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Danish Glaucoma Society releases PACG guidelines
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Adding to the continuing advancement of ophthalmology, the Danish Glaucoma Society released its guidelines for the diagnosis and management of primary angle-closure (PAC) and primary angle-closure glaucoma (PACG) in September 2003.
John Thygesen, MD, chairman of the Danish Glaucoma Society, told Ocular Surgery News that he and his colleague, Sv. Vedel Kessing, MD, DMSc, wrote the guidelines because diagnostic principles and terminology have changed in PACG and because the disease has received little attention at many glaucoma meetings.
Glaucoma Subspecialty Day spent just seven minutes on it during the 2003 meeting of the American Academy of Ophthalmology, Dr. Thygesen said.
The purpose of the guidelines is to focus on a difficult and seldom addressed problem, he continued. “It is an important subject. Patients that have angle-closure are not glaucoma patients until they develop changes in line with the definition of glaucoma. That is something we focus on. ...”
Dr. Thygesen noted the PACG guidelines are based primarily on Dr. Kessing’s three decades of clinical experience. The guidelines describe an alternative to the normal trial and error system of doing laser iridotomy in all cases.
“If you use indentation gonioscopy ... you might find those cases with plateau iris that need iridoplasty,” he said. “You will see that you will not be able to open the angle in these cases [using iridotomy].”
The guidelines also review risk factors for angle-closure, including central chamber depths.
“If you have the option, do a measurement of the central chamber by pachymetry,” he said. “Based on that, you know you would have to at least do a YAG iridotomy in groups with the highest risks. ... They are all those who have chambers less than 2 mm, while those in the range of 2 mm to 2.5 mm are in a gray zone where they could have attacks due to plateau iris. Above 2.5 mm you will find only plateau iris cases.”
Well received
The Danish guidelines for the diagnosis and management of PAC and PACG were supported by an unconditional grant from Pfizer Inc. and are currently available in the Danish language.
Dr. Thygesen said he feels the guidelines have been fairly well-received and has even been asked to have the book translated into English.
“We did not realize that there was so much focus on the guidelines before we made them. ... But they have just been flying out of the office,” he said. “We have been invited to give talks around the country to present the guidelines, and also in Norway. And they were the best attended meetings that we have ever had,” he said.
For Your Information:
- John Thygesen, MD, can be reached at Rigshospitalet, Department of Ophthalmology, Blegdamsvej 9, University of Copenhagen, Copenhagen, DK-2100, Denmark; +45-35-45-31-77; fax: +45-35-45-32-70; e-mail: jthygesen@rh.dk.
- The Danish Glaucoma Society, publishers of the Danish Guidelines for the Diagnosis and Management of Primary Angle-Closure Glaucoma, can be reached at the above address.