GLAUCOMA
AND visual
REHABILITATION
SATYENDRA S SACHAN
ASSISTANTPROFESSOR
RAMA UNIVERSITY
Content
Glaucoma
 Definition
 Classification
 Characteristics of IOP
 Anatomy and tests for
Glaucoma
 Management
Low vision
 Definition of Low Vision
 Impacts
 Low Vision Devices
 Rehabilitative Management
for Glaucoma
Glaucoma
 A group of diseases of progressive optic neuropathy with
loss of retinal neurons and their axons (Nerve Fiber Layer)
resulting in blindness if left untreated.
https://youtu.be/_VtFBnexqm0
 https://youtu.be/_VtFBnexqm0
Definition
“Glaucoma describes a group of diseases that kill retinal
ganglion cells.”
“High IOP is the strongest known risk factor for glaucoma but it
is neither necessary nor sufficient to induce the
neuropathy.”
Ref: Libby, RT, et al: Annu Rev Genomics Hum Genet 6: 15, 2005
Classification
Glaucoma
Congenital Acquired
Primary Secondary
Open angle Close angle Open angle Close angle
Phacomorphic
Angle rescission
Phacolytic
Pseudo
expholiation
Neovascular
Steroid Induced
Traumati
c
Characteristics of IOP
 Normal range: 10-21 mm Hg
 30-50% of open angle glaucoma patients
have IOP <22 mmHg
Diurnal fluctuation normally < 6 mmHg
Women have slightly higher pressures
American Journal of Ophthalmology
2012
Anatomy of anterior Chamber
Tests for Glaucoma
 IOP:
 CT
 Schiotz
 Applanation
 Tono pen
 NCT
 Air puff
Tests for Glaucoma
 Angle Structure
 The Iris Root,
 The Ciliary Body Band (CBB),
 The Scleral Spur (SS),
 The Pigmented / Anterior TM
 Non-pigmented / Posterior TM
 The Schwalbe's Line (SL)
GLAUCOMA
Grades of Angle
Grade I Grade 0 Grade III Grade II
Tests for Glaucoma
 Visual Field
 Perimetry(Manual)
 Bjerom’s Screen
 Perimetry(Automated)
 HVFA
 GVFA
Visual Field Test
Tests for Glaucoma
 Posterior segment
 C:D
 Fundus Examination
Clinical features
 Eye pain
 Pressure / Heaviness.
 Headaches.
 Rainbow-colored halos around lights.
 Red eyes.
 Low vision, blurred vision, narrowed vision (tunnel vision) or blind
spots.
 Nausea and vomiting.
https://my.clevelandclinic.org/health/diseases/4212-
glaucoma#:~:text=Rainbow%2Dcolored%20halos%20around%20lights,Re
d%20eyes
Management
 Therapeutic
 Surgical
 Rehabilitation
Low vision definition by
WHO
WHO definition (1992)
 A person with low vision is one, who
has impairment of visual functioning
even after treatment and/or standard
refractive correction and has Visual
Acuity less than 6/18(20/60) to light
perception or Visual Field less than 10o
from the point of fixation.
Lighthouse Definition (1996)
Functional visual impairment is a significant
limitation of visual capability resulting from
disease, trauma, or congenital conditions which
can not corrected by standard refractive
conditions, medications or surgery and
manifested by one of the following
 Insufficient visual resolution (worse than 6/18 in better
eye with best correction)
 Inadequate field if vision (worse than 20o)
 Reduced peak contrast sensitivity (<1.7 log CS
binocularly at high or low illuminances )
Impacts of ocular disease on patient:
 Visual disorder: Anatomical changes in the
visual organ caused by disease of the eye e.g.
