Glaucoma is a group of eye diseases that damage the optic nerve and can result in vision loss and blindness. It is often associated with increased fluid pressure in the eye. The most common type is open-angle glaucoma which progresses slowly over time and has no early symptoms. Treatment aims to lower intraocular pressure through eye drops, laser treatment, or surgery to slow the progression and prevent further vision loss. Left untreated, glaucoma can lead to permanent vision loss and blindness.
The document discusses different lens materials used in ophthalmic lenses, including their properties and characteristics. It covers natural materials like quartz, glass materials like crown glass and flint glass, and plastic materials like CR-39, polycarbonate, high index plastics, and Trivex. For each material, it provides details on composition, refractive index, Abbe value, advantages and disadvantages. The document aims to educate about different lens materials and their properties for lens manufacturing.
This document discusses mydriatics and cycloplegics, which are drugs that dilate the pupil (mydriasis) or paralyze accommodation (cycloplegia). It describes how the iris and ciliary muscles are innervated by the third cranial nerve and how pharmacological agents like atropine and phenylephrine work by blocking the responses of the sphincter muscle of the iris and ciliary body muscles to produce mydriasis and cycloplegia. These drugs are used clinically to dilate the pupil for exams or produce cycloplegia for refractive exams.
Retinoscopy is an objective refraction technique used to determine a patient's refractive error. Dynamic retinoscopy is performed with the patient fixating on a near target. Several methods of dynamic retinoscopy have been developed, including MEM, Bell retinoscopy, Nott's retinoscopy, and Book retinoscopy. The movements observed during dynamic retinoscopy - with, against, and neutral - provide information about a patient's accommodative response and ability. The document discusses the procedures, interpretations, limitations, and histories of various dynamic retinoscopy techniques.
Cycloplegic refraction involves temporarily paralyzing the ciliary muscle with eye drops in order to determine a person's full refractive error. This is important for children who accommodate too much. Common cycloplegic agents include atropine, homatropine, and cyclopentolate. Cyclopentolate is often the drug of choice due to its faster onset and shorter duration. A cycloplegic refraction allows an accurate assessment of refractive error, especially in children and other patients where accommodation can affect results.
Maddox Rod
Use of Maddox Rod
Method of Assessment MR
Double MR Test procedure
Recording procedure of MR Test
Heterophoria, Cyclophoria, Esophoria,Exophoria,Hyperphoria,Hypophoria
The document discusses various techniques for measuring intraocular pressure (IOP), including Goldmann applanation tonometry, Perkins tonometry, non-contact tonometry, and digital evaluation. Goldmann applanation tonometry is described as the most accurate method. The document provides details on properly using Goldmann tonometry, including preparing the patient, aligning the probe, applying the correct amount of force, and interpreting the results. Contraindications and sources of error are also reviewed.
The document discusses different lens materials used in ophthalmic lenses, including their properties and characteristics. It covers natural materials like quartz, glass materials like crown glass and flint glass, and plastic materials like CR-39, polycarbonate, high index plastics, and Trivex. For each material, it provides details on composition, refractive index, Abbe value, advantages and disadvantages. The document aims to educate about different lens materials and their properties for lens manufacturing.
This document discusses mydriatics and cycloplegics, which are drugs that dilate the pupil (mydriasis) or paralyze accommodation (cycloplegia). It describes how the iris and ciliary muscles are innervated by the third cranial nerve and how pharmacological agents like atropine and phenylephrine work by blocking the responses of the sphincter muscle of the iris and ciliary body muscles to produce mydriasis and cycloplegia. These drugs are used clinically to dilate the pupil for exams or produce cycloplegia for refractive exams.
Retinoscopy is an objective refraction technique used to determine a patient's refractive error. Dynamic retinoscopy is performed with the patient fixating on a near target. Several methods of dynamic retinoscopy have been developed, including MEM, Bell retinoscopy, Nott's retinoscopy, and Book retinoscopy. The movements observed during dynamic retinoscopy - with, against, and neutral - provide information about a patient's accommodative response and ability. The document discusses the procedures, interpretations, limitations, and histories of various dynamic retinoscopy techniques.
Cycloplegic refraction involves temporarily paralyzing the ciliary muscle with eye drops in order to determine a person's full refractive error. This is important for children who accommodate too much. Common cycloplegic agents include atropine, homatropine, and cyclopentolate. Cyclopentolate is often the drug of choice due to its faster onset and shorter duration. A cycloplegic refraction allows an accurate assessment of refractive error, especially in children and other patients where accommodation can affect results.
Maddox Rod
Use of Maddox Rod
Method of Assessment MR
Double MR Test procedure
Recording procedure of MR Test
Heterophoria, Cyclophoria, Esophoria,Exophoria,Hyperphoria,Hypophoria
The document discusses various techniques for measuring intraocular pressure (IOP), including Goldmann applanation tonometry, Perkins tonometry, non-contact tonometry, and digital evaluation. Goldmann applanation tonometry is described as the most accurate method. The document provides details on properly using Goldmann tonometry, including preparing the patient, aligning the probe, applying the correct amount of force, and interpreting the results. Contraindications and sources of error are also reviewed.
This document discusses various refractive errors including astigmatism, aniseikonia, and anisometropia. It defines astigmatism as a refractive error where light fails to come to a single focus on the retina due to unequal refraction in different meridians. It describes the different types of regular and irregular astigmatism. Aniseikonia is defined as an anomaly of binocular vision where the ocular images are unequal in size or shape. Anisometropia is when the total refraction of the two eyes is unequal. The document discusses the symptoms, investigations, and treatment options for these refractive errors including spectacles, contact lenses, and refractive surgery.
How spectacle lenses are made.
In this section you will get the information about lens manufacturing (part 1),i.e, how lens blanks are manufactured and in lens surfacing (part 2) you will get the information about how lenses are surfaced and a finished lens is manufactured.
Cellulose acetate, nylon, and titanium are common materials used for eyeglass frames. Cellulose acetate is lightweight but can cause allergic reactions. Nylon is strong, flexible, and hypoallergenic. Titanium is very lightweight and strong, resistant to corrosion, and hypoallergenic, but more expensive than other materials. Other materials used include aluminum, stainless steel, gold, and plastic materials like polycarbonate. The ideal frame material is lightweight, strong, resistant to corrosion and breakage, non-flammable, inexpensive, durable, adjustable, and non-allergic.
Accommodation is the process by which the eye focuses on near objects. It occurs through changes in the shape and thickness of the elastic lens, induced by contraction of the ciliary muscle. The amplitude of accommodation is the difference between the near point and far point, measured in diopters. Accommodative ability peaks at around 10 years old and gradually declines with age. Presbyopia is the age-related loss of accommodation, causing difficulty with near vision. Other anomalies include insufficiency, spasm, paralysis and excessive accommodation, which can be caused by factors like refractive error, drugs, trauma or ocular disease. Assessment of accommodation involves measuring the near point, amplitude and facility of accommodation using tools like lenses, rulers and
This document discusses Contact Lens-Induced Acute Red Eye (CLARE), a sterile inflammatory reaction that causes redness, irritation, mild pain, and photophobia in one eye. It is characterized by redness at the limbus and sterile infiltrative keratitis without anterior chamber involvement or fluorescein staining. Potential causes include bacterial contamination, hypoxia, tight lens fit, or deposits on the lens. The document outlines symptoms, signs, etiology, examination techniques, differential diagnosis, prognosis, and management of CLARE.
