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APGS Webinar 8th May: Medical Management in Glaucoma

Webinar Description

Central European Time: 1200 hours
India / Sri Lanka: 1630 hours
Myanmar: 1730 hours
Thailand / Indonesia (Jakarta): 1800 hours
Malaysia / Hong Kong / Singapore / Taipei: 1900 hours
Korea / Japan:  2000 hours
Australia (Sydney):  2100 hours

For other locations, you can use the following link to convert the timing to your local time.

Due to connectivity issues during the session, we have provided Dr. Tatham's Q&A responses as follow:

Do you suggest that IOP checked by technician is better than the doctor?

No, it is more a matter of what device gives the most reproducible measurements in a technician's hands, with closest agreement to the doctor, and which tonometer is best for a given setting. Our study found quite a high level of disagreement between IOP measured by technicians and glaucoma specialists using Goldmann, with the major problem that there was no way of determining the accuracy of IOP measured by goldmann once the measurement has been taken. This is important in virtual clinics when the patient is not being seen face to face by an ophthalmologist. We found the ocular response analyzer gave more reproducible results, closer to that obtained by ophthalmologists using the same device. 

What is the significance of measuring 24hours monitoring IOP?

We know that IOP fluctuates and there is growing evidence that fluctuations may be a risk factor for progression. We also know that there is variability in IOP measurements, which can make it difficult to determine the effect of treatments. Obtaining more frequent IOP measurements can help us determine therapeutic effect more precisely and provide knowledge about true peak IOP and magnitude of fluctuations. The difficulty is knowing in which patients obtaining more frequent measures might be important. My preference is to perform home IOP monitoring in patients who are progressing despite seemingly low IOP.

What is the target IOP for normal tension glaucoma?

There are many factors that affect target IOP, including life expectancy, severity of glaucoma, presenting IOP. If someone has developed glaucoma with a low IOP, it is first important to rule out other causes of optic neuropathy or visual field loss. Second, it is important to establish baseline IOP and if possible it is good to obtain more than one IOP measurement before starting treatment. It is also good to try and assess the rate of progression and modify the target IOP accordingly. It can be particularly challenging to determine therapeutic effects based on IOP alone in NTG as the measurement error of tonometry devices accounts for a relatively large proportion of absolute IOP values when baseline IOP is low. We should also remember that IOP is a surrogate and measuring other endpoints such as the visual field is more important when determining if treatment is effective.

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