Key points for review of glaucoma patients

  The first issue is the interval of review. How often should the review be done? This depends on the type of glaucoma, the control of IOP after dropping the medication, and the degree of damage to the visual field and optic nerve, so that a reasonable treatment and examination plan can be formulated. Generally speaking, for patients with glaucoma who have good control of their rhythm of life, regular eye medication, and whose IOP is always maintained at a normal level, they can go to the hospital every one to two months to have their IOP measured and have their visual function reviewed once a year or so. For some patients who have poor control of life rhythm and emotion, unstable IOP, high and low IOP after medication, and occasional iris after exertion or lack of sleep, they should be reviewed once every two weeks or so, and if necessary, the number of drops should be increased appropriately.  In addition, if the IOP is always found to be at the high limit of normal or mildly elevated during the review, and the patient feels that the visual field is progressively narrowing and the vision is diminishing, the review interval should be shortened or the treatment plan should be changed in time. For patients with suspected glaucoma or high IOP, IOP can be reviewed every 3 months or so, and visual function every 6 to 9 months.  Second, the items that need to be checked during the review. For patients with diagnosed glaucoma, visual acuity, intraocular pressure, and fundus should be checked at each review to see if the patient’s condition is under control, and visual function should be checked, mainly for visual field. Optic nerve structure examination, such as fundus photography, Heidelberg Retinal Tomograph (HRT-II), scanning laser polarimeter combined with individualized corneal surrogate technique (GdxVcc) and optical coherence tomography (OCT), can be performed in hospitals that are in a position to do so.  Moreover, in addition to measuring a single IOP, IOP examinations also require multiple IOP measurements, especially at night. Because IOP is higher in patients with glaucoma when they sleep in the recumbent position at night than in the seated position during the day, this increases the chance of deterioration. Therefore, for those patients with normal daytime IOP but progressive visual field deterioration, measuring IOP only during the day is not sufficient to accurately determine the risk of blindness, and IOP changes should be monitored over a 24-hour period.  For different patients with suspected glaucoma, the items to be reviewed differ. For example, in patients with suspected closed-angle glaucoma, in addition to IOP and visual field, it is more important to observe their atrial angle, so atrial angle microscopy and ultrasound biomicroscopy are necessary for review; for suspected patients with hypertension and large visual cups, examination of visual function and optic nerve structure is the focus of review.