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Tips archive
Here you can find all the previously published Tips of the month.

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Ask your glaucoma patients about mobility rather than vision (PDF) - Jun 2020

Glaucoma patients on topical treatment should be routinely checked for signs of ocular surface disease even if they are asymptomatic (PDF) - May 2020

Late in-the-bag intraocular lens dislocation several years after uncomplicated cataract surgery is relatively common in pseudoexfoliation (PDF) - Mar 2020

Consider Brinzolamide to prevent IOP Spikes after Cataract Surgery in Eyes with Glaucoma (PDF) - Feb 2020

When intraocular pressure lowering does not halt visual field progression in an eye which has classic features of glaucoma (glaucoma cupping, retinal nerve fiber loss and normal visual acuity and colour vision), a diagnosis of compressive optic neuropathy should be considered. While disc pallor is recognised to be a sign of potential ominous disease, it should be appreciated that in the early stages of compressive optic neuropathy, the disc may maintain its normal colour (PDF) - Dec 2019

While adherence to therapy is undoubtedly important, at least equally important is the patient’s adherence to a prescribed follow up schedule. Therapies can fail over time and missing follow up appointments can be particularly hazardous for fast progressors-practitioners should stress the importance of good follow up (PDF) - Nov 2019

Consider using a topical NSAID, or steroid, post SLT laser (PDF) - Oct 2019

Consider additional 10-2 visual field testing for diagnosing glaucoma, as limiting to 24-2 or 30-2 tests will frequently miss or underestimate paracentral field defects (PDF) - Sep 2019

When performing a laser peripheral iridotomy (LPI) for primary angle closure the position of the iridotomy in relation to the eyelid should always be considered (PDF) - Jul 2019

A glaucoma patient who progresses despite presumed good adherence might be using inadequate or insufficient technique when applying the anti-glaucomatous eye drops (PDF) - Jun 2019

Selective Laser Trabeculoplasty (SLT) can be considered as the first treatment for newly diagnosed patients with ocular hypertension and mild to moderate primary open angle glaucoma (PDF) - May 2019

Avoid the use of monocular prostaglandin analogue medication (PDF) - Apr 2019

Ocular coherence tomography (OCT) should be used cautiously in the context of uveitic glaucoma (PDF) - Mar 2019

Depression may follow a diagnosis of chronic glaucoma, but depressive symptoms are less likely to be present one year later (PDF) - Feb 2019

Early bleb revision usually results in successful resolution of hypotony maculopathy after trabeculectomy with mitomycin C (PDF) - Jan 2019

Children using topical corticosteroids for the treatment of allergic conjunctivitis must have their intraocular pressure regularly checked (PDF) - Dec 2018

The results of trabeculectomy with mitomycin C are significantly improved in children with glaucoma secondary to juvenile idiopathic arthritis if they are on immune-modulatory treatment (PDF) - Nov 2018

Microperimetry may be a more sensitive method of detecting a small glaucomatous defect close to fixation, than standard automated perimetry and OCT analysis of the retinal nerve fibre layer (RNFL) (PDF) - Oct 2018

A glaucoma drainage device may be more effective than trabeculectomy in lowering IOP after keratoplasty, but is more likely to result in graft failure (PDF) - Sep 2018

Glaucoma control can be detrimentally affected by recurrent anti- VEGF treatment for macular degeneration or diabetic macular oedema (PDF) - Jul 2018

When determining a therapeutic approach to a patient with glaucoma, the life expectancy of the patient needs to be considered (PDF) - Jun 2018

The insertion of a punctal plug improves ocular comfort and results in a modest reduction of IOP in patients with glaucoma who are using topical medication (PDF) - May 2018

In a patient with pigment dispersion syndrome, the most significant ocular risk factor for conversion to glaucoma is an IOP above 21mmHg on presentation (PDF) - Apr 2018

Validated prediction models are helpful to determine the risk of an individual with ocular hypertension developing chronic glaucoma (PDF) - Mar 2018

Measuring the intraocular pressure (IOP) not only in sitting, but also in supine position, may help to identify the 24-hour IOP characteristics of your glaucoma patient (PDF) - Feb 2018

Treatment of ischaemic central retinal vein occlusion with prophylactic anti-VEGF injections reduces the risk of neovascular glaucoma, but careful long-term monitoring for ocular new vessels remains essential (PDF) - Jan 2018

OCT measurement of the retinal nerve fibre layer is useful for detecting progression in early glaucoma (PDF) - Dec 2017

