Glaucoma Final

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Glaucoma “a silent thief of sight":

Glaucoma “a silent thief of sight" Presented By:- Vijay S Singh

Normal Eye Function:

Normal Eye Function


Glaucoma Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve. This nerve carries visual information from the eye to the brain. In most cases, damage to the optic nerve is due to increased pressure (normal IOP is 15.5 mmHg) in the eye, also known as intraocular pressure (IOP).

Types of Glaucoma:

Types of Glaucoma There are four major types of glaucoma: Open-angle (chronic) glaucoma Primary Chronic open angle glaucoma. Normal Tension or low tension glaucoma. Congenital (infantile) glaucoma. Pigmentary glaucoma. Exfoliative glaucoma Secondary open angle glaucoma. Angle-closure (acute) glaucoma

Primary Open Angle Glaucoma:

Primary Open Angle Glaucoma Open-angle (chronic) glaucoma is the most common type of glaucoma. The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve. Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease . Symptoms Most people have no symptoms Once vision loss occurs, the damage is already severe There is a slow loss of side (peripheral) vision (also called tunnel vision) Advanced glaucoma can lead to blindness

Open Angle Glaucoma.:

Open Angle Glaucoma.

Normal tension (pressure) glaucoma or low tension glaucoma:

Normal tension (pressure) glaucoma or low tension glaucoma This type of glaucoma is thought to be due to decreased blood flow to the optic nerve. This condition is characterized by progressive optic-nerve damage and loss of peripheral vision despite intraocular pressures in the normal range or even below normal. This type of glaucoma can be diagnosed by repeated examinations by the eye doctor to detect the nerve damage or the visual field loss.

Congenital Glaucoma:

Congenital Glaucoma Congenital glaucoma is seen in babies. It often runs in families (is inherited). It is present at birth. It is caused by abnormal eye development. SYMPTOMS Symptoms are usually noticed when the child is a few months old Cloudiness of the front of the eye Enlargement of one eye or both eyes Red eye Sensitivity to light Tearing

Congenital Glaucoma:

Congenital Glaucoma Glaucoma in One Eye Glaucoma in Both Eyes

Pigmentary Glaucoma:

Pigmentary Glaucoma This is s a type of secondary glaucoma that is more common in younger men. In this condition , granules of pigment detach from the iris, which is the colored part of the eye. These granules then may block the trabecular meshwork, which is a key element in the drainage system of the eye . These leads to blocked of drainage system which results in elevated intraocular pressure, and damage to the optic nerve.

Exfoliative glaucoma:

Exfoliative glaucoma This type of glaucoma is characterized by deposits of flaky material on the front surface of the lens and in the angle of the eye. The accumulation of this material in the angle is believed to block the drainage system of the eye and raise the eye pressure.

Secondary Open Angle Glaucoma.:

Secondary Open Angle Glaucoma. It can result from an eye (ocular) injury, even one that occurred many years ago. Other causes of secondary glaucoma are inflammation in the iris of the eye (iritis), diabetes, cataracts, or in steroid-susceptible individuals, the use of topical (drops) or systemic (oral or injected) steroids (cortisone). Secondary glaucoma is also caused by: Topical Eye Drops Eye diseases such as uveitis Systemic diseases Trauma

Narrow & Angle Closure Glaucoma.:

Narrow & Angle Closure Glaucoma. Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye. Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision. If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment. Dilating eye drops and certain medications may trigger an acute glaucoma attack . SYMPTOMS Symptoms may come and go at first, or steadily become worse Sudden , severe pain in one eye Decreased or cloudy vision, often called "steamy" vision Nausea and vomiting Rainbow-like halos around lights Red eye Eye feels swollen

Angle Closure Glaucoma.:

Angle Closure Glaucoma.

Normal Vision & Glaucoma Vision:

Normal Vision & Glaucoma Vision


Diagnosis Tonometry : determines the pressure in the eye by measuring the tone or firmness of its surface. M ost common being the applanation tonometer. After the eye has been numbed with anesthetic eyedrops , the tonometer's sensor is placed against the front surface of the eye. The firmer the tone of the surface of the eye, the higher the pressure reading . Applanation Tonometer :-An instrument for determining intraocular tension by measuring the pressure required to flatten a small area of the cornea.


Pachymetry This is a relatively new test being used for the diagnosis and treatment of glaucoma. Pachymetry determines the thickness of the cornea. After the eye has been numbed with anesthetic eye drops, the pachymeter tip is touched lightly to the front surface of the cornea.


Gonioscopy This is done by numbing the eye with anesthetic drops and placing a special type of contact lens with mirrors inside the eye. The mirrors enable the doctor to view the interior of the eye from different directions. The purpose of this test is to examine the drainage angle and drainage area of the eye . In this procedure, the doctor can determine whether the angle is open or narrow and find any other abnormalities within the angle area.


