tailieunhanh - The Guide to Clinical Preventive Services 2008 - part 8

Cũ hơn người Mỹ gốc Phi đã có tỷ lệ cao hơn của bệnh tăng nhãn áp và có lẽ là một bệnh tiến triển nhanh hơn, và nếu nó được thể hiện tầm soát bệnh tăng nhãn áp làm giảm sự phát triển của suy giảm thị lực, người Mỹ gốc Phi có thể sẽ lớn hơn lợi ích tuyệt đối hơn người da trắng. | Screening for Glaucoma Increased IOP family history older age and being of African American descent place an individual at increased risk for glaucoma. Older African Americans have a higher prevalence of glaucoma and perhaps a more rapid disease progression and if it is shown that screening for glaucoma reduces the development of visual impairment African Americans would likely have greater absolute benefit than whites. People with a limited life expectancy would likely have little to gain from glaucoma screening. The natural history of glaucoma is heterogeneous and not well defined. There is a subgroup of people with POAG in whom there is either no disease progression or the progression is so slow that the condition would never have an important effect on their vision. The size of this subgroup is uncertain and may depend on the ethnicity and age of the population. Others experience more rapidly progressing disease leading to reduced vision-related function within 10 years. Whether an individual s glaucoma will progress cannot be predicted with precision but those with higher levels of IOP and worse visual fields at baseline and those who are older tend to be at greater risk for the more rapid progression of glaucoma. Whether the rate of progression of visual field defects remains uniform throughout the course of glaucoma is unknown. 174 Screening for Glaucoma Measurement of visual fields can be difficult. The reliability of a single visual field measurement may be low several consistent visual field measurements are needed to establish the presence of defects. Dilated opthalmoscopy or slit lamp exam are used by specialists to examine changes in the optic disc however even experts vary in their ability to detect glaucomatous optic disc progression. Additionally there is no agreed-upon single standard to define and measure progression of visual field defects. The primary treatments for POAG reduce IOP these include medications laser therapy or surgery. These .