Amblyopia is a condition of reduced vision in one or both eyes that is not caused by structural eye problems. It occurs during early childhood development when there is inadequate visual stimulation to one or both eyes. Common causes include strabismus, significant refractive error differences between the eyes, form deprivation, and abnormal binocular interaction. Treatment involves correcting any refractive errors and using occlusion therapy or drugs to blur vision in the non-amblyopic eye, forcing use of the amblyopic eye. Occlusion therapy is the most common treatment but requires compliance to achieve results. Other options include penalization, visual stimulation, and drugs, but occlusion remains the standard first approach. Success depends on early diagnosis and treatment before age 7.
This document provides an overview of contact lenses, including their history, uses, types, fitting parameters, and indications/contraindications. Some key points:
- The first contact lenses were developed in the late 1800s but were uncomfortable scleral lenses. Modern soft and rigid gas permeable lenses emerged later.
- Contact lenses are used for vision correction, therapy, prevention of eye issues, diagnosis, surgery assistance, cosmetic purposes, and occupations like sports or acting.
- Lens types include soft hydrogel lenses, silicone hydrogel lenses, rigid gas permeable lenses, and the now obsolete hard PMMA lenses. Parameters like material, diameter, base curve, and thickness must be selected properly.
This document summarizes various tests for binocular single vision. It describes three grades of binocular single vision - simultaneous perception, fusion, and stereopsis. It also discusses normal and abnormal retinal correspondence, diplopia, confusion, and suppression. Several tests are described that evaluate retinal correspondence, suppression, fusion, and stereopsis, including the Worth four-dot test, Bagolini striated glasses test, after image test, 4 prism base out test, and red filter test. The document provides details on administering and interpreting the results of these common binocular vision tests.
The document defines and describes various types of strabismus including tropia, phoria, comitant and incomitant deviations. It outlines the assessment of strabismus including taking a patient history, testing visual acuity, and performing an examination of motor and sensory status. The examination involves evaluating ocular alignment using tests such as cover testing, evaluating eye movements and fusion, and identifying suppression or abnormal retinal correspondence.
Glass and plastic are the main materials used for ophthalmic lenses. Glass is referred to as mineral lenses while plastic is organic material. Crown glass is commonly used with an index of 1.523. High-index glass up to 1.90 is available to reduce lens thickness. Plastic lenses like CR-39 and polycarbonate are lighter than glass. Other plastics include Trivex and NXT Material 2. Lenses can be made of multiple layers through lamination. Key optical properties of lenses include Abbe value, reflectance, absorption, and refractive index. Important mechanical properties are specific gravity, impact resistance, and scratch resistance. Lens design is determined by the base curve selection.
Cycloplegia is the paralysis of the ciliary muscle resulting in the loss of accommodation. Cycloplegic agents cause cycloplegia by blocking the muscarinic receptors in the eye. Cyclopentolate is commonly used for routine cycloplegic refraction in children and adults due to its fast onset and relatively short duration. Cycloplegic refraction is used to objectively determine refractive error when accommodation is paralyzed, and is indicated for young children with suspected latent hyperopia or accommodative esotropia. Cycloplegia is considered complete for refraction when a dilated pupil and no residual accommodation is detected via push-up test.
The trial case contains spherical and cylindrical lenses of known power ranging from +0.12D to -20.00D for spherical lenses and +0.25D to -6.00D for cylindrical lenses. It also includes prisms up to 10 prism diopters, trial frames, occluders, pinholes, filters, and other accessories used to perform refraction tests and examinations.
Graves' ophthalmopathy, also known as thyroid eye disease, is an inflammatory disorder affecting the eye muscles and surrounding tissues that is associated with Graves' disease and hyperthyroidism. Symptoms include bulging or protruding eyes, eyelid retraction, double vision, and potential vision loss if left untreated. The condition results from antibodies that cause swelling of eye muscles and tissues. Diagnosis involves examination of the eyes and imaging tests. Treatment focuses on medications and surgery to reduce swelling and pressure on the eyes.
Accommodation anomalies can occur due to various causes and present with different symptoms. Assessment involves dynamic retinoscopy and measuring accommodation amplitudes. Accommodative fatigue can result from overuse and be treated by correcting refractive errors and discussing visual hygiene. Presbyopia is age-related and treated with near vision correction. Other failures of accommodation include insufficiency, paralysis, spasm, and sustained accommodation, each with different etiologies, signs, and treatments.
The document discusses various methods of dynamic retinoscopy that have been developed over time to objectively measure the accommodative response and lag of accommodation. Some of the key methods mentioned include Cross method, Sheard's method, Tait's method, Monocular Estimate method, Nott dynamic retinoscopy, Bell retinoscopy, and stress point retinoscopy. The document also discusses the typical lag of accommodation values found in studies and how lags can indicate problems with accommodation.
This document discusses low vision and provides definitions, classifications, common causes, and management strategies.
[1] Low vision is defined as visual impairment even after treatment that results in visual acuity worse than 6/18 but ability to use vision. It can be caused by conditions like macular degeneration, retinitis pigmentosa, cataract, and glaucoma.
[2] Low vision affects people's ability to perform visual tasks and can cause blurry or decreased vision, loss of peripheral vision, and light sensitivity. Evaluation involves assessing vision and goals, while management includes low vision devices and counseling.
[3] Common low vision devices include telescopes, magnifiers, and electronic
(1) Accommodation is the mechanism by which the eye changes refractive power by altering the shape of the lens to focus on objects at different distances.
(2) Theories of accommodation include the relaxation theory of Helmholtz which proposes that contraction of the ciliary muscle relaxes the suspensory ligaments of the lens allowing it to take on a more spherical shape.
(3) Accommodative anomalies include decreased accommodation seen in presbyopia and other conditions, as well as increased accommodation seen in conditions like accommodative excess or spasm.
The synoptophore is an ophthalmic instrument used to diagnose and treat imbalances of the eye muscles. It consists of two cylindrical tubes with mirrored bends that allow pictures to be presented simultaneously to both eyes, compensating for any angle of squint. It is used to investigate binocular function in patients with a manifest squint, detect suppression and abnormal retinal correspondence, and measure horizontal, vertical and torsional misalignments. The synoptophore can test for three grades of binocular vision - simultaneous perception, fusion, and stereopsis - and detect whether a patient has normal or abnormal retinal correspondence based on differences between subjective and objective angles of squint.
Glaucoma is a group of eye diseases that cause damage to the optic nerve and vision loss. It is often associated with increased pressure inside the eye. The most common type is open-angle glaucoma, which has no pain and gradual vision loss. Left untreated, glaucoma can lead to permanent vision loss and blindness. Treatment aims to prevent further vision loss and damage to the optic nerve through lowering eye pressure with eye drops or surgery. Glaucoma is a leading cause of blindness worldwide.
Glaucoma is a group of diseases characterized by optic neuropathy and visual field loss caused by elevated intraocular pressure. The document discusses the various types of glaucoma including open-angle glaucoma, angle-closure glaucoma, and childhood glaucoma. It covers topics such as the definition and classification of glaucoma, risk factors, clinical evaluation including measurement of intraocular pressure and examination of the optic nerve and visual fields, and medical and surgical treatment options.
This document discusses various refractive errors including astigmatism, aniseikonia, and anisometropia. It defines astigmatism as a refractive error where light fails to come to a single focus on the retina due to unequal refraction in different meridians. It describes the different types of regular and irregular astigmatism. Aniseikonia is defined as an anomaly of binocular vision where the ocular images are unequal in size or shape. Anisometropia is when the total refraction of the two eyes is unequal. The document discusses the symptoms, investigations, and treatment options for these refractive errors including spectacles, contact lenses, and refractive surgery.
