Transcript Glaucoma - Nebraska Optometric Association

Diagnosis, Treatment and Management
of Glaucoma
Desinee Drakulich O.D.
 What
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
is Glaucoma?
A progressive optic neuropathy that damages
retinal ganglion cells and other mechanisms in
the visual pathway.
Retinal ganglion cells are very pressure sensitive
and once damaged they do not regenerate.
 Eye
Pressure- most people associate eye
pressure or Intraocular Pressure (IOP) with
glaucoma.
 Normal eye pressure is between 10 mmHg
and 21 mmHg
 Average is between 14 mmHg and 16 mmHg
 Misconception is that the measured value is
the pressure in the eye, it is actually the
difference between the pressure in the eye
and the atmospheric pressure.
 Not all forms of glaucoma have IOPs > 21
mmHg
 Anatomy
of the Eye
 Types
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
of Glaucoma
Primary Open Angle Glaucoma
Angle Closure Glaucoma
Low Tension Glaucoma
Pigmentary Glaucoma
Exfoliative Glaucoma
Acute Glaucoma
Congenital Glaucoma
Secondary Glaucoma

Traumatic Glaucoma
 Most
difficult to diagnose
 Patient have IOPs in the normal range
 Thought to be caused by poor blood flow to
the optic nerve
 New research is answering some questions
 In the past, diagnosis was made with the
appearance of visual field loss.
 With scanning laser technology normal
tension patients are often caught before
visual field damage appears
 The
most common form of glaucoma in
African Americans and Caucasians.
 Approximately 1% of Americans have this
form of glaucoma.
 Most common form in people over the age of
50.
 Defined as increased intraocular pressure
inconsistent with a health optic nerve and
consistent with an open angle of aqueous
drainage.
 Increased
IOP > 21 mmHg
 Thin central corneal thickness > 555 um
 Peripapillary Atrophy
 Notching or thinning of the neuroretinal rim
 Family History
 Large cup to disc ratio
 Affect
about half a million people in the US
 Tends to be inherited
 Affects Asians and hyperopes most frequently
 Anterior chamber smaller than average
 Angle < 45 degrees
 Iris forced up against trabecular meshwork
causes complete closure or an acute
glaucoma attack
 Age can be a factor due to increasing size of
the lens of the eye
 Medication
Drops
 Laser Treatments
 Surgery
 Optometrist
can detect and treatment POAG
in adults with drops.
 If pressure and vision loss can not be
controlled with drop referrals must be made
to Ophthalmology for laser or surgical
consideration.
 Cholinergics
 Beta
Blockers
 Alpha Agonists
 Carbonic Anhydrase Inhibitors
 Prostaglandins
 Older
method of treating glaucoma rarely
used anymore.
 Two major drugs: Pilocarpine and Carbachol
 How do they work?
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They constrict the pupil increasing drainage out
of the trabecular meshwork in the angle of the
eye.
Side effects included decrease vision in dim
lighting and headaches
 Also
an older method of treating Glaucoma
however still commonly used today
 Most commonly used drops are: Timolol,
Betoptic and Betagan.
 How do they work? Decrease the production
of aqueous
 Side effects include decreased heart rate,
decreased pulse, fatigue and shortness of
breath. Caution with people with Asthma or
COPD and people currently taking Beta
Blockers for BP control.
 Newer
method of glaucoma treatment.
 Two different drops available: Iopidine and
Alphagan P
 How to they work? Both decreasing aqueous
production and increasing outflow of
aqueous. Also considered a neuroprotective
agent.
 Side effects include fatigue, headache and
dry mouth.
 Commonly
used for patients who can’t take
Beta Blockers
 Two drops available and one oral medication:
Azopt, Trusopt and Diamox. Optometrists in
NE can’t Rx Diamox.
 How do they work? Decrease the production
of aqueous.
 Side effects include tingling or loss of
strength of the hands and feet, upset
stomach, mental fuzziness, memory
problems, depression, kidney stones, and
frequent urination.
 Relatively
new, good for patient who drop
want to do multiple drops per day.
 Two types of drops: Combigan and Cosept
 Combigan is Alphagan and Timolol.
 Cosept is Trusopt and Timolol
 How to they work? Both increase outflow
and decrease production
 Side effects are the same as the individual
drugs.
 Newest
method of treating glaucoma
considered the DOC of glaucoma medication.
 Three major drops: Xalatan, Lumigan and
Travatan
 How do they work? Increase drainage of the
aqueous via and uveal scleral pathway.
 Side effects include iris pigment change,
redness in eye, stinging and itching.
 Current
studies from the Review of
Optometry March 2009 show that the DOC is
still Xalatan.