Glaucoma

1–10 of 14 articles Page 1 of 2

All Cornea 36 Cataract 17 Glaucoma 14 Retina & Vitreous 72 Neurophthalmology 8 Oculoplasty 15 Uvea & Inflammatory Diseases 24 Miscellaneous 20 Oncology 9 Pediatric Ophthalmology 16

12 min read

Optic Disc Evaluation in Glaucoma

Glaucoma, by definition, is chronic, progressive optic neuropathy.[1-3] Structural damage to the optic nerve head (ONH) is a characteristic feature of glaucoma and precedes visual field loss in most cases. Para-papillary changes may also be observed in eyes with glaucoma. The mere presence of raised intraocular pressure is not glaucoma. Hence, the optic disc evaluation is the first and most important step in diagnosing glaucoma. [4, 5] Subjectivity and overlap in appearance of the normal and glaucomatous optic disc make ONH evaluation challenging. Subtle changes may also be missed easily. Adequate training and experience are required to determine minor abnormalities in the ONH accurately. [6] Examination of the optic disc Direct ophthalmoscopy, Slit lamp biomicroscopy with a handheld +66, +78 or +90 dioptre aspheric convex lens or Hruby lens, or a contact lens (Goldmann lens) or Indirect ophthalmoscopy may be done to examine the ONH. The pupil should be dilated prior to the examination

Dr. Chandrima Paul · Dr. Divya J
11 min read

i-File: Pigmentary Glaucoma

A 30-year-old male presented to the glaucoma clinic with complaints of gradually progressive diminution of vision in both eyes, left eye more than right, since 5 years. The visual disturbance was not associated with redness, pain, photophobia, or colored haloes. Past Ocular History: He was diagnosed with glaucoma elsewhere 5 years ago and started on anti-glaucoma medications(AGM). His baseline intraocular pressure (IOP) according to the old records was 52 mmHg In both eyes. At the time of his visit to the hospital, he was using 3 AGMs which he had stopped using for the past 7 days. No history of trauma or laser in the past Past Medical history: No history of any systemic illness Family history: No family history of glaucoma Systemic Examination: All vitals and systemic examination was within normal limits Ocular Examination Best Corrected Visual Acuity (Snellens) Right Eye (OD) 6/9 Left Eye (OS) 3/60 Ocular Motility/Alignment Full, free and painless in all gazes Intraocular pressure (I

Dr. K. Sugepriya · Dr. Rathini David
15 min read

Trials in Glaucoma You Should Know

Ocular Hypertension Treatment Study (OHTS) This multicentric trial recruited 1,632 patients of ocular hypertension (OHT) to answer two questions. First, if early treatment in patients of OHT with topical medication would prevent the onset of primary open-angle glaucoma (POAG). Second, which patients of OHT are more likely to develop POAG, in other words, what are the risk factors for conversion from OHT to POAG? The patients who had IOP of at least 24 mmHg in one eye and 21 mmHg in other eye, were recruited in this study. They were randomized into two groups-those who received intraocular pressure (IOP) lowering drops (Medication arm) and those who did not receive any IOP lowering drops (Observation arm). The IOP reduction was targeted at 20% in the medication group. After enrollment, patients were examined every 6-months and follow-up included a white-on-white visual field at every visit and stereoscopic disc photograph annually. The endpoint was the development of new, reproducible d

Dr. Parveen Rewri
4 min read

Ten Tips for Trabeculectomy

1. Counseling: Careful counseling before trabeculectomy regarding complications, possible need for post-operative interventions, and chance of success is most important. Always make it a point to explain that trabeculectomy is surgery for intraocular pressure reduction it will not improve vision, and post-operative chances of vision deterioration for short period of time. The possibility and risks of early and late post operative complications like hypotony, hyphema, serous choroidal detachment bleb failure and late bleb leak should be explained. Explain the possibility of the need for common interventions such as subconjunctival 5 fluorouracil injections, removal of releasable suture , bleb massage and pressure bandage for early leak should be mentioned to patient. Also very important to explain beforehand about need for close follow up post surgery and stress that it is not a permanent solution follow up and monitoring must be lifelong. 2. Preoperative IOP: Control IOP before surgery

Dr. Palak Sakaria · Dr. Ronnie George
14 min read

Primary Angle Closure Glaucoma

Primary Angle Closure Glaucoma is a condition in which elevation of intraocular pressure (IOP) occurs as a result of obstruction of aqueous outflow by partial or complete closure of angle by the peripheral iris. I. Classical Classification: Prodromal Stage Stage of constant instability Acute Congestive Stage Chronic Angle Closure Stage Absolute Stage II. Newer Classification: Recommended by the American Academy of Ophthalmology (AAO) and World Glaucoma Association (WGA). 1. Primary Angle Closure Suspect This includes any eye that has a primary, abnormally narrow angular width of the anterior-chamber-angle recess, wherein the peripheral iris is located close to, yet not touching, the posterior pigmented trabecular meshwork. Patients with primary anatomic narrow anterior-chamber angles are at risk for subsequent primary angle closure (PAC). 2. Primary Angle Closure and Primary Angle-Closure Glaucoma Any eye that has a primary anatomic narrow anterior-chamber angle and evidence such as pe

