GLAUCOMA

What You Need to Know

DEBORAH R. EEZZUDUEMHOI
GLAUCOMA SPECIALIST
 Definition
• Glaucoma is a collective term for
heterogeneous group of disorders

- progressive optic neuropathy

-associated visual field loss

-generally marked by elevated intraocular

pressure.
 Epidemiology

• The leading cause of blindness among African

Americans

• The leading cause of blindness among older

Hispanic persons

• The second cause of irreversible blindness

• The third-leading cause of blindness worldwide

 Epidemiology
• 67 million worldwide
• USA:
-2.5 million Americans have glaucoma

-1 million may be unaware

-5,500 people become legally blind each year

-80.000 Americans are blind from glaucoma

 Classification
• Open-Angle Glaucomas: impairement of outflow
through the trabecular meshwork

• Angle-Closure Glaucoma: obstruction of

trabecular meshwork by the peripheral iris.

• Developmental: Anomalies of the anterior

chamber angle
• Diabetes
• Sickle cell disease
• Trauma
 Physiology
• Aqueous humor:
Nonpigmented epithelium
of ciliary body

• 2-3 microliters/min

• Flows into the PC,

through the pupil into AC
-trabecular
-uveoscleral
 Outflow Facility
• Schlemm’s canal
• Collector channels
• Aqueous veins
• Episcleral and conjunctival veins
• Anterior ciliary and ophthalmic veins
• Cavernous sinus
 Pathogenesis
-Mechanical

-Vascular

-Genetic
 Pathophysiology
• 1.2 million axons of
retinal ganglion cells form
the optic nerve

• Progressive loss of retinal

ganglion cells

• Gradual optic disc

cupping
-reduction of optic nerve
fibers
-Alterations in lamina
cribrosa
Glaucomatous optic neuropathy
Primary Open Angle Glaucoma
• The most ominous characteristics

-slowly progressive

-painless

-symptomless
Primary Risk factors For Glaucoma
• Elevated intraocular pressure

• Increasing age

• Family history

• African heritage

• Hispanic heritage
 Intraocular Pressure
• Resistance to aqueous humor outflow

• 10-21mmHg

• There is no absolute “safe” IOP

Primary Open Angle Glaucoma
RACE/Ethnicity
• Four-fold greater prevalence blacks/whites

-larger optic discs

-thinner corneas
-damage at lower IOP
-earlier presentation

• Hispanics at older age

 Angle Closure-Risk factors
• Age
-0.22% 40-49
-14.9% 80+ years of
age
• Race (1.4%
Chinese, 2.65% Inuit)
• Gender
• Refractive error
• Family history
 Precipitating factors
• Dim illumination
• Emotional stress
• Drugs
-Anticholinergics: systemic atropine
-Antihistamine
-gastrointestinal spasmolytic drugs
-anti-Parkisonism
-antipsychotic
-TCA
 Precipitating factors

• Adrenergics
-vasoconstrictors
-CNS stimulants
-appetite suppressants
-bronchodilators
-hallucinogenic agents

• Sulfa-based compounds
- Oral hydrochlorothiazide:
 Symptoms
• Pain
• Headache
• Nausea
• Vomiting
• Bradycardia
• Profuse sweating
• Conjunctival hyperemia
• Blurred vision
 IOP control
• Traditional medical
• Population Studies and surgical therapies
-Prevalence of glaucoma for glaucoma are
increases with increasing directed
IOP

• Treatment Studies -facilitate outflow

-lowering IOP reduces
the risk of optic nerve
damage
-decrease production
-delays the progression
 Treatment Of Glaucoma
• Agents that reduce • Agents that increase
aqueous production: aqueous outflow:
• -Beta blockers • -Alpha-2-adrenergic
• -Carbonic anhydrase agonists
inhibitors • -Cholinergic drugs
• -Alpha-2 adrenergic • -Prostanglandins
agonists • -Laser burn
• -Surgical techniques that
increase outflow
• -Surgical bypass of the
trabecular meshwork
 The Ideal Drug
• Reduces elevated IOP

• Slows or prevents optic nerve damage and

further loss of vision

• Void of serious ocular or systemic adverse

effects

• Monotherapy
 Who is at risk
• ANYONE
• African Americans over age 40
• Hispanic origin
• Over age 65
• Family history
• Previous eye injury
• People with diabetes
• Systemic steroids
 Public Health Problem
• 3 million office visits are made to monitor
glaucoma

• $1,3 billion is lost because of decreased

productivity

• $1billion spent on federal assistance to

blind glaucoma patients
 Goals
Collective efforts:
• Individuals will be brought into the system

• Promote earlier detection of the disease

• Optimize cost-effectiveness
 Questions
• What is glaucoma?

• Who is at risk?

• What are the major types of glaucoma?

 Give 4 agents that will reduce
intraocular pressure
• -Beta blockers
• -Carbonic anhydrase inhibitors
• -Alpha-2 adrenergic agonists
• -Cholinergic drugs
• -Prostanglandins
 Give 5 risk factors for open angle
glaucoma
• Elevated intraocular pressure

• Increasing age

• Family history

• African heritage

• Hispanic heritage
• What is the leading cause of irreversible
blindness worldwide
-Trachoma

• The leading cause of reversible blindness

-unoperated cataract
 Name 5 risk factors for angle
closure glaucoma
• Age
• Race
• Gender (female)
• Refractive error (hyperopia)
• Family history
 Glaucoma: Definition and
characteristics
• Glaucoma is a collective term for
heterogeneous group of disorders

- progressive optic neuropathy

-associated visual field loss

-generally marked by elevated intraocular

pressure.
 Who is at risk?

• ANYONE
• African Americans over age 40
• Hispanic origin
• Over age 65
• Family history
• Previous eye injury
• People with diabetes
• Systemic steroids
 What are the major types of
glaucoma?

• Open-Angle Glaucomas: impairement of

outflow through the trabecular meshwork

• Angle-Closure Glaucoma: obstruction of

trabecular meshwork by the peripheral iris.

• Developmental: Anomalies of the anterior

chamber angle
 Give at least 5 symptoms of acute
angle closure glaucoma
• Pain
• Headache
• Nausea
• Vomiting
• Bradycardia
• Profuse sweating
• Conjunctival hyperemia
• Blurred vision