Bleb encapsulation after trabeculectomy can be successfully treated by using aqueous suppressant treatment for a short period (PDF) - Nov 2017

A patient who presents with raised intraocular pressure or glaucoma and distended episcleral veins in one eye needs to be investigated for a spontaneous carotid – cavernous fistula (PDF) - Oct 2017

Glaucoma associated with congenital aniridia is difficult to treat, but tube-shunt drainage devices offer the best results (PDF) - Sep 2017

In a young patient with acute congestive angle closure or recurrent angle closure in the presence of a patent laser iridotomy, the underlying cause is usually plateau iris configuration (PDF) - Jul 2017

The chronic use of prostaglandin analogues may lead to a modest underestimation of IOP when measured by Goldmann applanation tonometry (PDF) - Jun 2017

In a patient with glaucoma who has unexplained hair loss, stop topical beta-blocker treatment (PDF) - May 2017

Patients with normal tension glaucoma who develop a branch retinal vein occlusion should be monitored with greater care (PDF) - Apr 2017

Visual function may improve after trabeculectomy in some adults with moderately advanced glaucoma (PDF) - Mar 2017

The regular (and sometimes clandestine) application of periocular corticosteroid cream can induce glaucoma in susceptible individuals (PDF) - Feb 2017

In patients with primary angle-closure glaucoma and primary angle closure with high intraocular pressure (IOP), there is a good evidence to support the use of clear lens extraction with intraocular lens implantation as initial treatment (PDF) - Jan 2017

Patients with neovascular glaucoma should be referred to a general physician as management of their underlying systemic disease should increase their life expectancy (PDF) - Dec 2016

The risk of secondary haemorrhage after hyphaema can be reduced by using topical steroids and oral tranexamic acid (PDF) - Nov 2016

Despite the increased central corneal thickness (CCT) that may follow lamellar corneal surgery, reliable IOP measurements can be obtained with Goldmann applanation tonometry or Pascal dynamic tomography (PDF) - Oct 2016

In patients with pigment dispersion syndrome, YAG laser peripheral iridotomy can reduce the risk of raised intraocular pressure (IOP) in some patients, but does not prevent glaucoma (PDF) - Sep 2016

An optic disc haemorrhage indicates ongoing structural change and is an important sign of progressive glaucoma (PDF) - Jul 2016

Gradual intraocular pressure (IOP) elevation with a need for additional treatment is common in pseudophakic glaucoma patients following Nd; YAG laser posterior capsulotomy (PDF) - Jun 2016

Early detection of hypotony maculopathy is essential, as permanent chorioretinal changes and poor visual outcomes will occur without rapid surgical intervention (PDF) - May 2016

In patients with glaucoma who require treatment for age-related macular degeneration or diabetic macular oedema, aflibercept may be a better choice of therapy than ranibizumab, as it is less likely to result in a delayed and sustained rise in IOP (PDF) - Apr 2016

Beware of the patient who presents with acute angle closure and transient myopia, as this may occur as an idiosyncratic side effect of oral sulfonamides (PDF) - Mar 2016

If a choroidal effusion develops after surgery in a patient with nanophthalmos then a partial thickness lamellar sclerectomy is an effective therapeutic option (PDF) - Jan 2016

Patients with neovascular glaucoma secondary to ocular ischaemia syndrome need pan-retinal photocoagulation and urgent referral to a physician (PDF) - Dec 2015

Avoid the upper nasal quadrant when inserting an aqueous drainage implant, as it can result in acquired Brown syndrome (PDF) - Nov 2015

Artifacts in the SD-OCT images in a patient with glaucoma or suspected glaucoma may lead to an erroneous conclusion (PDF) - Oct 2015

The ISNT rule is of limited benefit in differentiating early glaucoma from normal (PDF) - Sep 2015

Patients with advanced glaucoma who are to undergo trabeculectomy should be warned that there is a small risk of permanent visual loss as a consequence of the surgery (PDF) - Jul 2015

In clinical practice, anterior segment OCT cannot replace gonioscopy as a method of examining the filtration angle (PDF) - Jun 2015

In every patient with ocular hypertension, search for signs of pseudoexfoliation syndrome as these patients are at significant risk of converting to glaucoma (PDF) - May 2015

Patients with progressive normal tension glaucoma may benefit from elevation of the head of the bed when they sleep (PDF) - Apr 2015

