Blind World

Revised Treatment Guidelines Aim to Advance Glaucoma Care Across Europe.

December 8, 2003.

The European Glaucoma Society.
News Release.

LONDON, December 8 /PRNewswire/ -- The European Glaucoma Society (EGS) has published the second edition of its treatment guidelines for glaucoma which include the role of patient compliance and the measurement of quality of life in treatment decisions and outcome. In an effort to support the management of glaucoma patients, the guidelines, first published in 1998, are targeted for general ophthalmologists and incorporate the latest clinical research and thinking on glaucoma, together with an update on the evidence for the latest therapies and surgical techniques.

"These updated guidelines have been based on the most current glaucoma literature, conferences and clinical experiences available," explains Professor Roger Hitchings, President, EGS. "They're critical for physicians because glaucoma treatment and management is unique for every patient, which the second edition of the guidelines emphasises even more strongly."

The EGS hopes to be supportive of advancing glaucoma care across Europe with the revised guidelines. Presented in two main sections, the publication provides the EGS' view on the management and diagnosis of glaucoma, taking into account the results of recent clinical trials, patient examinations, available medical therapies, and simplified diagrams for diagnosis and therapy through flow charts.

Glaucoma, as a progressive disease requiring topical medication and follow-up appointments, requires continuous co-operation from patients for its successful management.

As the third leading preventable cause of blindness, glaucoma affects approximately 105 million people worldwide[1], and non-compliance plays a large role in progression to blindness.

Glaucoma patients are frequently elderly and may have diminished cognitive abilities, poor hearing and other ailments, such as arthritis, which may impede or reduce their ability to administer medication correctly. In addition, glaucoma patients do not always fully understand the chronic, progressive nature of the disease and the role that correct use of medication, together with persistent use, has in slowing or halting the progression of the disease.

"Although hard to quantify, quality of life is an important outcome measure for patients and the effect of both diagnosis and treatment on the individual have to be considered," says Professor John Thygesen, Associate Professor in the Department of Ophthalmology, University Hospital of Copenhagen, Denmark. "Visual function is closely linked to quality of life so treatment side effects, dosing schedule and cost all have to be taken into account when choosing a therapy."

According to the EGS, the ultimate goal of glaucoma treatment is to maintain a patient's quality of life (QoL) at reasonable cost. QoL is closely linked with visual function and presently, the only approach proven to be efficient in preserving visual function is to lower the intraocular pressure (IOP). The updated guidelines confirm that the choice of therapy must now take into account quality of life, monetary cost and patient compliance and persistence with therapy. Not addressed in the previous edition of the guidelines, these costs, which include the cost of treatment in terms of inconvenience and side effects, as well as the financial cost for the individual and society, require careful evaluation.

"The EGS decided to make important additions to the guidelines as there have been advances in glaucoma care since 1998," says Professor Carlo Traverso of the Clinica Oculistica, Di.N.O.G., University of Genoa, Genoa, Italy. "These recommendations incorporate the latest scientific evidence and we are delighted to be able to support ophthalmologists in this way."

What new clinical evidence shows

The second edition of the guidelines has been updated to reflect recent results from several large, randomised controlled trials which provide new clinical evidence that current treatments for glaucoma are effective in decreasing visual loss from the disease. In many cases, prostaglandin derivatives have superseded beta-blockers as first-choice therapy and this shift is reflected in the new recommendations. The guidelines advocate that if the first-choice therapy is not measurably effective on IOP, it is then preferable to change the initial therapy rather than use a second drug. Investigations on the effect of IOP-lowering in the treatment of glaucoma showed that a lower IOP meant better protection against vision loss, as initial IOP-lowering slowed the progression to blindness in later years. This aids in clarifying the aim of treatment, which needs not be zero progression, but a reduction of the rate of progression in line with a patient's life expectancy.

About the EGS

The EGS guidelines were produced with the aim of improving the management and treatment of glaucoma and to further the understanding of this disease. Both healthcare practitioners and patients are expected to benefit from this work, which includes diagnosis and treatment recommendations, and issues on quality of life and patient compliance. The definition and guidelines project was developed by the EGS Committee for Education and Research and was reviewed by the Executive Committee of the EGS.

Notes to Editors:

Glaucoma represents a variety of conditions where the intraocular pressure (IOP) inside the eye becomes too high for the optic nerve and, if left untreated, can damage the nerve resulting in loss of vision and eventual blindness. Loss of efficiency in the eye's drainage mechanism can cause a build-up of pressure within the eye. The aim of effective glaucoma treatment is to lower the IOP to a target pressure so as to preserve visual function and prevent further disease progression.

The European Glaucoma Society website is

Useful link - The International Glaucoma Association, which is UK-based, offers advice and support to glaucoma sufferers and aims to increase public awareness of glaucoma, as well as funding research. The IGS works with organisations across the world to prevent sight loss from glaucoma and membership is open to patients, optometrists, opticians and doctors.

[1] Blindness and Visual Disability. World Health Organization Website. Address:

Distributed by PR Newswire on behalf of The European Glaucoma Society

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