Statement of Principles

concerning

OPEN-ANGLE GLAUCOMA

Instrument No. 69 of 2001 as amended

made under section 196B(2) of the

This compilation was prepared on 15 May 2006 taking into account Amendment of Statement of Principles concerning OPEN-ANGLE GLAUCOMA (Instrument No. 23 of 2006)

Prepared by the Repatriation Medical Authority Secretariat, Brisbane.

Revocation and Determination

of

Statement of Principles

concerning

OPEN-ANGLE GLAUCOMA

ICD-10-AM CODES: H40.1, H40.3-H40.8, H42

Veterans’ Entitlements Act 1986

1.         The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):

(a)       revokes Instrument No.13 of 1999; and

(b)       determines in its place the following Statement of Principles.

Kind of injury, disease or death

2.         (a)       This Statement of Principles is about open-angle glaucoma and death from open-angle glaucoma.

(b)       For the purposes of this Statement of Principles, “open-angle glaucoma”, means glaucoma associated with an open iridocorneal angle, and includes both primary and secondary forms, attracting ICD-10-AM code H40.1, H 40.3-H40.8 or H42.  This definition excludes congenital glaucomas.

Basis for determining the factors

3.         The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that open-angle glaucoma and death from open-angle glaucoma can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.

Factors that must be related to service

4.         Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.

Factors

5.         The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting open-angle glaucoma or death from open-angle glaucoma with the circumstances of a person’s relevant service are:

(a)       suffering from exfoliation syndrome involving the affected eye at the time of the clinical onset of open-angle glaucoma; or

(b)       suffering from iridocorneal endothelial syndrome involving the affected eye at the time of the clinical onset of open-angle glaucoma; or

(c)       suffering from uveitis of the affected eye before the clinical onset of open-angle glaucoma; or

(d)              suffering significant trauma to the affected eye before the clinical onset of open-angle glaucoma; or

(e)              undergoing a course of therapeutic radiation to the region of the affected eye before the clinical onset of open-angle glaucoma; or

(f)               having undergone penetrating keratoplasty or other intraocular surgery of the affected eye before the clinical onset of open-angle glaucoma; or

(g)             undergoing corticosteroid therapy as specified where such therapy or part of such therapy has been received within the 12 months before the clinical onset of open-angle glaucoma; or

(h)               suffering from endogenous hypercortisolism within the 12 months before the clinical onset of open-angle glaucoma; or

(j)               suffering from a neoplasm which is either invading or shedding cells into the anterior chamber of the affected eye at the time of the clinical onset of open-angle glaucoma; or

(k)             suffering from Graves’ disease at the time of the clinical onset of open-angle glaucoma; or

(m)            suffering from hypothyroidism at the time of the clinical onset of open-angle glaucoma; or

(n)             suffering from ipsilateral elevated episcleral venous pressure at the time of the clinical onset of open-angle glaucoma; or

(o)             suffering from rhegmatogenous retinal detachment of the affected eye at the time of the clinical onset of open-angle glaucoma; or

(p)       for neovascular glaucoma only, suffering from a condition which may give rise to neovascularisation of the iridocorneal angle of the affected eye before the clinical onset of open-angle glaucoma; or

(q)       for phacolytic glaucoma only, suffering from cataract of the affected eye at the time of the clinical onset of open-angle glaucoma; or

(r)               for ghost cell glaucoma only, suffering vitreal haemorrhage, hyphema or intraocular surgery involving the affected eye before the clinical onset of open-angle glaucoma; or

(s)       for pigmentary glaucoma only, suffering from pigment dispersion syndrome involving the affected eye before the clinical onset of open-angle glaucoma; or

(t)                inability to obtain appropriate clinical management for open-angle glaucoma.

Factors that apply only to material contribution or aggravation

6.         Paragraph 5(t) applies only to material contribution to, or aggravation of, open-angle glaucoma where the person’s open-angle glaucoma was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.

