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Tri city allied health-acute glc
- 1. The Acute Glaucomas TriCity Allied Health Lecture Joshua R. Ehrlich, MD, MPH Assistant Professor of Ophthalmology and Visual Sciences University of Michigan
- 2. Financial disclosures Grant support National Eye Institute ASCRS Foundation
- 3. Glaucoma Classifications • Open vs Closed Angle • Primary vs Secondary • Acute vs Chronic
- 4. The Acute Glaucomas Acute Open Angle Glaucomas • glaucomatocyclitic crisis • acutely elevated episcleral venous pressure Primary Angle Closure Glaucomas • pupillary block • plateau iris configuration Secondary Angle Closure Glaucomas • pupillary seclusion • malignant glaucoma • ciliary body or choroidal swelling • space occupying lesions • anteriorly displaced lens • tight scleral buckle • uveitic or neovascular membranes
- 5. Treatment Eye Drops in Bottles (Greyling) Pills in Blister Pack (Arnold) Slit Lamp (2009, NEI) Cataract Surgery (Harrison)
- 6. It depends! Anterior photograph (Okonuki ) Acute Angle Closure (Trobe)
- 7. The angle is key Anterior segment photography (Jeong )
- 8. Gonioscopy Optical Principles of Gonioscopy (Saunders)
- 9. Gonioscopy Insertion of a Goniolens (Salmon)
- 10. The normal angle Gonioskopie des Kammerwinkels (Snoop)
- 11. Pupillary block Acute Angle Closure (Trobe) An Acute Attack of Angle Closure (Wu)
- 12. Plateau iris Plateau UBM (Ehrlich)
- 13. Neovascular Neovascularization of the Angle (Frezzotti)
- 14. Iris bombé (uveitic) Clinical photography (Fernandes)
- 15. Malignant glaucoma or aqueous misdirection Ultrasonographic Biomicroscopy (Premsenthil)
- 16. Diagnostic pearls • a good history is key! • anterior chamber depth • iris anomalies • lens status • the angle
- 17. References Acute Angle Closure Glaucoma. Jonathan Trobe. https://commons.wikimedia.org/wiki/File:Acute_Angle_Closure- glaucoma.jpg. License CC 3.0. Cataract Surgery Aboard Mercy. Eddie Harrison. https://commons.wikimedia.org/wiki/File%3AUS_Navy_100604-N- 4044H-022_Doctors_perform_cataract_surgery_on_a_Vietnamese_patient_aboard_Mercy.jpg. Public Domain. Eye Drops in Bottles. Lynn Greyling. https://www.publicdomainpictures.net/view- image.php?image=90954&picture=eye-drops-in-bottles. CC0 Public Domain. Fernandes et al. Clinical-histopathological correlation in a case of Coats' disease. Diagn Pathol, 2006;1:24. Frezzotti et al. Management of intraocular pressure elevation during hemodialysis of neovascular glaucoma: a case report. BMC Ophthalmol, 2016;16:23. Gonioskopie des Kammerwinkels. Benutzer Snoop. https://commons.wikimedia.org/wiki/File:Kammerwinkel.jpg. License CC 3.0. Jeong et al. Acute angle closure attack after an intravitreal bevacizumab injection for branch retinal vein occlusion: a case report. BMC Ophthalmol, 2017;17(1):25. Okonuki et al. A case of herpes zoster uveitis with severe hyphema. BMC Ophthalmol, 2014;14:74. Pills in Blister Pack. Karen Arnold. https://www.publicdomainpictures.net/view-image.php?image=54900&picture=pills- in-blister-pack. CC0 Public Domain. Pleateau UBM. Joshua Ehrlich. With Permission Premsenthil. Spontaneous malignant glaucoma in a patient with patent peripheral iridotomy. BMC Ophthalmol, 2012;12:64. Salmon JF. Gonioscopy. In: Glaucoma. Second Ed, edited by Shaarawy, Sherwood, Hitchings and Crowston. Philadelphia: Saunders Ltd. 2014. Slit Lamp Examination at the Eye Clinic (2009). National Eye Institute. https://www.flickr.com/photos/nationaleyeinstitute/with/37865157324/. With permission for educational use. Wu et al. Acute angle-closure glaucoma in retinopathy of prematurity following pupil dilation. BMC Ophthalmol, 2015;15:96.
Editor's Notes
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL
- Little evidence for the effectiveness of vision rehab interventions Evidence even more scarce regarding interventions for patients with PVL from causes like glaucoma and retinal dystrophy This is needed, as studies by Owsley and others have suggested that around 20% of those seen in low vision clinics have PVL as primary complaint or a component of their vision loss A single recent RCT showed that available LVADs improved ability to perform activities like reading -- but not activities requiring peripheral vision Likely two reasons that this RCT failed to show improvement for activities requiring peripheral vision Most existing LVADs aim to improve central vision Most existing outcome measures are not relevant to PVL