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Monitoring
Following iridotomy, patients with a residual open angle or a
combination of open angle and some PAS with or without glaucomatous optic
neuropathy should be followed at least yearly. Repeat gonioscopy to determine
interval changes (eg increased extent of PAS, development of secondary angle-closure
from cataract progression and increased lens thickness). Subsequent follow-up
intervals will depend on the clinical findings. Reassess visual function, risk
factors (especially gonioscopic changes and IOP), and quality of life. Reassess
the structure and function of the optic nerve. Assess adherence to the
treatment plan. Revise the management plan, if necessary, and discuss follow-up
plan.
Indications for more frequent surveillance/follow-up are:
- Change in health status
- IOP above target
- Side effect to glaucoma medication
- Disc change
- VF change
- Intervening eye infection (especially for postoperative eyes), surgery, trauma, and iritis
If
PACD diagnosis is in question or is refractory to treatment, the patient should
be referred to an ophthalmologist with special training or experience in
managing this condition.