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  1. 1. 0Glaucoma
  2. 2. 1The healthy eye• Light rays enter the eyethrough the cornea, pupil andlens.• These light rays are focuseddirectly onto the retina, thelight-sensitive tissue lining theback of the eye.• The retina converts light raysinto impulses; sent through theoptic nerve to your brain, wherethey are recognized as images.
  3. 3. 2What is glaucoma?• Disease of the optic nerve.• When damage to the optic nerve fibersoccurs, blind spots develop; blind spotsusually go undetected until optic nerve issignificantly damaged.• Leading cause of blindness in the UnitedStates, especially for older people.• Early detection and treatment are keys topreventing vision loss from glaucoma.Normal visionVision as it might beaffected by glaucoma
  4. 4. 3Anatomy of glaucoma• Clear liquid called aqueous humor circulates inside the frontportion of the eye.• To maintain a healthy level of pressure within the eye, a smallamount of aqueous humor is produced constantly, while an equalamount flows out of the eye through a microscopic drainagesystem—the trabecular meshwork.
  5. 5. 4Anatomy of glaucoma• With glaucoma, aqueous humor does notflow through the trabecular meshworkproperly.• Over time, eye pressure IOP increases,damaging the optic nerve fibers.
  6. 6. 5Types of glaucomaTwo main categories of glaucoma:• Open-angle glaucoma: the most common form of glaucoma - (the mostcommon form that affects approximately 95% of individuals)• Closed-angle glaucoma: a less common and more urgent form ofglaucoma.Other Types of glaucoma:Normal-Tension GlaucomaCongenital glaucomaJuvenile glaucomaSecondary glaucoma
  7. 7. 6Types of glaucoma – Open-angleOpen-angle glaucoma• Trabecular meshwork becomes lessefficient at draining aqueous humor.• Intraocular pressure (IOP) builds up,which leads to damage of the opticnerve.• Damage to the optic nerve occurs atdifferent eye pressures amongdifferent patients.• Typically, glaucoma has nosymptoms in its early stages.Open-angle glaucoma
  8. 8. 7Types of glaucoma – Open-angleOpen-angle glaucoma is the most common form of the disease, isprogressive and characterized by optic nerve damage. The most significantrisk factor for the development and advancement of this form is high eyepressure. Initially, there are usually no symptoms, but as eye pressuregradually builds, at some point the optic nerve is impaired, and peripheralvision is lost. Without treatment, an individual can become totally blind.
  9. 9. 8Glaucoma risk factors – Open-angleStrong risk factors for open-angle glaucoma include: High eye pressure (IOP) Family history of glaucoma Age 40 and older for African Americans Age 60 and older for the general population, especially Mexican Americans Thin cornea Suspicious optic nerve appearance with increased cupping (size of cup,the space at the center of optic nerve, is larger than normal)Continued
  10. 10. 9Glaucoma risk factors – Open-angle (cont)Additional risk factors for open-angle glaucoma include: High myopia (severe nearsightedness) Diabetes Eye surgery or injury High blood pressure Use of corticosteroids (for example, eye drops, pills*, inhalers and creams)
  11. 11. 10Types of glaucoma – Closed-angleClosed-angle (or narrow-angle) glaucoma:• The drainage angle of trabecularmeshwork becomes blocked by the iris.• IOP builds up very fast.• Symptoms include severe eye orbrow pain, redness of the eye,decreased or blurred vision.• Must be treated as a medicalemergency—must visitophthalmologist immediately.Closed-angle glaucoma
  12. 12. 11Types of glaucoma – Closed-angleClosed-angle glaucoma may be acute or chronic. In acute closed-angle glaucomathe normal flow of eye fluid (aqueous humor) between the iris and the lens issuddenly blocked. Symptoms may include severe pain, nausea, vomiting, blurredvision and seeing a rainbow halo around lights. Acute closed-angle glaucoma is amedical emergency and must be treated immediately or blindness could result in oneor two days. Chronic closed-angle glaucoma progresses more slowly and candamage the eye without symptoms, similar to open-angle glaucoma.