How spectacle lenses are made.
In this section you will get the information about lens manufacturing (part 1),i.e, how lens blanks are manufactured and in lens surfacing (part 2) you will get the information about how lenses are surfaced and a finished lens is manufactured.
Cellulose acetate, nylon, and titanium are common materials used for eyeglass frames. Cellulose acetate is lightweight but can cause allergic reactions. Nylon is strong, flexible, and hypoallergenic. Titanium is very lightweight and strong, resistant to corrosion, and hypoallergenic, but more expensive than other materials. Other materials used include aluminum, stainless steel, gold, and plastic materials like polycarbonate. The ideal frame material is lightweight, strong, resistant to corrosion and breakage, non-flammable, inexpensive, durable, adjustable, and non-allergic.
Accommodation is the process by which the eye focuses on near objects. It occurs through changes in the shape and thickness of the elastic lens, induced by contraction of the ciliary muscle. The amplitude of accommodation is the difference between the near point and far point, measured in diopters. Accommodative ability peaks at around 10 years old and gradually declines with age. Presbyopia is the age-related loss of accommodation, causing difficulty with near vision. Other anomalies include insufficiency, spasm, paralysis and excessive accommodation, which can be caused by factors like refractive error, drugs, trauma or ocular disease. Assessment of accommodation involves measuring the near point, amplitude and facility of accommodation using tools like lenses, rulers and
This document discusses Contact Lens-Induced Acute Red Eye (CLARE), a sterile inflammatory reaction that causes redness, irritation, mild pain, and photophobia in one eye. It is characterized by redness at the limbus and sterile infiltrative keratitis without anterior chamber involvement or fluorescein staining. Potential causes include bacterial contamination, hypoxia, tight lens fit, or deposits on the lens. The document outlines symptoms, signs, etiology, examination techniques, differential diagnosis, prognosis, and management of CLARE.
Amblyopia is a condition of reduced vision in one or both eyes that is not caused by structural eye problems. It occurs during early childhood development when there is inadequate visual stimulation to one or both eyes. Common causes include strabismus, significant refractive error differences between the eyes, form deprivation, and abnormal binocular interaction. Treatment involves correcting any refractive errors and using occlusion therapy or drugs to blur vision in the non-amblyopic eye, forcing use of the amblyopic eye. Occlusion therapy is the most common treatment but requires compliance to achieve results. Other options include penalization, visual stimulation, and drugs, but occlusion remains the standard first approach. Success depends on early diagnosis and treatment before age 7.
This document provides an overview of contact lenses, including their history, uses, types, fitting parameters, and indications/contraindications. Some key points:
- The first contact lenses were developed in the late 1800s but were uncomfortable scleral lenses. Modern soft and rigid gas permeable lenses emerged later.
- Contact lenses are used for vision correction, therapy, prevention of eye issues, diagnosis, surgery assistance, cosmetic purposes, and occupations like sports or acting.
- Lens types include soft hydrogel lenses, silicone hydrogel lenses, rigid gas permeable lenses, and the now obsolete hard PMMA lenses. Parameters like material, diameter, base curve, and thickness must be selected properly.
This document summarizes various tests for binocular single vision. It describes three grades of binocular single vision - simultaneous perception, fusion, and stereopsis. It also discusses normal and abnormal retinal correspondence, diplopia, confusion, and suppression. Several tests are described that evaluate retinal correspondence, suppression, fusion, and stereopsis, including the Worth four-dot test, Bagolini striated glasses test, after image test, 4 prism base out test, and red filter test. The document provides details on administering and interpreting the results of these common binocular vision tests.
The document defines and describes various types of strabismus including tropia, phoria, comitant and incomitant deviations. It outlines the assessment of strabismus including taking a patient history, testing visual acuity, and performing an examination of motor and sensory status. The examination involves evaluating ocular alignment using tests such as cover testing, evaluating eye movements and fusion, and identifying suppression or abnormal retinal correspondence.
Glass and plastic are the main materials used for ophthalmic lenses. Glass is referred to as mineral lenses while plastic is organic material. Crown glass is commonly used with an index of 1.523. High-index glass up to 1.90 is available to reduce lens thickness. Plastic lenses like CR-39 and polycarbonate are lighter than glass. Other plastics include Trivex and NXT Material 2. Lenses can be made of multiple layers through lamination. Key optical properties of lenses include Abbe value, reflectance, absorption, and refractive index. Important mechanical properties are specific gravity, impact resistance, and scratch resistance. Lens design is determined by the base curve selection.
Cycloplegia is the paralysis of the ciliary muscle resulting in the loss of accommodation. Cycloplegic agents cause cycloplegia by blocking the muscarinic receptors in the eye. Cyclopentolate is commonly used for routine cycloplegic refraction in children and adults due to its fast onset and relatively short duration. Cycloplegic refraction is used to objectively determine refractive error when accommodation is paralyzed, and is indicated for young children with suspected latent hyperopia or accommodative esotropia. Cycloplegia is considered complete for refraction when a dilated pupil and no residual accommodation is detected via push-up test.
The trial case contains spherical and cylindrical lenses of known power ranging from +0.12D to -20.00D for spherical lenses and +0.25D to -6.00D for cylindrical lenses. It also includes prisms up to 10 prism diopters, trial frames, occluders, pinholes, filters, and other accessories used to perform refraction tests and examinations.
Graves' ophthalmopathy, also known as thyroid eye disease, is an inflammatory disorder affecting the eye muscles and surrounding tissues that is associated with Graves' disease and hyperthyroidism. Symptoms include bulging or protruding eyes, eyelid retraction, double vision, and potential vision loss if left untreated. The condition results from antibodies that cause swelling of eye muscles and tissues. Diagnosis involves examination of the eyes and imaging tests. Treatment focuses on medications and surgery to reduce swelling and pressure on the eyes.
Accommodation anomalies can occur due to various causes and present with different symptoms. Assessment involves dynamic retinoscopy and measuring accommodation amplitudes. Accommodative fatigue can result from overuse and be treated by correcting refractive errors and discussing visual hygiene. Presbyopia is age-related and treated with near vision correction. Other failures of accommodation include insufficiency, paralysis, spasm, and sustained accommodation, each with different etiologies, signs, and treatments.
The document discusses various methods of dynamic retinoscopy that have been developed over time to objectively measure the accommodative response and lag of accommodation. Some of the key methods mentioned include Cross method, Sheard's method, Tait's method, Monocular Estimate method, Nott dynamic retinoscopy, Bell retinoscopy, and stress point retinoscopy. The document also discusses the typical lag of accommodation values found in studies and how lags can indicate problems with accommodation.
This document discusses low vision and provides definitions, classifications, common causes, and management strategies.
[1] Low vision is defined as visual impairment even after treatment that results in visual acuity worse than 6/18 but ability to use vision. It can be caused by conditions like macular degeneration, retinitis pigmentosa, cataract, and glaucoma.
[2] Low vision affects people's ability to perform visual tasks and can cause blurry or decreased vision, loss of peripheral vision, and light sensitivity. Evaluation involves assessing vision and goals, while management includes low vision devices and counseling.
[3] Common low vision devices include telescopes, magnifiers, and electronic
(1) Accommodation is the mechanism by which the eye changes refractive power by altering the shape of the lens to focus on objects at different distances.
