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Glaucoma – The Silent Thief of Sight

Glaucoma – The Silent Thief of Sight. Prof. S. Melamed Director, The Sam Rothberg Glaucoma Center, Sheba Hospital, Tel Hashomer Tel Aviv University. Definition of Glaucoma. Optic Nerve Disease with typical nerve damage and visual field loss ** Elevated IOP is a causative risk factor.

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Glaucoma – The Silent Thief of Sight

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  1. Glaucoma – The Silent Thief of Sight Prof. S. Melamed Director, The Sam Rothberg Glaucoma Center, Sheba Hospital, Tel Hashomer Tel Aviv University

  2. Definition of Glaucoma Optic Nerve Disease with typical nerve damage and visual field loss ** Elevated IOP is a causative risk factor

  3. Glaucoma and Blindness * Still reason # 2 for Blindness in the developed world !! * Reason # 1 for Blindness in most 3rd world countries !!

  4. Eye Anatomy • The optic nerve is a bundle of nerve fibers • It carries visual information from the retina to the brain

  5. Fluid Circulation • The eye has an internal fluid circulation system • Fluid is produced at the base of the iris

  6. Fluid Circulation • The fluid flows through the pupil to the front of the iris

  7. Irido-Corneal Angle

  8. CB-TM-SC Relationship Scleral Spur

  9. Inner Wall of SC

  10. “Self Cleaning Filter” Trabecular Cells Are: Phagocytic Secrete Proteo-Glycans Are constantly moving Retain Conductivity of TM Remove blocking Particles

  11. Normal Glaucoma

  12. End- Stage Glaucoma

  13. In Glaucoma Due to Obstruction/Malfunction of Drainage * IOP is Elevated * It causes damage to Optic Nerve and Visual Field

  14. Normal Visual Field Healthy Optic Nerve Damaged Visual Field Sick Optic nerve Elevated IOP

  15. In the Normal Population * IOP is 12-20 mm Hg * 8% have elevated IOP – “OHT” * The OHT group has more chances for conversion to Glaucoma

  16. Risk Factors for Conversion to Glaucoma *Family History of Glaucoma *Thin Corneas *Myopia *Black race *Vaso-occlusive diseases

  17. What do we recommend * With risk factors OHT patients should be treated * All people above age of 40 should be checked regularly, every year, by an eye doctor * People with family history of glaucoma should be checked earlier

  18. Why do we call Glaucoma “The Silent Thief of Sight”?? * Because high IOP causes a gradual damage to nerve and visual field WITHOUT pain, discomfort or loss of Central Vision * The Damage is IRREVERSIBLE and can cause BLINDNESS * So, there are no “alarming signs” in most cases, and many people are diagnosed too late

  19. Symptoms of Primary OpenAngle Glaucoma • POAG develops gradually and painlessly and has no initial symptoms Vision is normal in the early stages

  20. Symptoms of Primary OpenAngle Glaucoma • If untreated, peripheral or side vision is slowly lost Tunnel vision

  21. Symptoms of Primary OpenAngle Glaucoma • Eventually, all vision may be lost

  22. Glaucoma Tests:Slit Lamp & Gonioscopy • A special microscope called a slit lamp is used to examine the structures of the eye • A gonioscopy lens may be used to view the drainage angle

  23. Glaucoma Tests:Ophthalmoscopy • Eye drops may be placed in the eyes to dilate the pupils • Special magnifying lenses are used to examine the retina and optic nerve for damage Normal Optic Nerve Suspicious Optic Nerve

  24. Glaucoma Tests:Ophthalmoscopy • Advances are being made in digital imaging of the retina

  25. Glaucoma Tests:Tonometry • Eye pressure is measured with an instrument called a tonometer • Three types that are commonly used are: • Goldmann (Perkins) • Non-contact (air puff)

  26. Glaucoma Tests:Visual Field Test • Peripheral (side) vision is tested with a perimeter The patient responds to flashes of light in different locations

  27. Recent Developments • Recent studies have found that patients with thin corneas have a greater risk of developing glaucoma • Measurement of corneal thickness using an instrument called a pachymeter will become increasingly important

  28. Recent Developments • Laser technology can now be used to image the retina and optic nerve and measure nerve fiber layer thickness

  29. End Stage Glaucoma – Severely damaged nerve with Tubular vision

  30. So, How can we treat Glaucoma when Diagnosis is made?? Treatment is aimed at lowering IOP to Normal Level * A variety of drugs (drops, pills) * Laser Treatment – Safe and Easy * Surgery – Filters, Valves, Shunts

  31. Glaucoma Medications • Medications are usually the first type of treatment used • Eyedrops or pills are used to either decrease the fluid production or to increase the fluid drainage

  32. What is new in Glaucoma Therapy? * New medications * New laser Treatments (SLT – The “Homeopatic Laser”) * New surgical methods – Drainage implants, Gold Shunts

  33. SLT-New Laser Treatment Spot size comparison: 50µm ALT SLT ALT SLT 6Latina MA, Tumbocon JA. Selective Laser Trabeculoplasty: The Evolution of Laser Treatment for Open Angle Glaucoma

  34. SLT * The easiest and Safest Laser * Very efficient in lowering IOP * 5 minutes procedure in office * No pain, No complications * Now offered as a primary treatment before Drugs

  35. When Laser and Medications fail or non-sufficient.. Glaucoma Surgery is recommended.. *Trabeculectomy *Drainage Devices *Gold Shunt

  36. Gold Shunt

  37. A Miniature Shunt

  38. Gold Shunt Implantation

  39. Gold Shunt

  40. Early Detection and Treatment • Regular eye health examinations are important to detect glaucoma early so that treatment can be started and vision loss can be prevented

  41. Thank You

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