  13. 13. 12Glaucoma risk factors – Closed-angleClosed-Angle Glaucoma Age Family history Poor short-distance vision (farsightedness) Eye injury or eye surgery East Asian and Inuit ethnicity
  14. 14. 13Types of glaucomaNormal-Tension Glaucoma Cardiovascular disease Family history of glaucoma Japanese ethnicity Low eye pressure IOPNormal-tension glaucoma occurs when eye pressure is normal, yet the optic nerve isdamaged and peripheral vision is lost. Lowering eye pressure through medicationsometimes slows the progress of the disease, but this type of glaucoma may worsendespite low pressure. Treatment is generally the same as for open-angle glaucoma withhigh eye pressure.
  15. 15. 14Types of GlaucomaCongenital glaucoma affects infants born with defects that preventthe normal drainage of fluid from the eye.Juvenile glaucoma is open-angle glaucoma that affects children,adolescents and young adults.Secondary glaucoma can be open-angle or closed-angle, and is theresult of some other medical condition in the eye or the body.Examples of secondary glaucoma include:Pigmentary glaucoma, a rare form, in which pigment granules from the iris flake off into the eye fluid(aqueous humor) and clog the eye’s drainage system (trabecular meshwork).Pseudoexfoliation Syndrome occurs when white material appears to flake off the lens of the eye andblock normal flow of the aqueous humor.Neovascular glaucoma occurs when abnormal blood vessel growth blocks the eye’s fluid drainagechannels and leads to increased eye pressure. This abnormal growth can be caused by low bloodsupply to the eye due to diabetes, insufficient blood flow to the head because of blocked neck arteries,or blood vessel blockage in the back of the eye.Iridocorneal Endothelial Syndrome (ICE) has a number of features, including the breaking off of cellsfrom the cornea, which blocks the drainage channels in the eye and leads to increased eye pressure.Scars may also connect the iris to the cornea.
  16. 16. 15Detecting GlaucomaRegular glaucoma check-ups include two routine eye tests:1. Tonometry – eye pressure test IOP2. Ophthalmoscopy is a test that allows a health professional to see inside theback of the eye (called the fundus) and other structures using a magnifying instrument(ophthalmoscope) and a light source.Additional tests:Perimetry (the perimetry test is also called a visual field test)Gonioscopy is a painless eye test that checks if the angle where the irismeets the cornea is open or closed, showing if either open angle or closedangle glaucoma is present.
  17. 17. 16Detecting GlaucomaTonometry:The tonometry eye test measures the inner pressure of the eye also known asIntraocular Pressure or IOP.Tonometry is carried out by an instrument called a TONOMETER.
  18. 18. 17Types of Tonometry:Applanation tonometry measures intraocular pressure either by the force requiredto flatten a constant area of the cornea (e.g. Goldmann tonometry) or by the areaflattened by a constant force.Goldmann tonometer: Stationary device requires anesthesia drops, requirescontact with cornea and is attached to a slit lamp – usually is used by anOphthalmologist.
  19. 19. 18Types of tonometrynon-contact tonometry or air-puff tonometry:This type of tonometer uses a rapid air pulse to applanate the cornea. Intraocular pressure is estimatedby detecting the force of the air jet at the instance of applanation.In most cases a stationary unit,Does not require anesthetic drops
  20. 20. 19Types of tonometryTono-pen - is a portable electronic, digital pen-like instrument that determines IOPby making contact with the cornea, after use of topical anesthetic eye drops – tipcovers are used between the patients.