(2) Theories of accommodation include the relaxation theory of Helmholtz which proposes that contraction of the ciliary muscle relaxes the suspensory ligaments of the lens allowing it to take on a more spherical shape.
(3) Accommodative anomalies include decreased accommodation seen in presbyopia and other conditions, as well as increased accommodation seen in conditions like accommodative excess or spasm.
The synoptophore is an ophthalmic instrument used to diagnose and treat imbalances of the eye muscles. It consists of two cylindrical tubes with mirrored bends that allow pictures to be presented simultaneously to both eyes, compensating for any angle of squint. It is used to investigate binocular function in patients with a manifest squint, detect suppression and abnormal retinal correspondence, and measure horizontal, vertical and torsional misalignments. The synoptophore can test for three grades of binocular vision - simultaneous perception, fusion, and stereopsis - and detect whether a patient has normal or abnormal retinal correspondence based on differences between subjective and objective angles of squint.
Glaucoma is a group of eye diseases that cause damage to the optic nerve and vision loss. It is often associated with increased pressure inside the eye. The most common type is open-angle glaucoma, which has no pain and gradual vision loss. Left untreated, glaucoma can lead to permanent vision loss and blindness. Treatment aims to prevent further vision loss and damage to the optic nerve through lowering eye pressure with eye drops or surgery. Glaucoma is a leading cause of blindness worldwide.
Glaucoma is a group of diseases characterized by optic neuropathy and visual field loss caused by elevated intraocular pressure. The document discusses the various types of glaucoma including open-angle glaucoma, angle-closure glaucoma, and childhood glaucoma. It covers topics such as the definition and classification of glaucoma, risk factors, clinical evaluation including measurement of intraocular pressure and examination of the optic nerve and visual fields, and medical and surgical treatment options.
The Ocular Hypertension Treatment Study (OHTS) was a landmark randomized controlled trial that showed treating patients with ocular hypertension reduced the risk of developing primary open-angle glaucoma by more than 50% compared to observation alone. Increased risk factors for developing glaucoma included older age, larger cup-to-disc ratios, higher baseline intraocular pressure, and thinner central corneal thickness. The Early Manifest Glaucoma Trial found that treating newly diagnosed glaucoma patients lowered their intraocular pressure by 25% on average and reduced the risk of visual field progression by about 20% compared to no treatment. The Collaborative Initial Glaucoma Treatment Study found that both medical and surgical treatment were effective for initially lowering intra
Glaucoma describes conditions characterized by raised intraocular pressure, optic nerve damage, and visual field loss. It is one of the leading causes of blindness worldwide. Primary open-angle glaucoma is the most common type, where the anterior chamber angle remains open and there is no identifiable cause for optic nerve damage other than statistically elevated pressure. It is typically asymptomatic until late in the disease when significant vision has already been lost. Treatment aims to lower pressure sufficiently to stop further visual field loss and involves topical eye drops or surgery.
El documento resume la información sobre el glaucoma, incluyendo que es la segunda causa de ceguera en el mundo, afecta a alrededor de 70 millones de personas y es más frecuente en personas mayores de 40 años. Explica los diferentes tipos de glaucoma, factores de riesgo, exámenes para diagnosticarlo, tratamientos médicos y quirúrgicos, y daños que puede causar si no es tratado, llevando a la ceguera irreversible.
Glaucoma is caused by increased pressure in the eye (intraocular pressure) that damages the optic nerve and causes vision loss. It can be primary open-angle glaucoma, angle-closure glaucoma, congenital glaucoma, secondary glaucoma, pigmentary glaucoma, or normal tension glaucoma. Diagnosis involves tests of eye pressure, optic nerve examination, and visual field tests. Treatment options include eye medications, laser surgery, and filtration surgery to manage pressure and slow vision loss.
Glaucoma is a group of diseases characterized by progressive damage to the optic nerve and vision loss. It is typically associated with increased pressure within the eye (intraocular pressure). The document discusses the anatomy of the eye and how fluid circulates to maintain normal pressure. It defines glaucoma and describes the two main types: open-angle and angle-closure glaucoma. Treatment aims to reduce intraocular pressure through various eye drops and surgeries to prevent further optic nerve damage and vision loss from glaucoma.
Glaucoma is a neurodegenerative eye condition characterized by increased intraocular pressure that can cause progressive vision loss and blindness if left untreated. It is the second leading cause of blindness worldwide. Treatment aims to lower intraocular pressure through prescription eye drops, oral medications, laser therapy, surgery, or a combination of approaches to slow or prevent further vision loss. Regular eye exams are important for early detection and treatment monitoring to help preserve sight.
This document provides an overview of HEENT disorders therapeutics, focusing on glaucoma. It defines glaucoma and discusses the two main types: open-angle glaucoma and closed-angle glaucoma. For each type, it covers risk factors, pathophysiology, clinical presentation, diagnosis, and treatment goals and approaches. Treatment typically begins with medications to lower intraocular pressure and may progress to laser therapy or surgery if medication is not effective. The document provides detailed information on evaluating and managing both chronic open-angle glaucoma and acute angle-closure glaucoma.
Prevalence and treatment pattern of GlaucomaASRAF SOHEL
This document is a thesis submitted by a student to partially fulfill the requirements for a B.Pharm degree. It examines the prevalence and treatment patterns of glaucoma through a questionnaire survey of 100 glaucoma patients across three hospitals in Dhaka, Bangladesh from March to December 2018. The student finds that the most common symptoms reported were halos around lights and sudden visual disturbances. Most patients were over 48 years old. The most commonly prescribed medications for glaucoma were hyperosmotic agents, while prostaglandin analogues were the least prescribed. The thesis concludes that glaucoma remains a major public health issue in Bangladesh and increased awareness of its diagnosis and treatment is needed.
This document discusses glaucoma, defining it as an eye disease characterized by loss of retinal ganglion cells and their axons caused by increased intraocular pressure. It is the leading cause of irreversible blindness. There are two main types - open angle glaucoma, the most common type, and angle closure glaucoma. Diagnosis involves measuring intraocular pressure and examining the optic nerve and visual field. Treatment options include eye drop medications, laser treatments, and surgeries like trabeculectomy to improve fluid drainage from the eye. Nursing care focuses on managing pain, allaying fears, and educating patients.
INTRODUCTION
ETIOLOGY
RISK FACTORS
PATHOPHYSIOLOGY
CLASSIFICATION
CLINICAL FEATURES
DIAGNOSTIC MEASURES
MANAGEMENT
Medical
Surgical
Nursing
CONCLUSION
BIBLIOGRAPHY
POST TEST
This document summarizes a veterinary case involving a 4-year-old female donkey named Javed Ali brought in for glaucoma treatment. Glaucoma is an eye disorder caused by increased fluid pressure in the eye that damages the optic nerve and can lead to blindness if untreated. The donkey was prescribed Batinisol eye drops to treat its glaucoma. The case was submitted by veterinarian Zakir Hussain.
The document discusses glaucoma, a group of eye disorders characterized by optic nerve damage and vision loss caused by increased intraocular pressure. It defines glaucoma and describes the main types: open-angle glaucoma, angle-closure glaucoma, normal-tension glaucoma, and congenital glaucoma. Risk factors, clinical features, diagnostic evaluation, medical and surgical management, complications, prognosis, and nursing management are outlined. The presentation concludes with a research abstract on glaucoma and a bibliography.
