Statement of Principles

concerning

ANGLE-CLOSURE GLAUCOMA
(Reasonable Hypothesis)

(No. 5 of 2021)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated                                           24 December 2020

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1               Name

This is the Statement of Principles concerning angle-closure glaucoma (Reasonable Hypothesis) (No. 5 of 2021).

2               Commencement

              This instrument commences on 25 January 2021.

3               Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

4               Repeal

The Statement of Principles concerning angle-closure glaucoma No. 25 of 2012 (Federal Register of Legislation No. F2012L00470) made under subsections 196B(2) and (8) of the VEA is repealed.

5               Application

This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.

6               Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

7               Kind of injury, disease or death to which this Statement of Principles relates

(1)          This Statement of Principles is about angle-closure glaucoma and death from angle-closure glaucoma.

Meaning of angle-closure glaucoma

(2)          For the purposes of this Statement of Principles, angle-closure glaucoma means acquired closure of the anterior chamber angle of the eye, leading to reduction in aqueous outflow and elevation of intraocular pressure, and with associated ocular symptoms and signs.

Note 1: Angle-closure glaucoma can be acute, subacute or chronic.

Note 2: Typical symptoms and signs of acute angle-closure glaucoma are rapid onset of severe eye pain, nausea or vomiting, corneal oedema and poor visual acuity.

Note 3: Chronic angle-closure glaucoma causes a progressive neuropathy involving characteristic optic disc abnormalities and visual field defects.

(3)          While angle-closure glaucoma attracts ICD‑10‑AM code H40, in applying this Statement of Principles the meaning of angle-closure glaucoma is that given in subsection (2).

(4)          For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Death from angle-closure glaucoma

(5)          For the purposes of this Statement of Principles, 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.

Note: terminal event is defined in the Schedule 1 - Dictionary.

8               Basis for determining the factors

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 under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.

9               Factors that must exist

At least one of the following factors 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:

(1)          taking a drug from the specified list of drugs within the 21 days before the clinical onset of angle-closure glaucoma;

Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

(2)          taking a drug which causes:

(a)           mydriasis or miosis in the affected eye; or

(b)          an allergic or inflammatory reaction involving structures of the anterior segment of the affected eye;

within the 21 days before the clinical onset of angle-closure glaucoma;

(3)          having uveitis, scleritis or episcleritis at the time of the clinical onset of angle-closure glaucoma, where the disease involves the structures of the anterior chamber of the affected eye;

Note: uveitis, scleritis and episcleritis are defined in the Schedule 1 - Dictionary.

(4)          having:

(a)          a benign or malignant neoplasm; or

(b)          a non-neoplastic lesion;

which involves the anterior segment of the affected eye at the time of the clinical onset of angle-closure glaucoma;

Note 1: Examples of a benign or malignant neoplasm include melanoma, retinoblastoma, leukaemia and lymphoma.

Note 2: Examples of a non-neoplastic lesion include amyloidosis, cyst, ocular haemorrhage, retinal detachment and vascular malformation or thrombosis.

(5)          having a disorder of the lens of the affected eye at the time of the clinical onset of angle-closure glaucoma;

Note: Examples of a disorder of the lens include cataract and lens displacement, subluxation or dislocation.

(6)          having growth of new blood vessels (neovascularisation) of the iridocorneal angle due to a condition or procedure involving the affected eye from the specified list of conditions or procedures, before the clinical onset of angle-closure glaucoma;

Note: specified list of conditions or procedures is defined in the Schedule 1 - Dictionary.

(7)          having trauma to the affected eye before the clinical onset of
angle-closure glaucoma;

Note: trauma is defined in the Schedule 1 - Dictionary.

(8)          having sympathetic ophthalmia at the time of the clinical onset of angle-closure glaucoma;

Note: sympathetic ophthalmia is defined in the Schedule 1 - Dictionary.

(9)          having surgery to the affected eye, or eyelid of the affected eye, before the clinical onset of angle-closure glaucoma;

(10)      having surgery requiring a general anaesthetic, or surgery in the prone position, within the 21 days before the clinical onset of angle-closure glaucoma;

(11)      undergoing a course of therapeutic radiation for cancer, where the affected eye was in the field of radiation, before the clinical onset of angle-closure glaucoma;

(12)      taking a drug from the specified list of drugs within the 21 days before the clinical worsening of angle-closure glaucoma;

Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

(13)      taking a drug which causes:

(a)           mydriasis or miosis in the affected eye; or

(b)          an allergic or inflammatory reaction involving structures of the anterior segment of the affected eye;

within the 21 days before the clinical worsening of angle-closure glaucoma;

(14)      having uveitis, scleritis or episcleritis at the time of the clinical worsening of angle-closure glaucoma, where the disease involves the structures of the anterior chamber of the affected eye;

Note: uveitis, scleritis and episcleritis are defined in the Schedule 1 - Dictionary.

