Download Glaucoma And Related Syndromes - Sight Loss and Vision Priority

The Sight Loss and Vision Priority Setting Partnership
FORM A: LONG LIST OF UNCERTAINTIES FOR GLAUCOMA AND RELATED SYNDROMES
The uncertainties listed on this form have been gathered from a survey and consultation with people affected by sight loss, their
partners, relatives and carers and eye health professionals. The survey submissions relating to glaucoma and related syndromes
were checked and formatted into questions. Where there were duplicates, or very similar submissions, these were combined. The
questions below are defined as uncertain because they cannot be answered by an up-to-date systematic review of relevant
research evidence. You are being asked to choose and rank 10 of the uncertainties below. You may wish to choose 10 from a
single category or choose 10 from across a number of different categories. Please see Form B for instructions on this prioritisation
exercise.
There is a glossary of terms at the end of this document.
No.
Uncertainty
DETECTION AND DIAGNOSIS
1
What can be done to improve early diagnosis of glaucoma?
2
What is the most effective detection method for alerting to early stages of glaucoma in children and young adults?
3
How can we detect glaucoma patients with a higher risk to progress rapidly?
4
How and at what age should people be tested if there is glaucoma in the family?
5
What is the effectiveness of optical coherence tomography evaluation of the optic disc in early glaucoma
diagnosis?
How do we know whether someone with normal intraocular pressures will develop glaucoma?
6
7
Can the early tissue changes in the trabecular meshwork system be differentiated in eyes donated for research
where there is DNA evidence to identify a control and glaucoma risk group?
MONITORING
8
Can we develop better ways of measuring visual fields?
9
Are there alternative methods for assessing visual fields that are more acceptable to patients?
10
What is the most effective way of monitoring the progression of glaucoma?
No.
Uncertainty
11
How can we improve techniques for measuring the progression of glaucoma?
12
Can reliable methods of self monitoring eye pressure be developed and improve outcomes?
13
What is the optimal interval between eye tests for patients with glaucoma?
14
How can routine use of optical coherence tomography scanning and retrospective data analysis help in monitoring
glaucoma?
15
Can ophthalmic diagnostic equipment provide a more accurate diagnosis for glaucoma progression, than images
that are compared manually at appointments?
PROGNOSIS
16
How can we develop a structural test based on nerve condition that would be a good predictor of visual field loss?
17
What is the significance of very low blood pressure for the optic nerve in glaucoma patients?
18
Can the incidence of cataract in glaucoma patients be lessened?
19
What effect does cataract surgery have on glaucoma?
20
What effect do Prednisolone tablets have on glaucoma?
21
If glaucoma is present in one eye will the other eye always develop it?
22
Why does vision continue to deteriorate for some people with glaucoma after the pressure levels have been
controlled by drops?
Why is glaucoma more aggressive in people of Afro-Caribbean descent?
23
24
Is the progression of glaucoma different in patients with pigment dispersion syndrome as opposed to other types of
glaucoma?
CAUSE
25
What causes glaucoma?
26
What is the cause of pseudoexfoliation syndrome?
27
What is the cause of low tension glaucoma?
28
Is glaucoma hereditary?
No.
Uncertainty
29
What is the cause of increased intraocular pressure for glaucoma patients?
30
What is the reason for glaucomatous optic nerve damage?
31
What is the relationship between corneal thickness, intraocular pressure and glaucoma?
32
What is the risk of developing glaucoma if there is no family history of glaucoma?
33
What is the risk of developing glaucoma for people with vascular conditions?
34
Do diet and lifestyle factors contribute to glaucoma?
35
What is the relationship between glaucoma and blood pressure?
36
How much is known about links between normal tension glaucoma and Alzheimers?
37
What are the links between glaucoma and other diseases such as migraine and Raynaud's syndrome?
38
Is gender a risk factor for glaucoma?
PREVENTION
39
How can we prevent glaucoma?
40
Can dietary measures, dietary supplements, complementary therapies or lifestyle factors prevent the development
of glaucoma?
41
What part can gene therapy play in the prevention of congenital glaucoma?
