Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Mar 17:14:180.
doi: 10.3389/fnins.2020.00180. eCollection 2020.

The Hub-and-Spoke Management of Glaucoma

Raffaele Nuzzi  1 , Paola Marolo  1 , Alessia Nuzzi  2
Affiliations
Review

The Hub-and-Spoke Management of Glaucoma

Raffaele Nuzzi et al. Front Neurosci. .

Abstract

Glaucoma is an extremely significant public health issue, since it is the most common cause of irreversible blindness worldwide, nevertheless it is still widely undiagnosed because of its devious nature. Glaucoma diagnosis criteria are well-defined and have to be strictly observed and recognized: the earlier the disease is diagnosed, the earlier the patient can undergo the most suitable treatment, the better can be the prognosis. The three levels of prevention are essential in the approach to the disease and its pathophysiological features make it eligible for screening. This review provides an overview of the current state of the art in glaucoma management, starting from its prevention and coming to the hub-and-spoke organization. This model applied to glaucoma aims to direct patients toward professional and not professional figures who may guide them in integrated care pathway. This path should be designed in accordance with best practice to coordinate glaucoma prevention, diagnosis, treatment and follow up with the best cost-benefit ratio, protecting both the interests of the patient and of the society.

Keywords: diagnosis; glaucoma; hub-and-spoke; management; network; prevention; screening.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Diagram of glaucoma pathogenesis: the reduced outflow or the excessive production of aqueous humor is frequently associated with IOP elevation, which may generate pathological changes in the optic nerve fibers.
FIGURE 2
FIGURE 2
The Goldmann applanation tonometer: it shall be positioned on the slit lamp.
FIGURE 3
FIGURE 3
IOP measurement using the Goldmann tonometer. Written informed consent was obtained from the individuals for the publication of this image.
FIGURE 4
FIGURE 4
The non-contact air-puff tonometer.
FIGURE 5
FIGURE 5
The execution of pachymetry: the ultrasound probe shall be placed on the corneal apex. Written informed consent was obtained from the individuals for the publication of this image.
FIGURE 6
FIGURE 6
Pachymetry report: this has been obtained by an OCT execution of the anterior segment.
FIGURE 7
FIGURE 7
A visual field examination showing campimetric defects.
FIGURE 8
FIGURE 8
The Advanced Glaucoma Intervention Study (AGIS Investigators, 2000): sustained low IOP gives visual field stabilization over time. The greater is the percentage of examinations with IOP less than 18 mmHg, the smaller is the mean change in visual field defect score over months.
FIGURE 9
FIGURE 9
(A,B) Optical Coherence Tomography (OCT): it evaluates the status of the optic papilla, nerve fibers (RNFL) and ganglion cell layer.
FIGURE 10
FIGURE 10
Glaucoma prevention, where and how: the primary prevention should be mainly a competence of the territorial healthcare, the secondary prevention should be carried out by screening facilities and the third prevention should be operated by the Eye hospital wards and the third level specialized centers. The essential link that unites and connects all these identities shall be the creation of a real-time computer network.
FIGURE 11
FIGURE 11
The “hub and spoke” model of glaucoma management: the hubs correspond to optometrists, pharmacists, pediatricians, general medical practitioners (GMPs), the local ophthalmologist, health workers, screening facilities and hospitals, while the spoke is represented by the national and international glaucoma centers and the Eye University Clinics.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. AGIS Investigators (2000). The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am. J Ophthalmol. 130 429–440. 10.1016/s0002-9394(00)00538-9 - DOI - PubMed
    1. Balendra S. I., Normando E. M., Bloom P. A., Cordeiro M. F. (2015). Advances in retinal ganglion cell imaging. Eye 29 1260–1269. 10.1038/eye.2015.154 - DOI - PMC - PubMed
    1. Bausch+Lomb (2012). Barometer of Global Eye Health: Globally, We Are Losing Sight of Our Eye Health, a New Public Opinion Poll Reveals. Available: https://www.bausch.com/our-company/recent-news/artmid/11336/articleid/28... (accessed August 22, 2019).
    1. Belovay G. W., Goldberg I. (2018). The thick and thin of the central corneal thickness in glaucoma. Eye 32 915–923. 10.1038/s41433-018-0033-3 - DOI - PMC - PubMed
    1. Boles Carenini B. (1990). Il glaucoma come riconoscerlo, come trattarlo, come prevenirlo. Fed. Med. 43:3.