  21. 21. 20Types of tonometryThe newest Advancement in tonometry is DIATON TONOMETER –It measures intraocular pressure (IOP) through the Eyelid.Diaton Tonometer is intended for use by Inpatient & Outpatient Clinics such asHospitals, Emergency Rooms, Nursing & Elderly Homes,General & Specialty Practitioners as well as Ophthalmologists and Optometrists.DIATON Requires No Contact with Cornea No Anesthetic Drops, No Risk of Infecting
  22. 22. 21Diaton Tonometry•Safe•Quick•Efficient•Painless•NoninvasiveCan be used onChildren and Adults
  23. 23. 22Four Key Facts About GlaucomaGlaucoma is a leading cause of blindnessGlaucoma can cause blindness if it is left untreated. And unfortunately approximately 10% of peoplewith glaucoma who receive proper treatment still experience loss of vision.There is no cure (yet) for glaucomaGlaucoma is not curable, and vision lost cannot be regained. With medication and/or surgery, it ispossible to halt further loss of vision. Since glaucoma is a chronic condition, it must be monitored forlife.Screening, detection and prevention is the first step to preserving your vision.Everyone is at risk for glaucomaEveryone is at risk for glaucoma from babies to senior citizens. Yes, older people are at a higher risk forglaucoma but babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in theUnited States).Young adults can get glaucoma, too. African-Americans in particular are susceptible at a younger age.There may be no symptoms to warn youWith open angle glaucoma, the most common form, there are virtually no symptoms. Usually, no pain isassociated with increased eye pressure.Vision loss begins with peripheral or side vision. You may compensate for this unconsciously byturning your head to the side, and may not notice anything until significant vision is lost. The best wayto protect your sight from glaucoma is to get tested. If you have glaucoma, treatment can beginimmediately.
  24. 24. 23Statistics About GlaucomaIt is estimated that over 4 million Americans have glaucoma but only half of those know they have it. (1)Approximately 120,000 are blind from glaucoma, accounting for 9% to 12% of all cases of blindness inthe U.S. (2)About 2% of the population ages 40-50 and 8% over 70 have elevated IOP.Glaucoma is the second leading cause of blindness in the world, according to the World HealthOrganization.Glaucoma is the leading cause of blindness among African-Americans. (2)Glaucoma is 6 to 8 times more common in African-Americans than Caucasians. (3)African-Americans ages 45-65 are 14 to 17 times more likely to go blind from glaucoma than Caucasianswith glaucoma in the same age group.The most common form, Open Angle Glaucoma, accounts for 19% of all blindness among African-Americans compared to 6% in Caucasians. (4)Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics,and people who are severely nearsighted.Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide. (5)
  25. 25. 24Statistics About Glaucoma contPrevent Blindness America Survey found that:Blindness ranked third (after cancer and heart disease) as people’s majorfear.20% of people knew that glaucoma was related to elevated pressurewithin the eye. Most of them mistakenly thought people could tell if theyhad glaucoma due to symptoms, or that it was easily cured, or that it didnot lead to blindness.50% had heard of glaucoma, but weren’t sure what it was.30% had never heard of glaucoma.
  26. 26. 25Statistics About GlaucomaEconomic Impact:Glaucoma accounts for over 7 million visits to physicians each year. (1)In terms of Social Security benefits, lost income tax revenues, and healthcare expenditures, the cost to the U.S. government is estimated to be over$2.5 billion annually. (6)Sources: (1) Prevent Blindness America; (2) National Eye Health Program/National Institutes of Health; (3)American Academy of Ophthalmology; (4) Racial differences in the cause-specific prevalence of blindnessin east Baltimore. N Engl J Med. 1991 Nov 14;325(20):1412-7; (5) Quigley, “Number of people with glaucomaworldwide,” 1996; (6) NEI, Report of the Glaucoma Panel, Fall 1998
  27. 27. 26Statistics About Glaucomaas per University of Washington Department of Ophthalmology.In U.S. - there are ONLY:17,000 Ophthalmologists & 30,000 OptometristsThere is a great NEED for ADDITIONAL screening locations…60 million Americans are at RISK for developing Glaucoma,
  28. 28. 27FLORIDA AGE DEMOGRAPHICS:Florida National % NationalHouseholdsAll 6337929 1054801016%Age 65+ 1943478 24672708 7.9%Alone 710025 9722857 7.3%Not Alone 1233453 14949851 8.3%45 to 54 years 2069479 37677952 5.5%55 to 59 years 821517 13469237 6.1%60 to 64 years 737496 10805447 6.8%65 to 74 years 1452176 18390986 7.9%75 to 84 years 1024134 12361180 8.3%85 years and over 331287 4239587 7.8%TOTAL AT RISK (45 years and older) 6,436,089As population ages the impact of the disease will increase…
  29. 29. 28Glaucoma Prevention InitiativeThank you for your attentionand your openness to challenge the ―silent thief of sight‖!