Putting
It All Together Practically:
History,
Angle, Risk Factors, Disc, and the Individual Glaucoma Graph
George L. Spaeth, MD
With regard to
individuals there are four major aspects that need to be considered:
(1)
Does the person have active glaucoma?
(2)
Will the individual develop active glaucoma?
(3)
Is the person’s condition changing? And
(4)
If the condition is changing, how rapidly is it changing
and for what duration will the change continue?
Angle Damage Likelihood Scale
| Angle |
PAS |
Angle Approach |
Peripheral Curvature |
Iris Bowing |
| 0 |
0 |
>30o |
f |
0 |
| 1 |
0 |
25o – 29o |
f |
0 |
| 2 |
0 |
20o – 24o |
f |
0 |
| 3 |
10o |
15o – 19o |
f |
0 |
| 4 |
30o |
10o – 14o |
?s |
1+ |
| 5 |
90o |
5o – 9o |
s |
2+ |
| 6 |
180o |
1o – 4o |
s |
3+ |
| 7 |
360o |
0 |
s |
4+ |
Field
Damage Likelihood Scale
Does the Patient
Have Glaucoma?
1)
| Is Damage Present? |
No |
Yes |
| History |
- - - |
- - - |
| Angle |
No PAS
Wider than
C10F
No iris bow |
PAS |
| Disc |
Stage 0 - 1 |
Stage 4-7 |
| Field |
- - - |
Stage 4-7 |
2)
| Will Damage Occur? |
No |
Yes |
| Specific Gene |
--- |
Will be known |
| Intraocular Pressure |
--- |
>30 mm Hg |
| Angle |
--- |
Narrower than c10
Any s
Any 2+ - 4+ Bowing |
3)
| Is Condition Changing? |
No |
Yes |
| Disc |
No change |
2 or more stages |
| Angle |
No change |
10o narrower
1+ more bowed
new PAS |
| Field |
No change |
2 or more stages |
4)
How rapidly is condition changing and for how long.
Use the Glaucoma
Graph with the units on the y (vertical) axis being the HDLS,
ADLS, DDLS, or FDLS. Must have an estimate of life expectancy
based on:
Patient’s present
general state of health
Patient’s present
age
Age at death
of parents and siblings
Average longevity
in area in which person is living
Patient’s
self-care ability, including lifestyle, managerial skills, and
socioeconomic status.
Goals of Therapy
- Prevent a patient who does not have any loss of
function from developing any loss of function.
- To prevent a patient who has loss of function from
developing any further loss of function.
- To restore whatever visual loss or functional loss
is already present
- To preserve or enhance the patient’s health
and sense of well-being
REFERENCES
Anterior Chamber Angle
Spaeth GL: The normal development of the human anterior chamber
angle: A new system of descriptive grading. Trans Ophthalmol
Soc UK 1971;91:709-739.
Spaeth GL: Gonioscopy: Uses old
and new. The inheritance of occludable
angles. Ophthalmology 1978;85(3):222-232.
Oh Y, Minelli S, Spaeth GL et al: The anterior chamber angle is different in
different racial groups: A gonioscopic
study. Eye 1994;8:104-108.
Spaeth GL, Araujo S, Azuara A. Comparison of the Configuration of the Human Anterior
Chamber Angle, as Determined by the Spaeth
Gonioscopic Grading System and Ultrasound Biomicroscopy. Trans Am Acad Ophthalmol Soc 1995:93:377.
DDLS
Bayer A, Harasymowycz
P, Henderer JD, Steinmann WG, Spaeth,
GL. Validity of a new disk grading scale for estimating glaucomatous
damage: correlation with visual field damage. Am
J Ophthalmol. 2002 Jun;133(6):758-63.
Henderer JD, Liu C, Kesen M, Altangerel U, Bayer A, Steinmann WC and Spaeth
GL. Reliability of the disk damage likelihood scale. Am J Ophthalmol 2003; 135: 44-48.
Highlights of
Ophthalmology article
Field Damage Likelihood Scale
Spaeth GL (ed). Glaucoma.
In: Tasman W, Jaeger E (eds).
Wills Eye Hospital Atlas of Clinical Ophthalmology 2d ed. Philadelphia: Lippincott, Williams &
Wilkins, 2001. pp. 91-167.
History
No publication
as of the date of this conference.
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