Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Risk Management and Quality Assurance in Glaucoma Patients

Wiederholt M.
Charité-Universitätsmedizin Berlin,Campus Benjamin Franklin, Institut für Klinische Physiologie, Freie Universität Berlin und Humboldt-Universität zu Berlin

Target of the risk management is to deepen and quantify the knowledge about progression factors in patients with primary open angle glaucoma (POAG) as well as to perform a quality monitoring. A computerized documentation was performed for each patient and the data were transmitted for central data analysis either online via Internet or offline via floppy disc. Data security was guaranteed by a 128-bit-coding with patient ID from 2 lines. The following values were recorded: stages of optic disc and visual field, cup to disc ratio, IOP, IOP differences (24 hours), vascular risk factors, progression of glaucoma, blood pressure (systolic, diastolic, nocturnal dip). 336 ophthalmologists participated with 4,980 patients (6,958 eyes). The analysis of the data after one year revealed as outstanding result a V-shaped dependence of the progression of the stage of the optic disc, cup-disc-ratio and of stage of visual field on ocular perfusion pressure. This means that the considerable increase of perfusion pressure (due to increase of blood pressure and/or considerable decrease of IOP?) can just as well lead to a progression alike the decrease of the perfusion pressure (due to increase of IOP and/or blood pressure decrease). In order to reach the optimum range of perfusion pressure for glaucoma patients, IOP and possibly blood pressure have to be normalized. In at least 45% of

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