42
How can we prevent increased ocular pressure?
43
How can we prevent damage to the nerve structure of the eye before glaucoma is diagnosed?
44
How can we prevent glaucoma by genetically regulating excessive production of fluid in the eye?
45
What is the effectiveness of laser treatment in preventing glaucoma?
TREATMENT - EYE DROPS
46
Can we eliminate the side effects of eye drops?
No.
Uncertainty
47
How can we test glaucoma patients for sensitivity on preservatives in eye drops?
48
How can we make eye drops easier to administer?
49
How effective are eye drops?
50
Are glaucoma drops available in a spray formulation?
51
Why are certain glaucoma eye drops not suitable for people who have, or have had, depression?
52
How effective are beta blockers in protecting visual fields given the possible vasoconstrictive effect they may have
on the optic nerve vasculature?
53
What is the most effective treatment for itchy eyes for people with glaucoma and blepharitis?
54
What research is being done on interactions between eye drops and systemic medications?
55
What is the best way of monitoring glaucoma medication compliance?
56
How can we improve patient compliance in glaucoma?
TREATMENT - SURGERY AND LASER
57
What treatment options are there if a trabeculectomy fails?
58
How effective is a trabeculectomy?
59
What is the effectiveness of combined simultaneous trabeculectomy and cataract surgery compared to
trabeculectomy alone followed by cataract surgery if necessary to ensure the best clinical outcomes and quality of
life for patients with mild cataract and medically uncontrolled glaucoma?
60
What is the effectiveness of surgical treatment compared to treatment with eye drops for glaucoma patients?
61
How effective is laser trabeculoplasty?
62
What is the effectiveness of stents at keeping pressure down for glaucoma patients?
TREATMENT - DIET, SUPPLEMENTS, LIFESTYLE
63
Can any dietary measures, dietary supplements, lifestyle changes or complementary therapies slow the
progression of glaucoma?
No.
Uncertainty
64
For people with pigment dispersion syndrome glaucoma, what is the best advice in terms of the effect of exercise
on intraocular pressure?
TREATMENT - GENERAL
65
What is the most effective glaucoma treatment?
66
What is the most effective glaucoma treatment for people with dementia?
67
How can we stop glaucoma progressing?
68
How can we prevent low tension glaucoma from progressing?
TREATMENT - NEW
69
Can we develop a stem cell treatment for glaucoma?
70
Can we repair or regenerate the optic nerve?
71
72
How can we protect the optic nerve from damage due to fluctuations in eye pressure that may not be detected in
the clinic?
How can we restore loss of vision for people with glaucoma?
73
Can we develop a gene therapy treatment for glaucoma?
74
Can a one stop treatment for glaucoma be developed?
75
Can medical cannabis help lower intraocular pressure and treat glaucoma?
76
Can we develop a treatment to stop or delay nerve cells dying in the optic nerve?
77
How can biomechanics help in support of glaucoma treatment?
78
What is the neurological impact of adalimumab in glaucoma treatment?
Glossary of terms:
Adalimumab: A treatment used to suppress inflammation associated with some autoimmune disorders.
Biomechanics: The application of engineering science to analyse biological systems.
Congenital disorder: An abnormality in the body’s function which arises prior to birth.
Gene therapy: The introduction of genes into the body to treat disease.
Genetics: The science of heredity which attempts to understand inheritance factors.
Intraocular pressure: A measure of the fluid pressure inside the eye.
Laser trabeculoplasty: The use of a laser beam to help lower the intraocular pressure.
Optic disc / optic nerve head: A small blind spot on the surface of the retina where the fibres leave the retina to become
part of the optic nerve.
Optical coherence tomography: A technique for obtaining images of tissue to give cross sectional views inside the eye.
Prednisolone: A treatment to help control inflammatory conditions.
Stem cells: Cells that have the potential to become any type of cell in the body.
Systemic medication: A drug which has effects throughout the whole body.
Trabecular meshwork: A sponge-like tissue located near the cornea and iris which drains fluid into the blood system.
Trabeculectomy: A surgical procedure to help control the pressure in the eye.