open angle glaucoma frank j weinstock md facs professor of ophthalmology neoucom canton ohio usa n.
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OPEN ANGLE GLAUCOMA Frank J. Weinstock , MD, FACS Professor of Ophthalmology- NEOUCOM Canton, Ohio USA PowerPoint Presentation
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OPEN ANGLE GLAUCOMA Frank J. Weinstock , MD, FACS Professor of Ophthalmology- NEOUCOM Canton, Ohio USA - PowerPoint PPT Presentation


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OPEN ANGLE GLAUCOMA Frank J. Weinstock , MD, FACS Professor of Ophthalmology- NEOUCOM Canton, Ohio USA. TYPES OF GLAUCOMA. PRIMARY CHRONIC SIMPLE OPEN ANGLE ANGLE CLOSURE- NARROW ANGLE SECONDARY TRAUMATIC. PRIMARY CHRONIC SIMPLE OPEN ANGLE GLAUCOMA. SERIES OF CONDITIONS

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Presentation Transcript
types of glaucoma
TYPES OF GLAUCOMA
  • PRIMARY CHRONIC SIMPLE OPEN ANGLE
  • ANGLE CLOSURE- NARROW ANGLE
  • SECONDARY
  • TRAUMATIC
primary chronic simple open angle glaucoma
PRIMARY CHRONIC SIMPLE OPEN ANGLE GLAUCOMA
  • SERIES OF CONDITIONS
  • OPTIC NERVE AND VISUAL FIELD LOSS SECONDARY TO ELEVATED INTRAOCULAR PRESSURE OR POOR NUTRITION TO OPTIC NERVE
  • ETIOLOGY- NOT TRULY KNOWN
variants
VARIANTS
  • TRAUMATIC
  • SECONDARY
  • LOW TENSION
open angle glaucoma
OPEN ANGLE GLAUCOMA
  • US- 2.2 MILLION (3.4 MILLION BY 2020)
  • 175000 IN US BLIND (10% OF BLINDNESS)
  • BLACKS-HISPANICS (30% OF BLINDNESS)
  • 1 IN 1000 OVER 40 YR OLD- BLIND
  • OVER 75 YEARS- 2.7/1000 BLIND (6.7/1000 VISUALLY IMPAIRED)
compliance
COMPLIANCE
  • SCREENING $60/SCREENING AND $1000/CASE DISCOVERED
  • (SCREEN HIGH RISK-RELATIVES-AFRICAN AMERICANS-HISPANICS-)
  • 25-40% OF PTS. TAKING Rx TO STORE- DON’T PICK IT UP
  • 60% PICKING UP Rx D/C XALATAN DURING YR AND 76% WITH OTHER MEDS
diagnosis
DIAGNOSIS
  • OPTIC NERVE FIBER EVALUATION (OPHTHALMOCSCOPE)
  • VISUAL FIELD EVALUATION- OFFICE
  • OPTIC NERVE IMAGING AND ANALYSIS- OFFICE
  • MEASUREMENT OF INTRAOCULAR PRESSURE (PORTABLE)
  • MEASUREMENT OF CORNEAL THICKNESS
  • GENETIC PREDISPOSITION ????
screening
SCREENING
  • OPTIC NERVE EVALUATION- OPHTHALMOLOSCOPE
  • INTRAOCULAR PRESSURE (IOP) MEASUREMENT- APPLANATION TYPE TONOMETER
  • IOP HAS DIURNAL VARIATION
goals of screening
GOALS OF SCREENING
  • EDUCATION
  • DETECTION OF GLAUCOMA (NOT PROVEN)
    • TESTS NOT SPECIFIC OR SENSITIVE

SCREENING- NO VALUE IF:

NOT ABLE TO REFER FOR DEFINITIVE DIAGNOSIS, TREATMENT AND FOLLOWUP

screening1
SCREENING
  • CHOOSE HIGH RISK GROUPS E.G. HISPANICS, BLACKS (OVER AGE 40, WHITES (OVER 65 YEARS OLD), HISTORY OF EYE TRAUMA; DIABETICS;
  • FAMILY HISTORY OF GLAUCOMA
  • DIABETICS
  • PATIENTS WITH SEVERE MYOPIA
intraocular pressure
INTRAOCULAR PRESSURE
  • VERY EASY TO DO- PORTABLE INSTRUMENTS
  • POOR SENSITIVITY AND SPECIFICITY
  • NORMAL- 20 mmHg OR LESS
  • MEASURED BY: APPLANATION TONOMETER- NOT PRACTICAL
  • FINGER PALPATION- INACCURATE

