ophthalmology

HAP Glaucoma Staging (Hodapp-Anderson-Parrish)

HAP (Hodapp-Anderson-Parrish) classification stages glaucoma severity into Early, Moderate or Severe using visual-field mean deviation (MD) on 24-2 SITA-Standard fields. Used to stratify follow-up and treatment intensity.

Used in: Acute Red Eye

Score interpretation

Early glaucoma 1

→ Confirm with repeat field (≥2 reliable). 6-monthly fields and OCT-RNFL. Set an individual target IOP; NICE NG81: offer 360° SLT first-line for newly diagnosed COAG that is not advanced (generic PGA if SLT is declined or unsuitable). Lifestyle counselling, family screening.

Moderate glaucoma 2

→ Lower the target IOP; add a drug from another class or repeat SLT if progressing (NICE NG81). 4-monthly fields. Counsel re: progression risk and surgical options (trabeculectomy, MIGS, tube).

Severe / advanced glaucoma 3

→ Low target IOP. Specialist glaucoma service. NICE NG81: offer glaucoma surgery with MMC augmentation for advanced COAG (interim generic PGA while waiting); glaucoma drainage device if uncontrolled. DVLA notification if visual field loss meets failure criteria. Low-vision rehabilitation; CVI registration if eligible.

Interpretation bands for the HAP. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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