This document provides guidelines and information on glaucoma. It begins by outlining the preferred practice patterns for open angle glaucoma by the AAO and Canadian glaucoma guidelines. It then defines primary open-angle glaucoma and discusses clinical objectives such as monitoring optic nerve structure and function. Risk factors like elevated IOP, age, family history and type 2 diabetes are examined. The diagnostic process involving tests like visual fields, pachymetry and optic nerve imaging is summarized. Examination techniques like gonioscopy and optic nerve evaluation are also overviewed.
Glaucoma is always a chronic, long term disease.
Glaucoma is always associated with some damage to the optic nerve and often a related change in the visual field.
Overview of glaucoma from an engineering perspective for ophthalmologic technology used for diagnosis, disease management and eventually for personalized medicine.
External download link: https://www.dropbox.com/s/i7qmd5ecj8c247x/glaucoma_overview.pdf?dl=0
This document discusses various causes of unilateral and bilateral optic disc edema. For unilateral edema, the most common causes are NAION, optic neuritis, and orbital compressive lesions. Bilateral edema is often due to papilledema caused by increased intracranial pressure. Other possible causes discussed include infections, inflammatory conditions, compressive lesions, radiation effects, and genetic disorders like LHON. The document provides details on characteristics, diagnostic criteria, treatment approaches, and prognosis for each condition.
This document provides information about glaucoma, including its etiology, pathophysiology, clinical manifestations, types, and treatment options. It begins with an introduction to glaucoma as a group of disorders characterized by optic nerve damage and vision loss associated with increased intraocular pressure. The document then discusses the etiology and pathophysiology of glaucoma, describing how increased pressure damages the optic nerve. It outlines the clinical signs and symptoms of various types of glaucoma and concludes by explaining non-pharmacological and pharmacological treatment approaches that aim to lower intraocular pressure and prevent further vision loss.
Glaucoma: the “silent thief of sight”
Glaucoma is a leading cause of preventable sight loss. Vision can often be preserved with early identification, good adherence to treatment and long-term monitoring.
This document discusses various types of glaucoma including primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), and ocular hypertension. It defines these conditions and describes their signs, risk factors, treatments, and etiologies. POAG is the most common type and usually presents with asymptomatic, progressively worsening vision loss and characteristic optic nerve cupping. Risk factors include older age, family history, and elevated intraocular pressure (IOP). NTG is similar to POAG but occurs in patients with normal IOP. The cause is believed to involve vascular dysregulation but lowering IOP remains important for treatment and prevention of progression. Ocular hypertension refers to elevated IOP without optic nerve
This document provides information about glaucoma treatment from Dr. Michael Duplessie of Taiba Hospital. It discusses what glaucoma is, who is at risk, types of glaucoma, and treatments including eye drops, laser treatment, and microsurgery. Dr. Duplessie has performed over 10,000 cataract surgeries and 30,000 LASIK surgeries, and organized several major ophthalmology courses and conferences worldwide.
1. Glaucoma is a group of eye conditions characterized by optic nerve damage and vision loss due to increased pressure in the eye. The increased pressure damages the optic nerve, leading to blindness if not treated.
2. There are several types of glaucoma including open-angle glaucoma, which is the most common type, as well as angle-closure, normal tension, and congenital glaucoma.
3. Glaucoma is diagnosed through tests such as tonometry, ophthalmoscopy, visual field tests, and imaging of the optic nerve. Treatment options include eye drop medications to lower pressure, laser treatments, and surgeries like trabeculectomy to drain fluid from the eye
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Tests for analysis of different pharmaceutical.pptx
Glaucoma
1. Glaucoma is a disease in which the optic nerve is damaged, leading to progressive, irreversible loss of vision. It is often, but not always, associated with increased pressure of the fluid in the eye.[1]<br />The nerve damage involves loss of retinal ganglion cells in a characteristic pattern. There are many different sub-types of glaucoma but they can all be considered as a type of optic neuropathy. Raised intraocular pressure is a significant risk factor for developing glaucoma (above 22 mmHg or 2.9 kPa). One person may develop nerve damage at a relatively low pressure, while another person may have high eye pressure for years and yet never develop damage. Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress toblindness.<br />Glaucoma can be divided roughly into two main categories, quot;
open anglequot;
and quot;
closed anglequot;
glaucoma. Closed angle glaucoma can appear suddenly and is often painful; visual loss can progress quickly but the discomfort often leads patients to seek medical attention before permanent damage occurs. Open angle, chronic glaucoma tends to progress more slowly and the patient may not notice that they have lost vision until the disease has progressed significantly.<br />Glaucoma has been nicknamed the quot;
sneak thief of sightquot;
because the loss of vision normally occurs gradually over a long period of time and is often only recognized when the disease is quite advanced. Once lost, this damaged visual field can never be recovered. Worldwide, it is the second leading cause of blindness.[2] It is also the first leading cause of blindness among African Americans.[3] Glaucoma affects 1 in 200 people aged fifty and younger, and 1 in 10 over the age of eighty. If the condition is detected early enough it is possible to arrest the development or slow the progression with medical and surgical means.<br />Signs and symptoms<br />There are rarely any symptoms in the early stages of the disease so regular eye checks by qualified professionals are important. Ophthalmologists and optometrists will diagnose glaucoma on the basis of intraocular pressure, visual field tests and optic nerve head appearance.<br />Patients will sometimes notice patchy loss of peripheral vision or reduced clarity of colours and these people may benefit from a review by an eye specialist.<br />Symptoms of angle closure glaucoma can include pain in or around the eye ball, headache, nausea/vomiting and visual disturbances, for example halos around lights. In some cases there are no symptoms.<br />[edit]Pathophysiology<br />The major risk factor for most glaucomas and focus of treatment is increased intraocular pressure. Intraocular pressure is a function of production of liquid aqueous humor by the ciliary processes of the eye and its drainage through the trabecular meshwork. Aqueous humor flows from the ciliary processes into the posterior chamber, bounded posteriorly by the lens and the zonules of Zinn and anteriorly by the iris. It then flows through the pupil of the iris into the anterior chamber, bounded posteriorly by the iris and anteriorly by the cornea. From here the trabecular meshwork drains aqueous humor via Schlemm's canal into scleral plexuses and general blood circulation.[4] In open angle glaucoma there is reduced flow through the trabecular meshwork;[5] in angle closure glaucoma, the iris is pushed forward against the trabecular meshwork, blocking fluid from escaping.<br />The inconsistent relationship of glaucomatous optic neuropathy with ocular hypertension has provoked hypotheses and studies on anatomic structure, eye development, nerve compression trauma, optic nerve blood flow, excitatory neurotransmitter, trophic factor, retinal ganglion cell/axon degeneration, glial support cell, immune, and aging mechanisms of neuron loss.[6][7][8][9][10][11][12][13][14][15][16]<br />The major types of glaucoma are discussed below.<br />Causes<br />Ocular hypertension (increased pressure within the eye) is the largest risk factor in most glaucomas, but in some populations. Only 50% of patients with primary open angle glaucoma actually have elevated ocular pressure.[17]<br />Those of African descent are three times more likely to develop primary open angle glaucoma. People who are older have thinner corneal thickness and often suffer from myopia. They are also at higher risk for primary open angle glaucoma. People with a family history of glaucoma have about six percent chance of developing glaucoma.<br />Many East Asian groups are prone to developing angle closure glaucoma due to their shallower anterior chamber depth, with the majority of cases of glaucoma in this population consisting of some form of angle closure.[18] Inuit also have a twenty to forty times higher risk than Caucasians of developing primary angle closure glaucoma. Women are three times more likely than men to develop acute angle-closure glaucoma due to their shallower anterior chambers.<br />Other factors can cause glaucoma, known as quot;
