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Glaucoma: Diagnosis and Management

Glaucoma: Diagnosis and Management. 3 million individuals with glaucoma 1 million unaware they have glaucoma 80,000 blind from glaucoma. Introduction. GLAUCOMA: PREVALENCE IN USA. Elderly African-Americans Individuals with Elevated IOP 1st-degree relatives with glaucoma High myopia?

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Glaucoma: Diagnosis and Management

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  1. Glaucoma: Diagnosis and Management

  2. 3 million individuals with glaucoma 1 million unaware they have glaucoma 80,000 blind from glaucoma Introduction GLAUCOMA: PREVALENCE IN USA

  3. Elderly African-Americans Individuals with • Elevated IOP • 1st-degree relatives with glaucoma • High myopia? • Diabetes? Introduction GLAUCOMA: GROUPS AT RISK

  4. Definition: an optic neuropathy with characteristic optic nerve head and nerve fiber layer changes PROGRESSION Introduction GLAUCOMA Ganglion cell death Retinal nerve fiber layer change Optic nerve head changes Visual field changes

  5. Increased size of the cup Thinning of disc rim Progressive loss of neural rim tissue Disc hemorrhages Loss of nerve fibers Introduction GLAUCOMA:OPTIC NERVE HEAD CHANGES

  6. Nasal field loss Paracentral field loss Midperipheral field loss Introduction GLAUCOMA:VISUAL FIELD CHANGES

  7. Introduction POAG: PREVALENCE IN RELATION TO SCREENING IOP

  8. Introduction Reduce avoidable blindness and severe visual impairment.

  9. Primary open-angle (POAG) Angle-closure Congenital Childhood Secondary Types of Glaucoma GLAUCOMA: TYPES

  10. Most common type of glaucoma Bilateral but not always symmetric Characteristic optic nerve and visual field damage Adult onset Open, normal-appearing anterior chamber angles Absence of secondary causes Types of Glaucoma POAG: CHARACTERISTICS

  11. Types of Glaucoma

  12. Types of Glaucoma

  13. Asymptomatic in early stages Often marked visual loss has occurred when patient presents with vision symptoms Can result in blindness Types of Glaucoma POAG: PROGRESSION

  14. Types of Glaucoma

  15. Types of Glaucoma Congenital glaucoma

  16. Includes congenital glaucoma Asymptomatic in early stages Can result in total optic nerve atrophy and blindness Types of Glaucoma CHILDHOOD GLAUCOMA

  17. Trauma Uveitis Chronic steroid use Diabetic retinopathy Ocular vascular occlusion Types of Glaucoma SECONDARY GLAUCOMAS:SOME CAUSES

  18. Primary Open-Angle Glaucoma POAG: PREVALENCE RELATED TO AGE

  19. Primary Open-Angle Glaucoma POAG: PREVALENCE BY AGE, GENDER, AND RACE

  20. Blindness = 3–4 times more common Age >70 = 10% prevalence (2% for Caucasians >70) POAG occurs at earlier age POAG more advanced when discovered Primary Open-Angle Glaucoma POAG RISK FACTOR: AFRICAN-AMERICAN HERITAGE

  21. High IOP correlates poorly with presence of optic nerve damage IOP level is related to POAG prevalence, regardless of race Primary Open-Angle Glaucoma POAG RISK FACTOR: ELEVATED IOP

  22. Primary Open-Angle Glaucoma POAG: EXAMPLES OF GENETIC FACTORS

  23. Primary Open-Angle Glaucoma POAG: OTHER RISK FACTORS

  24. Primary Open-Angle Glaucoma Screening for POAG = IOP measurements + Optic disc evaluation + Visual field testing

  25. Primary Open-Angle Glaucoma RECOMMENDED FREQUENCY OF PERIODIC EYE EXAMINATIONS

  26. Primary Open-Angle Glaucoma RISK FACTOR WEIGHTING

  27. Primary Open-Angle Glaucoma RISK FACTOR ANALYSIS

  28. Normal visual fields; Open, normal-appearing angles + Elevated IOP and/or abnormal optic disc/nerve fiber layer Primary Open-Angle Glaucoma GLAUCOMA SUSPECTS

  29. Primary Open-Angle Glaucoma Pattern of retinal nerve fibers

  30. Primary Open-Angle Glaucoma Lamina cribrosa

  31. Primary Open-Angle Glaucoma C:D ratio = 0.3

  32. Primary Open-Angle Glaucoma Healthy neuroretinal rim

  33. Primary Open-Angle Glaucoma Thinning neuroretinal rim, elongated cup

  34. Primary Open-Angle Glaucoma Groove or wedge defect in nerve fiber layer

  35. Primary Open-Angle Glaucoma Healthy, symmetric optic nerves

  36. Primary Open-Angle Glaucoma C:D ratio = 0.9 C:D ratio = 0.7

  37. Primary Open-Angle Glaucoma Extensive glaucomatous damage

  38. Primary Open-Angle Glaucoma Flame-shaped disc hemorrhage

  39. PROGRESSIVE NEURAL TISSUE LOSS Year 1 Year 12 Primary Open-Angle Glaucoma

  40. Primary Open-Angle Glaucoma Evaluating optic disc

  41. Primary Open-Angle Glaucoma Record optic disc appearance in patient’s chart.

  42. Primary Open-Angle Glaucoma OPTICAL NERVE IMAGING: EXAMPLES OF NEW TECHNOLOGIES Scanning laser polarimetry Optical coherence tomography Confocal scanning laser ophthalmoscopy

  43. Primary Open-Angle Glaucoma Normal visual field

  44. Primary Open-Angle Glaucoma Nasal visual field and midperipheral vision loss

  45. Primary Open-Angle Glaucoma Automated perimetry

  46. Primary Open-Angle Glaucoma Visual field test results over time: progressive scotoma

  47. Primary Open-Angle Glaucoma Pattern electroretinogram

  48. Halt further visual loss Halt further optic nerve damage Treatment of POAG POAG: GOAL OF TREATMENT

  49. Glaucoma medications decrease intraocular pressure by decreasing aqueous productionorincreasing outflow. Treatment of POAG

  50. Treatment of POAG Topical beta-adrenergic antagonists

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