Dr. Srinivasan Kavitha · Dr. Rengaraj Venkatesh
11 min read

Newer Imaging Technology in Glaucoma

Clinical examination of the disc has been the basis of disc and nerve fibre layer evaluation for ages but it is marred by its subjectivity and non-reproducibility, in the diagnosis and detection of glaucoma. Though visual field changes give concrete and reproducible evidence of glaucomatous changes, it becomes manifest only after considerable damage has occurred to the retinal ganglion cells(RGCs) and the nerve fibre layer(NFL). There are normally 1.2 - 2.4 million nerve fibres and corresponding number of ganglion cells in the retina. Kerrigan-Baumann and Quigley et al 1 documented that a loss of 35.7% of the RGCs was required for the manifestation of corrected pattern standard deviation(CPSD) 90 seconds per eye Figure4: Print out of a normal C20 programme Threshold program (N20 and N30): This program uses more contrast levels to search for the patient's threshold at each of the tested location. N30- horizontal area extended to include an extra portion of the nasal visual field, result

Prof. Sushmita Kaushik · Dr. SS Pandav
28 min read

Medical Management of Glaucoma

Introduction The primary goal in the treatment of glaucoma is to prevent or retard the loss of visual function caused by damage to the optic nerve. Our therapeutic approaches, however, are currently limited to reducing IOP. This approach of lowering a potentially harmful pressure will apply to patients with documented optic nerve damage and visual field loss as well as those with elevated IOP or other well-described risk factors so that treatment is indicated to prevent the onset of damage. We now have five major randomized glaucoma clinical trials stating that intraocular pressure is important for protecting the susceptible optic nerve in patients with glaucoma. Basic Pharmacology Before going into the details of the drugs used in glaucoma, let us have a look at the basic pharmacologic principles in topical ocular treatment. Bioavailability of topical ocular medications: The penetration of topically applied medication into the eye is proportional to the concentration of the drug that

Dr. Rita Singh
17 min read

Evaluation of The Optic Nerve Head in Glaucoma

Introduction The diagnosis of primary open-angle glaucoma is based on the triad of increased intraocular pressure, visual field changes and optic nerve head changes. Apart from the glaucomatous changes in the optic nerve head, the other two factors in isolation lack diagnostic sensitivity. In fact, studies have shown that careful evaluation of the optic nerve head has high specificity and that an experienced observer may be better in distinguishing a normal from a glaucomatous disc as compared to any other technology, like the HRT or OCT.[1-3] IOP can be normal in 50% of patients of glaucoma.[4] Studies by Quigley et al have shown that up to 40% of the axons could be lost before a visual field defect develops on Goldmann perimetry and that 20% of axons are lost before a 5 db loss is detected on standard automated perimetry.[5] So to pick up early or pre-perimetric glaucoma, in the absence of imaging, a sound knowledge of assessment of optic nerve head changes in glaucoma is imperative.

Dr. Sahebaan Sethi
3 min read

Five Things You Should Know About Intracameral Bimatoprost Sustained Release Implant

The Implant Durysta (ALLERGAN) is the first-ever intracameral sustained-release bimatoprost implant. The glaucoma treatment paradigm has shifted towards earlier intervention and targeting the actual pathology. The main problem one faces with glaucoma management is compliance with the medications. The intracameral bimatoprost addresses the problem satisfactorily. Durysta, a 10-microgram bimatoprost implant, becomes the first biodegradable, intracameral sustained release implant indicated to reduce Intraocular pressure (IOP). It is hard for patients to maintain quality of life while being on topical anti-glaucoma medications – The Intracameral Bimatoprost makes it possible. Administration of the Implant Durysta is a rod-like implant preloaded within a sterile applicator with a 28-gauge needle tip. The needle is inserted under an aseptic condition in the anterior chamber and then with the press of a trigger button implant is released. After the implantation, the needle is removed and the

Dr. Tamonash Basu
18 min read

A Postgraduate's Guide To Tonometry

Tonometry is the procedure for the measurement of intraocular pressure. It is the most important risk factor for the development and progression of glaucoma. It is the only factor that can be treated and modified in the management of glaucoma. Therefore, the need for accurate and reproducible measurement of IOP is of utmost importance. Clinical measurement of IOP has undergone several technical advances from the initial digital tension measurements, through indentation tonometry, to applanation tonometry and non-contact tonometry. The current gold standard for the measurement of IOP is the Goldmann applanation tonometer. Tonometer in which the IOP is negligibly raised during measurements, for example less than 5%, are termed low-displacement tonometer. Tonometer that displace a large volume of fluid and consequently raise IOP significantly are termed high-displacement tonometer. Classification and Types of Tonometers are shown in Flowcharts 1 & 2. Classification of Tonometer 1 Classifi

Dr. Vidya Chelerkar · Dr. Mrunall Borrse