secondary glaucomas,quot;
including prolonged use of steroids (steroid-induced glaucoma); conditions that severely restrict blood flow to the eye, such as severe diabetic retinopathy and central retinal vein occlusion (neovascular glaucoma); ocular trauma (angle recession glaucoma); and uveitis (uveitic glaucoma).<br />Primary open angle glaucoma (POAG) has been found to be associated with mutations in genes at several loci.[19] Normal tension glaucoma, which comprises one third of POAG, is associated with genetic mutations.[20]<br />There is increasing evidence that ocular blood flow is involved in the pathogenesis of glaucoma. Current data indicate that fluctuations in blood flow are more harmful in glaucomatous optic neuropathy than steady reductions. Unstable blood pressure and dips are linked to optic nerve head damage and correlate with visual field deterioration.<br />A number of studies also suggest a possible correlation between hypertension and the development of glaucoma. In normal tension glaucoma, nocturnal hypotension may play a significant role.<br />There is no clear evidence that vitamin deficiencies cause glaucoma in humans. It follows then that oral vitamin supplementation is probably not useful in glaucoma treatment.[21]<br />Various rare congenital/genetic eye malformations are associated with glaucoma. Occasionally, failure of the normal third trimester gestational atrophy of the hyaloid canal and the tunica vasculosa lentis is associated with other anomalies. Angle closure induced ocular hypertension and glaucomatous optic neuropathy may also occur with these anomalies.[22][23][24] and modelled in mice [25].<br />Those at risk for glaucoma are advised to have a dilated eye examination at least once a year.[26]<br />[edit]Diagnosis<br />Screening for glaucoma is usually performed as part of a standard eye examination performed by ophthalmologists and optometrists. Testing for glaucoma should include measurements of the intraocular pressure via tonometry, changes in size or shape of the eye, anterior chamber angle examination or gonioscopy, and examination of the optic nerve to look for any visible damage to it, or change in the cup-to-disc ratio and also rim appearance and vascular change. A formal visual field test should be performed. The retinal nerve fiber layer can be assessed with imaging techniques such as optical coherence tomography (OCT), scanning laser polarimetry (GDx), and/or scanning laser ophthalmoscopy also known as Heidelberg Retina Tomography (HRT3).[27][28] Owing to the sensitivity of all methods of tonometry to corneal thickness, methods such asGoldmann tonometry should be augmented with pachymetry to measure central corneal thickness (CCT). A thicker-than-average cornea can result in a pressure reading higher than the 'true' pressure, whereas a thinner-than-average cornea can produce a pressure reading lower than the 'true' pressure. Because pressure measurement error can be caused by more than just CCT (i.e, corneal hydration, elastic properties, etc.), it is impossible to 'adjust' pressure measurements based only on CCT measurements. The Frequency Doubling Illusion can also be used to detect glaucoma with the use of a Frequency Doubling Technology (FDT) perimeter.[29] Examination for glaucoma also could be assessed with more attention given to sex, race, history of drugs use, refraction, inheritance and family history.[27]<br />[edit]Management<br />The modern goals of glaucoma management are to avoid glaucomatous damage, nerve damage, preserve visual field and total quality of life for patients with minimal side effects.[30][31] This requires appropriate diagnostic techniques and follow up examinations and judicious selection of treatments for the individual patient. Although intraocular pressure is only one of the major risk factors for glaucoma, lowering it via various pharmaceuticals and/or surgical techniques is currently the mainstay of glaucoma treatment. Vascular flow and neurodegenerative theories of glaucomatous optic neuropathy have prompted studies on various neuroprotective therapeutic strategies including nutritional compounds some of which may be regarded by clinicians as safe for use now, while others are on trial.<br />[edit]Medication<br />Intraocular pressure can be lowered with medication, usually eye drops. There are several different classes of medications to treat glaucoma with several different medications in each class.<br />Each of these medicines may have local and systemic side effects. Adherence to medication protocol can be confusing and expensive; if side effects occur, the patient must be willing either to tolerate these, or to communicate with the treating physician to improve the drug regimen. Initially, glaucoma drops may reasonably be started in either one or in both eyes.[32]<br />Poor compliance with medications and follow-up visits is a major reason for vision loss in glaucoma patients. A 2003 study of patients in an HMO found that half failed to fill their prescription the first time and one in four failed to refill their prescriptions a second time.[33] Patient education and communication must be ongoing to sustain successful treatment plans for this lifelong disease with no early symptoms.<br />The possible neuroprotective effects of various topical and systemic medications are also being investigated.[21][34][35][36]<br />[edit]Commonly used medications<br />Prostaglandin analogs like latanoprost (Xalatan), bimatoprost (Lumigan) and travoprost (Travatan) increase uveoscleral outflow of aqueous humor. Bimatoprost also increases trabecular outflow<br />Topical beta-adrenergic receptor antagonists such as timolol, levobunolol (Betagan), and betaxolol decrease aqueous humor production by the ciliary body.<br />Alpha2-adrenergic agonists such as brimonidine (Alphagan) work by a dual mechanism, decreasing aqueous production and increasing trabecular outflow.<br />Less-selective sympathomimetics like epinephrine and dipivefrin (Propine) increase outflow of aqueous humor through trabecular meshwork and possibly through uveoscleral outflow pathway, probably by a beta2-agonist action.<br />Miotic agents (parasympathomimetics) like pilocarpine work by contraction of the ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of the aqueous humour. Ecothiopate is used in chronic glaucoma.<br />Carbonic anhydrase inhibitors like dorzolamide (Trusopt), brinzolamide (Azopt), acetazolamide (Diamox) lower secretion of aqueous humor by inhibiting carbonic anhydrase in the ciliary body.<br />Physostigmine is also used to treat glaucoma and delayed gastric emptying.<br />[edit]Surgery<br />Conventional surgery to treat glaucoma makes a new opening in the meshwork. This new opening helps fluid to leave the eye and lowers intraocular pressure.<br />Main article: Glaucoma surgery<br />Both laser and conventional surgeries are performed to treat glaucoma.<br />Surgery is the primary therapy for those with congenital glaucoma.[37]<br />Generally, these operations are a temporary solution, as there is not yet a cure for glaucoma.<br />[edit]Canaloplasty<br />Canaloplasty is a nonpenetrating procedure utilizing microcatheter technology. To perform a canaloplasty, an incision is made into the eye to gain access to Schlemm's canal in a similar fashion to a viscocanalostomy. A microcatheter will circumnavigate the canal around the iris, enlarging the main drainage channel and its smaller collector channels through the injection of a sterile, gel-like material called viscoelastic. The catheter is then removed and a suture is placed within the canal and tightened. By opening the canal, the pressure inside the eye may be relieved, although the reason is unclear since the canal (of Schlemm) does not have any significant fluid resistance in glaucoma or healthy eyes. Long-term results are not available.[38][39]<br />[edit]Laser surgery<br />Laser trabeculoplasty may be used to treat open angle glaucoma. It is a temporary solution, not a cure. A 50 μm argon laser spot is aimed at the trabecular meshwork to stimulate opening of the mesh to allow more outflow of aqueous fluid. Usually, half of the angle is treated at a time. Traditional laser trabeculoplasty utilizes a thermal argon laser. The procedure is called Argon Laser Trabeculoplasty or ALT. A newer type of laser trabeculoplasty exists that uses a quot;
