Statement of Principles

concerning

ANGLE-CLOSURE GLAUCOMA

Instrument No. 15 of 1999 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 ANGLE-CLOSURE GLAUCOMA (Instrument No. 25 of 2006)

Prepared by the Repatriation Medical Authority Secretariat, Brisbane.

Revocation and Determination

of

Statement of Principles

concerning

ANGLE-CLOSURE GLAUCOMA

ICD-9-CM CODES: 365.2, 365.59, 365.61-365.65

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.243 of 1995; 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 angle-closure glaucoma and death from angle-closure glaucoma.

(b)       For the purposes of this Statement of Principles, “angle-closure glaucoma”, means glaucoma associated with closure of the iridocorneal angle, and includes both primary and secondary forms, attracting ICD-9-CM codes 365.2, 365.59, or in the range of 365.61-365.65.  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 angle-closure glaucoma and death from angle-closure 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 angle-closure glaucoma or death from angle-closure glaucoma with the circumstances of a person’s relevant service are:

(a)       for acute angle-closure glaucoma only, undergoing treatment with a drug that can cause mydriasis or miosis or a drug reported to have caused acute angle-closure glaucoma, where that treatment has occurred within the 24 hours before the clinical onset of angle-closure glaucoma; or

(b)       suffering from occlusion of the iridocorneal angle of the affected eye by a tumour or a cyst of the surrounding structures or from iridoschisis at the time of the clinical onset of angle-closure glaucoma; or

(c)       suffering from cataract of the affected eye at the time of the clinical onset of angle-closure glaucoma; or

(d)       suffering from anterior subluxation or dislocation of the lens of the affected eye at the time of the clinical onset of angle-closure glaucoma; or

(e)       suffering from iridocorneal endothelial syndrome, posterior polymorphous dystrophy (PPD) or Fuch’s endothelial dystrophy of the affected eye at the time of the clinical onset of angle-closure glaucoma; or

(f)        for neovascular glaucoma only, suffering from a condition giving rise to neovascularisation of the iridocorneal angle of the affected eye before the clinical onset of angle-closure glaucoma; or

(g)       suffering from an intraocular lesion of the affected eye at the time of the clinical onset of angle-closure glaucoma; or

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

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

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

(m)      inability to obtain appropriate clinical management for angle-closure glaucoma.

Factors that apply only to material contribution or aggravation

6.         Paragraph 5(m) applies only to material contribution to, or aggravation of, angle-closure glaucoma where the person’s angle-closure 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:

1.      central retinal vein obstruction of the affected eye

2.      diabetic retinopathy of the affected eye

3.      ipsilateral carotid artery occlusive disease

4.      retinal detachment of the affected eye

5.      intraocular tumour of the affected eye

6.      central retinal artery obstruction of the affected eye

7.      radiotherapy involving the affected eye;

“acute angle-closure glaucoma” means angle-closure glaucoma associated with excruciating eye pain, high intraocular pressure, corneal oedema and poor visual acuity.

“a drug reported to have caused acute angle-closure glaucoma” means a drug reported to have caused acute angle-closure glaucoma in the published peer-reviewed medical literature;

“a drug that can cause mydriasis or miosis” means a drug that can cause pupillary dilation or constriction such as atropine, salbutamol, trihexyphenidyl or scopolamine;

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

“Fuch’s endothelial dystrophy” means a disorder of the corneal endothelium also known as cornea guttata, in which there is deposition of collagen on the posterior surface of Descemet’s membrane;

“ICD-9-CM code” means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1996, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 24447 2;

“intraocular lesion” means benign or malignant tumour, cyst or choroidal effusion arising within the anterior or posterior segment of the eye;

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

“iridoschisis” means a separation of the anterior and posterior iris layers;

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

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

“posterior polymorphous dystrophy” means a form of corneal endothelial disorder;

“relevant service” means:

(a)       operational service; or

(b)       peacekeeping service; or

(c)       hazardous service;

“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;

“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 angle-closure glaucoma (Instrument No. 15 of 1999)

The Statement of Principles concerning angle-closure glaucoma (Instrument No. 15 of 1999) 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