Ophthalmoscopy This is an examination in which the doctor uses a handheld device to look directly through the pupil (the opening in the colored iris) into the eye. This procedure is done to examine the optic nerve (seen as the optic disc) at the back of the eye. Damage to the optic nerve, called cupping of the disc, can be detected in this way. A pale color of the nerve can suggest damage to the nerve from poor blood flow or increased intraocular pressure.

Visual Field testing or Perimetry.:

Visual Field testing or Perimetry . Visual Field Testing actually maps the visual fields to detect any early or late signs of glaucomatous damage to the optic nerve. This test can be grossly done by having the patient look straight ahead with one eye covered and count the fingers shown by the examiner from the side. More typically, however, visual fields are measured by a computerized assessment. For this procedure, one eye is covered and the patient places his or her chin in a type of bowl. Then, when the patient sees lights of various intensities and at different locations, he or she pushes a button. This process produces a computerized map of the visual field, outlining the areas where the eye can or cannot see.

Treatment (Pharmacological):

Treatment (Pharmacological) Target: To decrease Intraocular pressure (IOP) Prevent damage to the optic fiber. Alpha Agonist Alpha agonists work to both decrease production of fluid and increase drainage. They act as preservative and breaks down into natural tear components and may be more effective for people who have allergic reactions to preservatives in other eye drops. Example: Brimonidine (Generic) ALPHAGAN Dose: Adult : Instill 1 drop of a 0.2% solution bid- tid ALPHAGAN-P BRIMOCHEK BRIMOCOM BRIMODIN Example: Apraclonidine Hydrochloride. (Generic) ALFADROPS-DS

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2. Beta Blockers Beta blockers work by decreasing production of intraocular fluid . Eg :- T imolol , Levobunolol and Betaxolol (Generic) Marketed Products : Timolol Levobunolol Betaxolol Brimolol Betagan Bulol Glucomol ------------- Ocubeta Iotim --------------- Optipres

3.Carbonic Anhydrase Inhibitors:

Carbonic anhydrase inhibitors (CAIs) reduce eye pressure by decreasing the production of intraocular fluid by inhibiting carbonic anhydrase in the ciliary body. These are available as eye drops and as pills. Example: D orzolamide , B rinzolamide and Acetazolamide Marketed Products: 3. Carbonic Anhydrase Inhibitors Dorzolamide Brinzolamide Acetazolamide Dortas Not Marketed in India Acetamide Dorzox Avva Misopt Synomax

4.Cholinergic (Miotic):

4. Cholinergic ( Miotic ) These medications reduce eye pressure by increasing the drainage of intraocular fluid through the trabecular meshwork . Cholinergics can be used alone or combined with other glaucoma medications. A combination of medications can help control how much fluid is produced in the eye and increase the amount of fluid that drains out of the eye . Example: Pilocarpine (Generic) Marketed Products: 1. ANDRE CARPINE 2. LOCARP DPS

5. Prostaglandin Analogs:

5. Prostaglandin Analogs Prostaglandin analogs work by increasing the outflow of intraocular fluid from the eye. Prostaglandin analogs are taken as eye drops. They are effective at reducing intraocular pressure in people who have open-angle glaucoma . Example: L atanoprost , Bimatoprost and Travoprost Marketed Products: Latanoprost Bimatoprost Travoprost 9PM Careprost Lupitros Ioptame Ganfort Optrvo Laprost Plus Bitoma Travatan


Others Physostigmine is also used to treat glaucoma . Less-selective alpha agonists, such as epinephrine, decrease aqueous humor production through vasoconstriction of ciliary body blood vessels, useful only in open angle glaucoma .

Treatments (Surgical & Others):

Treatments (Surgical & Others) Canaloplasty Laser surgery Trabeculectomy Glaucoma drainage implants Veterinary implant Laser-assisted nonpenetrating deep sclerectomy

Laser Treatment of Closed Angle Glaucoma:

Laser Treatment of Closed Angle Glaucoma

Latest advancements in treatment of Glaucoma:

Latest advancements in treatment of Glaucoma Implanted sensor The world's smallest computer system, one square mm in size, has been developed by researchers at the University of Michigan, and is designed to be implanted in a person's eye as a pressure monitor to continuously track the progress of glaucoma. The processor consists of an ultra-low-power microprocessor, a pressure sensor, memory, a thin-film battery, a solar cell and a wireless radio with an antenna that can transmit data to an external reader device . ES cell The survey team of Dr.Yoshiki Sasai working at the RIKEN of Center for Developmental Biology in Japan, succeeded in making a retina cell in three dimension from embryonic stem cells, as was reported in Nature (7 April 2011 ).Which is expected to come in practical use in the retinas of human for clinical application in next 2 years.

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Eye Disease Statistics

Glaucoma in India : Facts and figures:

Glaucoma in India : Facts and figures Glaucoma is the third leading cause of blindness in India 12 million people are affected accounting for 12.8% of the countries blindness Population based studies report a prevalence between 2 to 13 % Glaucoma can affect any age group, including newborn, infants, children and elderly


Reference Principles of Anatomy and Physiology By- Tortora (11 th Edition) http :// http:// http :// PubMed Health (Glaucoma Society of India)

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