APPLANATION TONOMETRY

schiotz tonometer
SCHIOTZ TONOMETER

ADVANTAGES:

INEXPENSIVE

PORTABLE

EASY TO USE

READILY AVAILABLE

DISADVANTAGES:

NOT THE MOST ACCURATE

REQUIRES TOPICAL ANESTHETIC

ophthalmoscopy
OPHTHALMOSCOPY
  • EASY; QUICK
  • REQUIRES OPHTHALMOSCOPE- AVAILABLE
  • REQUIRES EXPERT AT OPHTHALMOSCOPY
  • PICKS UP DEFINITIVE GLAUCOMA ( A LATE STAGE)- MAY BE TOO LATE TO HAVE MUCH BENEFIT
  • INTER-OBSERVER VARIABILITY
  • NORMAL C:D RATIO- 0.3 OR LESS THAN 0.2 DIFFERENCE
  • (STEREO VIEWS ARE BEST (NOT PRACTICAL)
e 11 normal and cupped disc
E-11 Normal and Cupped Disc

NORMAL

CUPPED DISC

ENLARGED CUP

peripheral visual field testing
PERIPHERAL VISUAL FIELD TESTING
  • PICKS UP LATER GLAUCOMA
  • REQUIRES EXPENSIVE EQUIPMENT- DIFFICULT TO PERFORM- NOT PRACTICAL FOR SCREENING
  • OPTIC NERVE ANALYSIS- PICKS UP PROBLEMS EARLIER (REQUIRES EXPENSIVE EQUIPMENT AND TECHNNICAL SUPPORT)- NOT PRACTICAL FOR SCREENING
referral
REFERRAL
  • SET CRITERIA FOR EACH SCREENING
  • E.G PRESSURE OVER 20 MM hG
  • INDIVIDUALS WITH SUSPICIOUS DISCS (LARGE CUPS)
  • OPTIC NERVE- HEMORRHAGES; LARGE CUP:DISC RATIO (OVER 0.4) OR ASYMMETRY OF CUPS (HORIZONTAL AND VERTICAL CUP:DISC RATIO)- 0.3 DIFFERENCE
best screening
BEST SCREENING
  • COMPREHENSIVE EYE EXAM IN OFFICE SETTING- BY SPECIALIST
additional screening benefits
ADDITIONAL SCREENING BENEFITS
  • POSSIBLY MORE IMPORTANT THAN DIAGNOSING GLAUCOMA
  • EDUCATION OF NEED FOR EYE CARE
  • OPHTHALMOSCOPIC EXAM WILL PICK UP:
    • CATARACTS
    • CORNEAL SCARS
    • RETINAL DISEASE- DIABETES, HYPERTENSION, TUMORS
treatment of glaucoma
TREATMENT OF GLAUCOMA
  • MEDICATIONS- MANY NEW MEDICATIONS- POTENTIAL SIDE-EFFECTS
  • ONCE A DAY DOSAGE- BEST COMPLIANCE
  • TREAT EARLIER
  • LASER OR SURGERY- EARLIER ????- BEING EVALUATED
  • WHICH FIRST? – BEING EVALUATED
  • NEW PROCEDURES
  • GOAL- < 20mmHg. (LOWER IN MANY SITUATIONS)
summary
SUMMARY
  • GLAUCOMA SCREENING
  • QUESTIONNABLE BENEFIT FOR PREVENTING BLINDNESS
  • WILL PICK UP A NUMBER OF CASES GLAUCOMA AND OTHER EYE CONDITIONS
  • CONCENTRATE ON HIGH-RISK GROUPS
  • EASY TO DO
  • MARKED EDUCATIONAL AND PUBLIC RELATIONS BENEFIT