Inclusion of Statements of Principles

7.         In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.

Other definitions

8.      For the purposes of this Statement of Principles:

“a condition which may give rise to neovascularisation of the iridocorneal angle” means one of the conditions set out below:

(a)         central retinal vein obstruction of the affected eye;

(b)         diabetic retinopathy of the affected eye;

(c)         ipsilateral carotid artery occlusive disease;

(d)         retinal detachment of the affected eye;

(e)         intraocular tumour of the affected eye;

(f)          central retinal artery obstruction of the affected eye; or

(g)         radiotherapy involving the affected eye;

“a course of therapeutic radiation” means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;

“death from open-angle glaucoma” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s open-angle glaucoma;

“endogenous hypercortisolism” means excessive production of cortisol within the body;

“exfoliation syndrome” means a syndrome associated with the presence of extensive exfoliation material in the anterior chamber of the eye;

“ghost cell glaucoma” means an open-angle glaucoma resulting from obstruction to aqueous outflow from degenerated red blood cells devoid of haemoglobin (ghost cells) in the aqueous;

“Graves’ disease” means an autoimmune disorder of the thyroid usually associated with hyperthyroidism, goitre and exophthalmus;

“hyphema” means haemorrhage within the anterior chamber of the eye;

“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3;

“iridocorneal endothelial syndrome” means a syndrome in which there is characteristic abnormality of the corneal endothelium;

“neovascular glaucoma” means glaucoma resulting from neovascularisation of the iridocorneal angle;

“penetrating keratoplasty” means a surgical procedure in which the entire thickness of the cornea is removed and replaced by donor tissue;

“phacolytic glaucoma” means an open-angle glaucoma secondary to leakage of lens protein into the aqueous from a cataract;

“pigmentary glaucoma” means a form of open-angle glaucoma with evidence of pigment dispersion syndrome and a raised intraocular pressure over 21 mmHg;

“pigment dispersion syndrome’ means a syndrome characterised by pigment darkening (dark brown to black) of the trabecular meshwork in association with radial, peripheral iris transillumination defects; where iris defects are not visible, increased pigmentation of the corneal endothelium and pigment deposition on the posterior, peripheral lens surface are present;

“relevant service” means:

(a)       operational service; or

(b)       peacekeeping service; or

(c)       hazardous service;

“rhegmatogenous retinal detachment” means retinal detachment associated with a retinal tear;

“significant trauma to the affected eye” means penetrating, blunt, chemical or radiation injury involving the affected eye that results in intraocular inflammation, intraocular bleeding or other intraocular tissue disruption;

“terminal event” means the proximate or ultimate cause of death and includes:

(a)        pneumonia;

(b)       respiratory failure;

(c)        cardiac arrest;

(d)       circulatory failure; or

(e)              cessation of brain function;

“undergoing corticosteroid therapy as specified” means:

(a)              applying corticosteroid containing eye preparations topically to the affected eye on more days than not for a period of at least 6 months;

(b)             applying corticosteroid containing dermal preparations to the skin around the eyes on more days than not for a period of at least 12 months;

(c)             taking oral corticosteroids on more days than not for a period of at least 12 months;

(d)             inhaling corticosteroids (including nasal sprays) on more days than not for a period of at least 12 months;

(e)             having at least five corticosteroid injections within 12 months;

(f)              having a subconjunctival repository steroid injection in the affected eye;

(g)             having an ipsilateral orbital/periocular corticosteroid injection; or

(h)             using dermal corticosteroid preparations on more days than not for a period of at least five years;

“uveitis” means inflammation of the vascular middle coat of the eye ball, comprising the iris, ciliary body and choroid.

Application

9.         This instrument applies to all matters to which section 120A of the Act applies.

Notes to Statement of Principles concerning open-angle glaucoma (Instrument No. 69 of 2001)

The Statement of Principles concerning open-angle glaucoma (Instrument No. 69 of 2001) in force under section 196B(2) of the Veterans’ Entitlements Act 1986, as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Table of Amendments