coldquot;
(non-thermal) laser to stimulate drainage in the trabecular meshwork. This newer procedure which uses a 532 nm frequency-doubled, Q-switched Nd:YAG laser which selectively targets melanin pigment in the trabecular meshwork cells, called Selective Laser Trabeculoplasty or SLT. Studies show that SLT is as effective as ALT at lowering eye pressure. In addition, SLT may be repeated three to four times, whereas ALT can usually be repeated only once.<br />Nd:YAG laser peripheral iridotomy (LPI) may be used in patients susceptible to or affected by angle closure glaucoma or pigment dispersion syndrome. During laser iridotomy, laser energy is used to make a small full-thickness opening in the iris. This opening equalizes the pressure between the front and back of the iris correcting any abnormal bulging of the iris. In people with narrow angles, this can uncover the trabecular meshwork. In some cases of intermittent or short-term angle closure this may lower the eye pressure. Laser iridotomy reduces the risk of developing an attack of acute angle closure. In most cases it also reduces the risk of developing chronic angle closure or of adhesions of the iris to the trabecular meshwork.<br />Diode laser cycloablation lowers IOP by reducing aqueous secretion by destroying secretory ciliary epithelium.[27]<br />[edit]Trabeculectomy<br />The most common conventional surgery performed for glaucoma is the trabeculectomy. Here, a partial thickness flap is made in the scleral wall of the eye, and a window opening made under the flap to remove a portion of the trabecular meshwork. The scleral flap is then sutured loosely back in place. This allows fluid to flow out of the eye through this opening, resulting in lowered intraocular pressure and the formation of a bleb or fluid bubble on the surface of the eye. Scarring can occur around or over the flap opening, causing it to become less effective or lose effectiveness altogether. One person can have multiple surgical procedures of the same or different types.<br />[edit]Glaucoma drainage implants<br />There are also several different glaucoma drainage implants. These include the original Molteno implant (1966), the Baerveldt tube shunt, or the valved implants, such as the Ahmed glaucoma valve implant or the ExPress Mini Shunt and the later generation pressure ridge Molteno implants. These are indicated for glaucoma patients not responding to maximal medical therapy, with previous failed guarded filtering surgery (trabeculectomy). The flow tube is inserted into the anterior chamber of the eye and the plate is implanted underneath the conjunctiva to allow flow of aqueous fluid out of the eye into a chamber called a bleb.<br />The first-generation Molteno and other non-valved implants sometimes require the ligation of the tube until the bleb formed is mildly fibrosed and water-tight[40] This is done to reduce postoperative hypotony—sudden drops in postoperative intraocular pressure (IOP).<br />Valved implants such as the Ahmed glaucoma valve attempt to control postoperative hypotony by using a mechanical valve.<br />The ongoing scarring over the conjunctival dissipation segment of the shunt may become too thick for the aqueous humor to filter through. This may require preventive measures using anti-fibrotic medication like 5-fluorouracil (5-FU) or mitomycin-C (during the procedure), or additional surgery. And for Glaucomatous painful Blind Eye and some cases of Glaucoma, Cyclocryotherapy for ciliary body ablation could be considered to be performed.[27]<br />[edit]Veterinary implant<br />TR BioSurgical has commercialized a new implant specifically for veterinary medicine, called TR-ClarifEYE. The implant consists of a new biomaterial, the STAR BioMaterial, which consists of silicone with a very precise homogenous pore size, a property which reduces fibrosis and improves tissue integration. The implant contains no valves and is placed completely within the eye without sutures. To date, it has demonstrated long term success (> 1yr) in a pilot study in medically refractory dogs with advanced glaucoma [41]<br />[edit]Laser assisted non penetrating deep sclerectomy<br />The most common surgical approach currently used for the treatment of glaucoma, is trabeculectomy, in which the sclera is punctured to alleviate inner eye pressure (IOP). Non-penetrating deep sclerectomy (NPDS) surgery is a similar but modified procedure, in which instead of puncturing the scleral wall, a patch of the sclera is skimmed to a level, upon which, percolation of liquid from the inner eye is achieved and thus alleviating IOP, without penetrating the eye. NPDS is demonstrated to cause a significantly less side effects than trabeculectomy.[citation needed] However, NPDS is performed manually and requires great skill to achieve a lengthy learning curve.[citation needed]<br />Laser assisted NPDS is the performance of NPDS with the use of a CO2 laser system. The laser-based system is self-terminating once the required scleral thickness and adequate drainage of the intra ocular fluid have been achieved. This self-regulation effect is achieved as the CO2laser essentially stops ablating as soon as it comes in contact with the intra-ocular percolated liquid, which occurs as soon as the laser reaches the optimal residual intact layer thickness.<br />Research<br />Advanced Glaucoma Intervention Study (AGIS) - large American National Eye Institute (NEI) sponsored study designed quot;
to assess the long-range outcomes of sequences of interventions involving trabeculectomy and argon laser trabeculoplasty in eyes that have failed initial medical treatment for glaucoma.quot;
It recommends different treatments based on race.<br />Early Manifest Glaucoma Trial (EMGT) -Another NEI study found that immediately treating people who have early stage glaucoma can delay progression of the disease.<br />Ocular Hypertension Treatment Study (OHTS) -NEI study findings: quot;
...Topical ocular hypotensive medication was effective in delaying or preventing onset of Primary Open Angle Glaucoma (POAG) in individuals with elevated Intraocular Pressure (IOP). Although this does not imply that all patients with borderline or elevated IOP should receive medication, clinicians should consider initiating treatment for individuals with ocular hypertension who are at moderate or high risk for developing POAG.quot;
<br />Blue Mountains Eye Study quot;
The Blue Mountains Eye Study was the first large population-based assessment of visual impairment and common eye diseases of a representative older Australian community sample.quot;
Risk factors for glaucoma and other eye disease were determined.<br />[edit]Compounds in research<br />Natural compounds<br />Natural compounds of research interest in glaucoma prevention or treatment include: fish oil and omega 3 fatty acids, bilberries, vitamin E,cannabinoids, carnitine, coenzyme Q10, curcurmin, Salvia miltiorrhiza, dark chocolate, erythropoietin, folic acid, Ginkgo biloba, Ginseng, L-glutathione, grape seed extract, green tea, magnesium, melatonin, methylcobalamin, N-acetyl-L cysteine, pycnogenols, resveratrol, quercetinand salt.[34][35][36] Magnesium, ginkgo, salt and fludrocortisone, are already used by some physicians.<br />Cannabis<br />Studies in the 1970s showed that marijuana, when smoked, effectively lowers intraocular pressure.[43] In an effort to determine whether marijuana, or drugs derived from marijuana, might be effective as a glaucoma treatment, the US National Eye Institute supported research studies from 1978 to 1984. These studies demonstrated that some derivatives of marijuana lowered intraocular pressure when administered orally, intravenously, or by smoking, but not when topically applied to the eye.<br />In 2003 the American Academy of Ophthalmology released a position statement which said that quot;