RNFL measurement with SD OCT can contribute to glaucoma diagnosis, but only if prior clinical examination has yielded a relevant level of glaucoma suspicion (PDF) - Mar 2015

In patients with narrow filtration angles or primary angle-closure glaucoma who have a patent laser iridotomy, it is safe to prescribe any systemic drugs which have an anti-cholinergic effect on the pupil (PDF) - Feb 2015

Systemic beta-blocker and nitrates result in a lowering of IOP which has implications for the management of ocular hypertension and glaucoma (PDF) - Jan 2015

Corneal refractive surgery (LASIK) poses a risk to the glaucoma patient (PDF) - Dec 2014

If glaucoma progresses despite seemingly controlled IOP, then it may be worthwhile investigating and treating obstructive sleep apnoea syndrome (OSAS) (PDF) - Nov 2014

Per-operative use of anti-VEGF agents improves the chance of success of trabeculectomy (PDF) - Oct 2014

After the insertion of a drainage tube, the risk of a delayed supra-choroidal haemorrhage can be reduced by avoiding post-operative hypotony (PDF) - Sep 2014

Temporal placement of a laser peripheral iridotomy is safe and is less likely to result in linear dysphotopsia than if the PI is placed superiorly (PDF) - Jul 2014

Patients with pseudoexfoliation syndrome often have loss of hearing and should be referred for audiometry (PDF) - Jun 2014

Dietary supplementation and glaucoma (PDF) - May 2014

Patients with pigmentary glaucoma respond well to laser trabeculoplasty, but steps must be taken to reduce the risk of the IOP spike that may occur immediately after the laser treatment (PDF) - Apr 2014

It is important that glaucoma patients at risk of end-of-life visual impairment should be identified and treated accordingly (PDF) - Mar 2014

Perimetry should be undertaken soon after phacoemulsification and multifocal IOL implantation in patients with glaucoma, in order to establish new baseline parameters (PDF) - Feb 2014

The early diagnosis of glaucoma and early detection of glaucoma progression should be enhanced by the use of spectral domain OCT measurement of the neuro retinal rim (PDF) - Jan 2014

Consider using preservative-free topical medication in patients with ocular surface disease (PDF) - Dec 2013

Cataract surgery after trabeculectomy increases the risk of bleb failure and this risk is increased if the time between trabeculectomy and cataract surgery is short (PDF) - Nov 2013

Generic drops can differ from brand drops and it may be necessary to monitor patients more closely after switching (PDF) - Oct 2013

The measurement of retinal nerve fibre thickness is helpful in determining which patients with ocular hypertension will develop glaucoma (PDF) - Sep 2013

Post-traumatic angle-recession glaucoma is difficult to manage and surgical intervention is often required (PDF) - Jun 2013

The use of Ginkgo biloba may increase the risk of bleeding (PDF) - May 2013

If surgery is required to control IOP in a patient with nanophthalmos, phacoemulsification with IOL implantation is a good option, but the complication rate is high (PDF) - Apr 2013

Indefinite use of cycloplegics can be the last resort when surgery for malignant glaucoma has failed (PDF) - Mar 2013

Young men of European ancestry with angle-closure require thorough investigation (PDF) - Feb 2013

Intravitreal steroids should be used with caution in patients with glaucoma (PDF) - Dec 2012

Long-term application of benzalkonium chloride increases the risk of filtration surgery failure (PDF) - Nov 2012

In patients with pseudoexfoliation glaucoma, phacoemulsification with IOL implantation can result in a late, sustained reduction in intraocular pressure (PDF) - Oct 2012

Topical carbonic anhydrase inhibitors can cause damage in corneas with severe endothelial dysfunction (PDF) - Sep 2012

In patients with progressive normal tension glaucoma, the use of topical brimonidine may help to preserve visual function (PDF) - Jun 2012

A dry eye can hamper visual field test interpretation (PDF) - May 2012

Laser peripheral iridotomy can reduce the intraocular pressure in pigment dispersion syndrome, but may not prevent glaucoma (PDF) - Apr 2012

Gonioscopy should be performed using the minimal possible levels of illumination in order to reliably detect appositional angle closure (PDF) - Mar 2012

Laser peripheral iridotomy does not usually result in long-term intraocular pressure control in patients with chronic angle-closure glaucoma (PDF) - Feb 2012

Trial lens artifacts can be easily distinguished from glaucomatous field defects (PDF) - Jan 2012

