Presentation on theme: "Paras Guide to Glaucoma"— Presentation transcript:
1Paras Guide to Glaucoma Diagnosis, Treatment and Management of GlaucomaDesinee Drakulich O.D.
2Review What 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.
4ReviewEye Pressure- most people associate eye pressure or Intraocular Pressure (IOP) with glaucoma.Normal eye pressure is between 10 mmHg and 21 mmHgAverage is between 14 mmHg and 16 mmHgMisconception 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
8Review Types of Glaucoma Primary Open Angle Glaucoma Angle Closure GlaucomaLow Tension GlaucomaPigmentary GlaucomaExfoliative GlaucomaAcute GlaucomaCongenital GlaucomaSecondary GlaucomaTraumatic Glaucoma
9Low Tension Glaucoma Most difficult to diagnose Patient have IOPs in the normal rangeThought to be caused by poor blood flow to the optic nerveNew research is answering some questionsIn 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
10Primary open AngleThe 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.
11How to detect POAG Increased IOP > 21 mmHg Thin central corneal thickness > 555 umPeripapillary AtrophyNotching or thinning of the neuroretinal rimFamily HistoryLarge cup to disc ratio
12Angle closure glaucoma Affect about half a million people in the USTends to be inheritedAffects Asians and hyperopes most frequentlyAnterior chamber smaller than averageAngle < 45 degreesIris forced up against trabecular meshwork causes complete closure or an acute glaucoma attackAge can be a factor due to increasing size of the lens of the eye
13How do we treat POAGMedication DropsLaser TreatmentsSurgery
15What can Optometrist Do? 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.
16Current Types of Glaucoma Drops CholinergicsBeta BlockersAlpha AgonistsCarbonic Anhydrase InhibitorsProstaglandins
17Cholinergics Older method of treating glaucoma rarely used anymore. Two major drugs: Pilocarpine and CarbacholHow do they work?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
18Beta BlockersAlso an older method of treating Glaucoma however still commonly used todayMost commonly used drops are: Timolol, Betoptic and Betagan.How do they work? Decrease the production of aqueousSide 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.
19Alpha Agonists Newer method of glaucoma treatment. Two different drops available: Iopidine and Alphagan PHow 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.
20Carbonic Anhydrase Inhibitors Commonly used for patients who can’t take Beta BlockersTwo 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.
21Combination DropsRelatively new, good for patient who drop want to do multiple drops per day.Two types of drops: Combigan and CoseptCombigan is Alphagan and Timolol.Cosept is Trusopt and TimololHow to they work? Both increase outflow and decrease productionSide effects are the same as the individual drugs.
22ProstaglandinsNewest method of treating glaucoma considered the DOC of glaucoma medication.Three major drops: Xalatan, Lumigan and TravatanHow 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.
23So What is the Best Drop?Current studies from the Review of Optometry March 2009 show that the DOC is still Xalatan.