studies demonstrated that some derivatives of marijuana did result in lowering of IOP when administered orally, intravenously, or by smoking, but not when topically applied to the eye. The duration of the pressure-lowering effect is reported to be in the range of 3 to 4 hoursquot;
.[43][44]<br />However, the position paper qualified that by stating that marijuana was not more effective than prescription medications, stating that quot;
no scientific evidence has been found that demonstrates increased benefits and/or diminished risks of marijuana use to treat glaucoma compared with the wide variety of pharmaceutical agents now available.quot;
<br />The first patient in the United States federal government's Compassionate Investigational New Drug program, Robert Randall, was afflicted with glaucoma and had successfully fought charges of marijuana cultivation because it was deemed a medical necessity (U.S. v. Randall) in 1976.[45]<br />5-HT2A agonists<br />Peripherally selective 5-HT2A agonists such as the indazole derivative AL-34662 are currently under development and show significant promise in the treatment of glaucoma.[46][47]<br />[edit]Classification of glaucoma<br />Glaucoma has been classified into specific types:[48]<br />[edit]Primary glaucoma and its variants (H40.1-H40.2)<br />Primary glaucoma<br />Primary angle-closure glaucoma, also known as primary closed-angle glaucoma, narrow-angle glaucoma, pupil-block glaucoma, acute congestive glaucoma<br />Acute angle-closure glaucoma<br />Chronic angle-closure glaucoma<br />Intermittent angle-closure glaucoma<br />Superimposed on chronic open-angle closure glaucoma (quot;
combined mechanismquot;
- uncommon)<br />Primary open-angle glaucoma, also known as chronic open-angle glaucoma, chronic simple glaucoma, glaucoma simplex<br />High-tension glaucoma<br />Low-tension glaucoma<br />Variants of primary glaucoma<br />Pigmentary glaucoma<br />Exfoliation glaucoma, also known as pseudoexfoliative glaucoma or glaucoma capsulare<br />Primary angle-closure glaucoma - This is caused by contact between the iris and trabecular meshwork, which in turn obstructs outflow of the aqueous humor from the eye. This contact between iris and trabecular meshwork (TM) may gradually damage the function of the meshwork until it fails to keep pace with aqueous production, and the pressure rises. In over half of all cases, prolonged contact between iris and TM causes the formation of synechiae (effectively quot;
scarsquot;
). These cause permanent obstruction of aqueous outflow. In some cases, pressure may rapidly build up in the eye causing pain and redness (symptomatic, or so called quot;
acutequot;
angle-closure). In this situation the vision may become blurred, and halos may be seen around bright lights. Accompanying symptoms may include headache and vomiting. Diagnosis is made from physical signs and symptoms: pupils mid-dilated and unresponsive to light, cornea edematous (cloudy), reduced vision, redness, pain. However, the majority of cases are asymptomatic. Prior to very severe loss of vision, these cases can only be identified by examination, generally by an eye care professional. Once any symptoms have been controlled, the first line (and often definitive) treatment is laser iridotomy. This may be performed using either Nd:YAG or argon lasers, or in some cases by conventional incisional surgery. The goal of treatment is to reverse, and prevent, contact between iris and trabecular meshwork. In early to moderately advanced cases, iridotomy is successful in opening the angle in around 75% of cases. In the other 25% laser iridoplasty, medication (pilocarpine) or incisional surgery may be required.<br />Primary open-angle glaucoma - Optic nerve damage resulting in progressive visual field loss[49]. This is associated with increased pressure in the eye. Not all people with primary open-angle glaucoma have eye pressure that is elevated beyond normal, but decreasing the eye pressure further has been shown to stop progression even in these cases. The increased pressure is caused by trabecular blockage which is where the aqueous humor in the eye drains out. Because the microscopic passage ways are blocked, the pressure builds up in the eye and causes imperceptible very gradual vision loss. Peripheral vision is affected first but eventually the entire vision will be lost if not treated. Diagnosis is made by looking for cupping of the optic nerve. Prostoglandin agonists work by opening uveoscleral passageways. Beta blockers such as timolol, work by decreasing aqueous formation. Carbonic anhydrase inhibitors decrease bicarbonate formation from ciliary processes in the eye, thus decreasing formation of Aqueous humor. Parasympathetic analogs are drugs that work on the trabecular outflow by opening up the passageway and constricting the pupil. Alpha 2 agonists (brimonidine, apraclonidine) both decrease fluid production (via. inhibition of AC) and increase drainage.<br />[edit]Developmental glaucoma (Q15.0)<br />Developmental glaucoma<br />Primary congenital glaucoma<br />Infantile glaucoma<br />Glaucoma associated with hereditary of familial diseases<br />[edit]Secondary glaucoma (H40.3-H40.6)<br />Secondary glaucoma<br />Inflammatory glaucoma<br />Uveitis of all types<br />Fuchs heterochromic iridocyclitis<br />Phacogenic glaucoma<br />Angle-closure glaucoma with mature cataract<br />Phacoanaphylactic glaucoma secondary to rupture of lens capsule<br />Phacolytic glaucoma due to phacotoxic meshwork blockage<br />Subluxation of lens<br />Glaucoma secondary to intraocular hemorrhage<br />Hyphema<br />Hemolytic glaucoma, also known as erythroclastic glaucoma<br />Traumatic glaucoma<br />Angle recession glaucoma: Traumatic recession on anterior chamber angle<br />Postsurgical glaucoma<br />Aphakic pupillary block<br />Ciliary block glaucoma<br />Neovascular glaucoma (see below for more details)<br />Drug-induced glaucoma<br />Corticosteroid induced glaucoma<br />Alpha-chymotrypsin glaucoma. Postoperative ocular hypertension from use of alpha chymotrypsin.<br />Glaucoma of miscellaneous origin<br />Associated with intraocular tumors<br />Associated with retinal detachments<br />Secondary to severe chemical burns of the eye<br />Associated with essential iris atrophy<br />Toxic Glaucoma<br />Neovascular glaucoma is an uncommon type of glaucoma that is difficult or nearly impossible to treat. This condition is often caused by proliferative diabetic retinopathy (PDR) or central retinal vein occlusion (CRVO). It may also be triggered by other conditions that result inischemia of the retina or ciliary body. Individuals with poor blood flow to the eye are highly at risk for this condition.<br />Neovascular glaucoma results when new, abnormal vessels begin developing in the angle of the eye that begin blocking the drainage. Patients with such condition begin to rapidly lose their eyesight. Sometimes, the disease appears very rapidly, specially after cataract surgery procedure. A new treatment for this disease, as first reported by Kahook and colleagues, involves use of a novel group of medications known as Anti-VEGF agents. These injectable medications can lead to a dramatic decrease in new vessel formation and, if injected early enough in the disease process, may lead to normalization of intraocular pressure.<br />Toxic glaucoma is open angle glaucoma with an unexplained significant rise of intraocular pressure following unknown pathogenesis. Intraocular pressure can sometimes reach 80 mmHg (11 kPa). It characteristically manifests as ciliary body inflammation and massivetrabecular oedema that sometimes extends to Schlemm's Canal. This condition is differentiated from malignant glaucoma by the presence of a deep and clear anterior chamber and a lack of aqueous misdirection. Also, the corneal appearance is not as hazy. A reduction in visual acuity can occur followed neuroretinal breakdown. Associated factors include inflammation, drugs, trauma and intraocular surgery, including cataract surgery and vitrectomy procedures. Gede Pardianto (2005) reports on four patients who had toxic glaucoma. One of them underwent phaecoemulsification with small particle nucleus drops. Some cases can be resolved with some medication, vitrectomy procedures or trabeculectomy. Valving procedures can give some relief but further research is required.[50]<br />[edit]Absolute glaucoma (H44.5)<br />Absolute glaucoma<br />