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Diagnosis, Treatment and Management of Glaucoma Desinee Drakulich O.D.

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Presentation on theme: "Diagnosis, Treatment and Management of Glaucoma Desinee Drakulich O.D."— Presentation transcript:

1 Diagnosis, Treatment and Management of Glaucoma Desinee Drakulich O.D.

2  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.


4  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

5  Anatomy of the Eye



8  Types of Glaucoma  Primary Open Angle Glaucoma  Angle Closure Glaucoma  Low Tension Glaucoma  Pigmentary Glaucoma  Exfoliative Glaucoma  Acute Glaucoma  Congenital Glaucoma  Secondary Glaucoma Traumatic Glaucoma

9  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

10  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.

11  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

12  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

13  Medication Drops  Laser Treatments  Surgery


15  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.

16  Cholinergics  Beta Blockers  Alpha Agonists  Carbonic Anhydrase Inhibitors  Prostaglandins

17  Older method of treating glaucoma rarely used anymore.  Two major drugs: Pilocarpine and Carbachol  How 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

18  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.

19  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.

20  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.

21  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.

22  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.

23  Current studies from the Review of Optometry March 2009 show that the DOC is still Xalatan.

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