This module will cover best practice for glaucoma detection, investigation and monitoring methodologies used in both Optometry and Ophthalmology service. While discussing all of the treatment options, emphasis is placed upon the advanced optometric management of this group of disorders. Moreover, differential diagnosis of optic disc cupping will also be covered.

Principles of screening for glaucoma will be covered and their significance discussed in terms of standard diagnostic techniques; perimetry, intraocular pressure measurement and optic nerve head appearance. The limitations of these techniques will be discussed in the context of emerging technologies for the detection and monitoring of glaucoma. At the end of this module, candidates should be able to describe the types of glaucoma, understand their management and be able to select the appropriate diagnostic tests to efficiently diagnose glaucoma whilst understanding their limitations. The level of understanding achieved by candidates should enable them to take an active part in referral refinement and co-management schemes between Optometrists and Ophthalmologists. In some instances, education beyond current optometric  practice is introduced in an effort to prepare the candidates for advanced clinical challenges that this group of disorders might show.

Areas covered will include:

  • Primary glaucomas. definition, diagnosis, risk factors, IOP measurement and fluctuations, optic disc examination, other examination techniques, POAG:  risk factors, mechanism, POAG suspect, evaluation of potential glaucoma, NTG,: characteristics, confirmation, differential diagnosis, PACG: definition, risk factors, classification, manifestation, differential diagnosis, primary congenital glaucomas
  • Secondary glaucomas: OAG: definition, risk factors, CAG: definition, risk factors, pigmentary glaucoma (clinical features), PEX glaucoma (clinical features), inflammatory glaucoma (clinical features), neovascular glaucoma (clinical features), post-traumatic glaucoma, lens induced glaucoma, glaucomas associated with eye surgery, glaucomas associated with drug use, secondary congenital glaucoma
  • Glaucomatous versus non-glaucomatous optic disc cupping: differential diagnosis and optometric considerations
  • Glaucomas, management: POAG: factors to consider, aim, when to treat, target IOP, the glaucoma suspect, targets, treatment options (medication, laser, surgery), systemic management; PACG: immediate intervention, follow-up; secondary glaucomas: management, prevention
  • The principles of screening methodologies for the detection of glaucoma. How the effectiveness of diagnostic tests are evaluated in terms of sensitivity, specificity and predictive power
  • Theoretical principles of perimetry in relation to selection of the optimal testing strategy for the detection and monitoring of glaucoma
  • Statistical analysis of single and serial visual field data with respect to glaucoma diagnosis and monitoring
  • Measurement of intraocular pressure and its role in diagnosis and management of glaucoma. The assumptions and limitations of measurement techniques will be covered in conjunction with the relationship of intraocular pressure to corneal thickness
  • Anatomical features of the anterior segment will be evaluated in terms of their clinical assessment in relation to glaucoma; specifically slit lamp bio-microscopic examination and gonioscopy
  • New technologies for the detection and monitoring of glaucoma. The limitations of standard visual field assessment will be related to novel measures of the visual field using frequency doubling technology, pulsar perimetry, flicker perimetry and short-wavelength sensitive perimetry. The emergence of imaging technologies for evaluating the structure of the optic nerve head and retinal nerve fibre layer will evaluated in terms of glaucoma diagnosis and monitoring