmol Vis Sci 45:834-839.
12) Feke, G.T., and Pasquale, L.R. 2008. Retinal blood fl ow response to posture change in glaucoma patients compared with healthy subjects. Ophthalmology 115:246-252.
13) Garhofer, G., Zawinka, C., Resch, H., Huemer, K.H., Schmetterer, L., and Dorner, G.T. 2004. Response of retinal vessel diameters to fl icker stimulation in patients with early open angle glaucoma. J Glaucoma 13:340-344.
14) Kaiser, H.J., Flammer, J., Graf, T., and Stumpfi g, D. 1993. Systemic blood pressure in glaucoma patients. Graefes Arch Clin Exp Ophthalmol 231:677-680.
15) Emre, M., Orgul, S., Haufschild, T., Shaw, S.G., and Flammer, J. 2005. Increased plasma endothelin-1 levels in patients with progressive open angle glaucoma. Br J Ophthalmol 89:60-63.