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 Chronic angle-closure – Angle-closure glaucoma • Congenital glaucoma Siderosis • Secondary glaucoma 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) Acute Symptoms iridocyclitis Acute ACG conjunctivitis Slow Vision decrease Toboggan normal comparatively usually Ophthalmalgia Pain position located in slight or not and migraine ocular area Be often Nausea and No accompanied No vomit with Secretion No No A great deal Acute signs iridocyclitis Acute ACG conjunctivitis Congestio Ciliary or mixed Ciliary or mixed Conjunctival n Cornea clarity opaque clarity KP offwhite pigmentary No Anterior Not shallow shallow Not shallow chamber Aqueous Flare and Flare and cells Normal humor exudation Unclear furrow Segmental Iris Normal nodule atrophy of iris Dilate, vertical Pupil Shrink, irregular Normal oval shape Intraocular Normal or low IOP High IOP Normal pressure Thanks!