Glaucoma

Treatment of Glaucoma

Glaucoma Glaucoma is characterized by high IOP associated with optic disk cupping and visual field loss

Normal outflow through trabecular meshwork (large arrow) and uveoscleral routes (small arrow) and related anatomy.

In primary open-angle glaucoma, aqueous outflow by these pathways is diminished.

In angle-closure glaucoma, the iris is abnormally positioned so as to block aqueous outflow through the anterior chamber (iridocorneal) angle.

Normal optic disc. Note the distinct optic disc margins, the well-demarcated cup, and the healthy pink color of the neuroretinal rim. The cup-to-disc ratio of this optic nerve is 0.6. Clinical correlation with the patient's history and examination is required to decide if this optic nerve is abnormal. Glaucomatous optic nerve cupping. The cup in this optic nerve is enlarged to 0.8, and there is typical thinning of the inferior neuroretinal rim, forming a "notch."

Visual Field Impairment (A)normal (B)loss of visual field in the superior and nasal portion (C)visual field loss extends to superior and inferior portions (D)Finally,extensive damage to the entire visual field occurs, sparing the very central portion of vision.

Glaucoma classified according to etiology • Primary glaucoma – Open-angle glaucoma – Angle-closure glaucoma

• Congenital glaucoma • Secondary glaucoma

Chronic angle-closure

Siderosis

Trauma

Neovascular glaucoma Open-angle, trabecular abnormality

Treatment Goal The goal of glaucoma treatment is to preserve the visual field of patients and prevent the loss of visual function that is associated with the disease.” Ref: Survey of Ophthalmology; 2003 Vol. 48(1): S1-S3

THE FIRST TARGET ACHIEVING A LOW TARGET IOP WHICH IS UNIFORM DAY AND NIGHT

Target IOP: Definition Target IOP may be defined as a pressure, rather a range of intraocular pressure levels within which the progression of glaucoma and visual field loss will be delayed or stoped 　　　　　　　　　 Ref: Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57

The treatment options of glaucoma includes: • Drugs • Laser • Operation The treatment is decided by many factors: – Type of glaucoma – Stage of glaucoma – Damage done – Status of the other eye – Response to other treatment already taken – Patient compliance or reliability about taking drugs and follow up examination

Operation -Trabeculectomy

THE SECOND TARGET: VASOPROTECTION/ NEUROPROTECTION

GLAUCOMA: OPTIC NERVE DAMAGE Rise in IOP Mechanical back pressure On the junction of optic nerve/retina Reduce the blood supply to the optic nerve Loss of blood supply RGC loss

THE THIRD TARGET PERSISTENCY/ COMPLIANCE WITH DRUG THERAPY IN GLAUCOMA MANAGEMENT

Glaucoma Therapy: Persistency Pharmacologic therapy for glaucoma can be effective only if patients fill their prescriptions (persistency) and take their medications as directed (compliance) Ref: Am. J. Ophthalmol 2004; 137: S3-S12

So • Let your patients have good compliance – Tell him what is glaucoma – How to cooperate with doctor – Check your treatment

Differential diagnosis • Acute conjunctivitis • Acute angle-closure glaucoma (acute ACG)

Symptoms

iridocyclitis

Acute ACG

Acute conjunctivitis

Vision

Slow decrease comparatively

Toboggan

normal

Pain position

usually located in ocular area

Ophthalmalgia slight or not and migraine

Nausea and vomit

No

Be often accompanied with

Secretion

No

No

No

A great deal

signs

iridocyclitis

Acute ACG

Acute conjunctivitis

Congestio n

Ciliary or mixed

Ciliary or mixed

Conjunctival

Cornea

clarity

opaque

clarity

KP

offwhite

pigmentary

No

Anterior chamber

Not shallow

shallow

Not shallow

Aqueous humor

Flare and cells

Flare and exudation

Normal

Iris

Unclear furrow nodule

Segmental atrophy of iris

Normal

Pupil

Shrink, irregular

Dilate, vertical oval shape

Normal

Intraocular pressure

Normal or low IOP

High IOP

Normal

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