(15)      having:

(a)          a benign or malignant neoplasm; or

(b)          a non-neoplastic lesion;

which involves the anterior segment of the affected eye at the time of the clinical worsening of angle-closure glaucoma;

Note 1: Examples of a benign or malignant neoplasm include melanoma, retinoblastoma, leukaemia and lymphoma.

Note 2: Examples of a non-neoplastic lesion include amyloidosis, cyst, ocular haemorrhage, retinal detachment and vascular malformation or thrombosis.

(16)      having a disorder of the lens of the affected eye at the time of the clinical worsening of angle-closure glaucoma;

Note: Examples of a disorder of the lens include cataract and lens displacement, subluxation or dislocation.

(17)      having growth of new blood vessels (neovascularisation) of the iridocorneal angle due to a condition or procedure involving the affected eye from the specified list of conditions or procedures, before the clinical worsening of angle-closure glaucoma;

Note: specified list of conditions or procedures is defined in the Schedule 1 - Dictionary.

(18)      having trauma to the affected eye before the clinical worsening of angle-closure glaucoma;

Note: trauma is defined in the Schedule 1 - Dictionary.

(19)      having sympathetic ophthalmia at the time of the clinical worsening of angle-closure glaucoma;

Note: sympathetic ophthalmia is defined in the Schedule 1 - Dictionary.

(20)      having surgery to the affected eye, or eyelid of the affected eye, before the clinical worsening of angle-closure glaucoma;

(21)      having surgery requiring a general anaesthetic, or surgery in the prone position, within the 21 days before the clinical worsening of
angle-closure glaucoma;

(22)      undergoing a course of therapeutic radiation for cancer, where the affected eye was in the field of radiation, before the clinical worsening of angle-closure glaucoma;

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

10           Relationship to service

(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2)          The factors set out in subsections 9(12) to 9(23) apply 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 did not arise out of) the person's relevant service.

11           Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1)          if a factor referred to in section 9 applies in relation to a person; and

(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                               angle-closure glaucoma—see subsection 7(2).

                               episcleritis means acute or chronic inflammation of the superficial, episcleral layer of the eye ball.

                                MRCA means the Military Rehabilitation and Compensation Act 2004.

                               relevant service means:

(a)          operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)          warlike service under the MRCA; or

(f)           non-warlike service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                               scleritis means acute or chronic inflammation that affects the white outer coating of the eye ball.

                               specified list of conditions or procedures means:

(a)          carotid artery disease;

(b)          carotid endarterectomy;

(c)          diabetic retinopathy;

(d)          intraocular surgery;

(e)          intraocular tumour;

(f)           radiotherapy;

(g)          retinal detachment;

(h)          retinal vascular occlusion;

(i)            retinal vasculitis; or

(j)            another acquired condition causing posterior segment ischaemia.

                               specified list of drugs means:

(a)          alpha-adrenoceptor agonists;

(b)          amphetamines; 

(c)          anticholinergics; 

(d)          anticoagulants; 

(e)          antihistamines; 

(f)           benzodiazepines;

(g)          botulinum toxin; 

(h)          cabergoline;

(i)            candesartan;

(j)            cholinergic agents; 

(k)          daratumumab;

(l)            furosemide;

(m)        general anaesthetic;

(n)          intranasal or intraocular cocaine;

(o)          intravitreal injection;

(p)          isotretinoin;

(q)          monoamine oxidase inhibitors; 

(r)           phenothiazine antipsychotics; 

(s)           pilocarpine; 

(t)            selective serotonin reuptake inhibitors; 

(u)          serotonin noradrenaline reuptake inhibitors;

(v)          sulfa containing drugs;

(w)        sumatriptan;

(x)          tetracyclic antidepressants;

(y)          tetracycline; and

(z)          tricyclic antidepressants.

                               sympathetic ophthalmia means the presence of uveitis in both eyes following:

(a)          intraocular surgery to one eye; or

(b)          trauma to one eye.

Note: uveitis is also defined in the Schedule 1 - Dictionary.

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

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                               trauma means:

(a)           blunt or penetrating physical injury; or

(b)           chemical, thermal or radiation injury;

                               that results in intraocular inflammation, intraocular bleeding or other intraocular tissue disruption.

                               uveitis means acute or chronic inflammation of the vascular middle coat of the eye ball, comprising the iris, ciliary body and choroid. This definition includes choroidal effusion.

                               VEA means the Veterans' Entitlements Act 1986.