In neovascular glaucoma, the immediate injection of intravitreal bevacizumab (Avastin®) usually results in rapid regression of iris new vessels and pain relief (PDF) - Dec 2011

Washout periods vary significantly between glaucoma medications (PDF) - Nov 2011

To prevent early hypotony with a non-valved aqeous shunt, always occlude the tube with a suture (PDF) - Oct 2011

Prostaglandin analogues should be avoided in patients with a history of herpes keratitis (PDF) - Sep 2011

Rim/disc ratio is a more sensitive parameter than cup/disc ratio (PDF) - Jun 2011

In patients with juvenile-onset chronic open-angle glaucoma, trabeculectomy with mitomycin C is usually required to prevent progressive visual loss (PDF) - May 2011

The advantage of adding a 3rd or 4th drug may be negligible (PDF) - Apr 2011

The most effective treatment of glaucoma associated with epithelial downgrowth is to insert a drainage implant (PDF) - Mar 2011

Chronic miotics can be helpful in case of plateau iris configuration (PDF) - Feb 2011

To reduce the risk of late bleb-related infection, avoid multiple-dose eye drops in patients who have previously undergone trabeculectomy with mitomycin C (PDF) - Jan 2011

Small field depressions can be more worrying than large ones (PDF) - Dec 2010

The cataract surgeon should be informed that the patient has pseudo-exfoliation syndrome (PDF) - Oct 2010

If conservative measures are unsuccessful in the management of malignant glaucoma, phaco with IOL combined with posterior capsulotomy and anterior vitrectomy usually is (PDF) - Sep 2010

In patients with chronic angle-closure glaucoma and cataract, phacoemulsification with IOL implantation usually results in IOP control up to 2 years after surgery (PDF) - Jun 2010

Measurement of central corneal thickness is essential to ensure optimal management of glaucoma patients (PDF) - May 2010

Disc Haemorrhages (PDF) - Apr 2010

When should neuroradiological imaging be undertaken in patients with normal tension glaucoma? (PDF) - Mar 2010

Glaucoma medications may harm the foetus and neonate (PDF) - May 2009

Intraocular pressure is overestimated in eyes with a thick cornea (PDF) - Apr 2009

A thin cornea is a risk factor for primary open-angle glaucoma (PDF) - Mar 2009

Intraocular pressure is underestimated in eyes with a thin cornea (PDF) - Feb 2009

Visual field defects are filled-in by the brain (PDF) - Jan 2009

Pseudoexfoliation glaucoma has a strong genetic component (PDF) - Dec 2008

Chase the family of primary-open angle glaucoma patients (PDF) - Nov 2008

Intraocular pressure should be monitored after an acute episode of angle-closure (PDF) - Oct 2008

Topical medication may accelerate cataract formation (PDF) - Sep 2008

Closing the eyes as an alternative for nasolacrimal duct occlusion (PDF) - Jun 2008

There is no significant association between use of β-blockers and depression (PDF) - May 2008

Trabeculectomy significantly increases the incidence of cataract formation (PDF) - Apr 2008

Concomitant therapy with Cosopt® and Diamox® is not useful (PDF) - Mar 2008

Rate of false positive answers is the only reliable reliability parameter in computerized perimetry (PDF) - Feb 2008

Normal intraocular pressure in an eye with central retinal vein occlusion does not rule out associated glaucoma (PDF) - Jan 2008

Medication compliance can easily be improved (PDF) - Dec 2007

Poor visit keeping is associated with poor medication compliance (PDF) - Nov 2007

Heart failure is no contraindication to β-blocker therapy (PDF) - Oct 2007

Diabetes is no manifest risk factor for developing primary open-angle glaucoma (PDF) - Sep 2007

Bilateral acute angle-closure glaucoma may occur after uneventful blepharoplasty (PDF) - Jun 2007

Optic disc size can be quickly assessed at the slit lamp (PDF) - May 2007

Glaucoma and small optic discs: a diagnosis challenge (PDF) - Apr 2007

Tracking structural abnormalities is more important in early glaucoma than at the end of the disease (PDF) - Mar 2007

Target pressure is now an accepted part of standard glaucoma care (PDF) - Dec 2006

Early aggressive treatment is indicated in selected glaucoma cases (PDF) - Nov 2006

Check intraocular pressure up to several months after intravitreal injection of triamcinolone acetonide (PDF) - Sep 2006

Track structural changes in early disease and functional loss at the end of the disease (PDF) - Sep 2006

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