An evidence-based approach to glaucoma care

Abstract

Put several glaucoma specialists in a room and solicit opinions on just about any clinical issue and you are bound to receive multiple opinions on how to manage the problem. For example, a patient presents with shallow angles on van Herrick screening. What gonioscopic features would prompt you to perform a laser iridotomy? Would you perform a dark room provocative test to confirm your impression that the angle was potentially occludable? Do you perform a pharmacological challenge test before proceeding to prophylactic laser iridotomy? Would you order an ultrasound biomicroscopic test to confirm your impression? If you do decide that prophylactic laser iridotomy is indicated, what is the best surgical technique for achieving patency? Is there evidence to support a best approach to the patient with the narrow angle? In this chapter, we discuss how evidence-based medicine (EBM) can be used to provide the very best answers to questions such as these. This approach can be applied not only to glaucoma problems, but also to any clinical problem in medicine. © 2010 Springer-Verlag New York.