Glaucoma, cataract, ARMD
 Visual impairment: Functional loss that results
form visual disorder
 Visual disability: Vision related changes in the
skills and ability of an individual
 Visually handicapped: Psychological and
economical consequences of visual loss such loss
of independence and inability to work
LV Devices
 Two Types
 Optical
 Non-Optical
Rehabilitative management
for
Early and Moderate Glaucoma
 Electronic magnification system
 CCTV
 CPF
 Minus lens or Reverse telescope
 Prism system
 Other Non-optical Devices
Rehabilitative management
for
End Stage Glaucoma
 Cane
 Sighted-guide
THANKS FOR YOUR
PATIENCE

Glaucoma And Visual Rehabilitation.pptx

  • 1.
    GLAUCOMA AND visual REHABILITATION SATYENDRA SSACHAN ASSISTANTPROFESSOR RAMA UNIVERSITY
  • 2.
    Content Glaucoma  Definition  Classification Characteristics of IOP  Anatomy and tests for Glaucoma  Management Low vision  Definition of Low Vision  Impacts  Low Vision Devices  Rehabilitative Management for Glaucoma
  • 3.
    Glaucoma  A groupof diseases of progressive optic neuropathy with loss of retinal neurons and their axons (Nerve Fiber Layer) resulting in blindness if left untreated. https://youtu.be/_VtFBnexqm0
  • 4.
  • 5.
    Definition “Glaucoma describes agroup of diseases that kill retinal ganglion cells.” “High IOP is the strongest known risk factor for glaucoma but it is neither necessary nor sufficient to induce the neuropathy.” Ref: Libby, RT, et al: Annu Rev Genomics Hum Genet 6: 15, 2005
  • 6.
    Classification Glaucoma Congenital Acquired Primary Secondary Openangle Close angle Open angle Close angle Phacomorphic Angle rescission Phacolytic Pseudo expholiation Neovascular Steroid Induced Traumati c
  • 7.
    Characteristics of IOP Normal range: 10-21 mm Hg  30-50% of open angle glaucoma patients have IOP <22 mmHg Diurnal fluctuation normally < 6 mmHg Women have slightly higher pressures American Journal of Ophthalmology 2012
  • 8.
  • 9.
    Tests for Glaucoma IOP:  CT  Schiotz  Applanation  Tono pen  NCT  Air puff
  • 10.
    Tests for Glaucoma Angle Structure  The Iris Root,  The Ciliary Body Band (CBB),  The Scleral Spur (SS),  The Pigmented / Anterior TM  Non-pigmented / Posterior TM  The Schwalbe's Line (SL)
  • 11.
    GLAUCOMA Grades of Angle GradeI Grade 0 Grade III Grade II
  • 12.
    Tests for Glaucoma Visual Field  Perimetry(Manual)  Bjerom’s Screen  Perimetry(Automated)  HVFA  GVFA
  • 13.
  • 14.
    Tests for Glaucoma Posterior segment  C:D  Fundus Examination
  • 15.
    Clinical features  Eyepain  Pressure / Heaviness.  Headaches.  Rainbow-colored halos around lights.  Red eyes.  Low vision, blurred vision, narrowed vision (tunnel vision) or blind spots.  Nausea and vomiting. https://my.clevelandclinic.org/health/diseases/4212- glaucoma#:~:text=Rainbow%2Dcolored%20halos%20around%20lights,Re d%20eyes
  • 16.
  • 17.
    Low vision definitionby WHO WHO definition (1992)  A person with low vision is one, who has impairment of visual functioning even after treatment and/or standard refractive correction and has Visual Acuity less than 6/18(20/60) to light perception or Visual Field less than 10o from the point of fixation.
  • 18.
    Lighthouse Definition (1996) Functionalvisual impairment is a significant limitation of visual capability resulting from disease, trauma, or congenital conditions which can not corrected by standard refractive conditions, medications or surgery and manifested by one of the following  Insufficient visual resolution (worse than 6/18 in better eye with best correction)  Inadequate field if vision (worse than 20o)  Reduced peak contrast sensitivity (<1.7 log CS binocularly at high or low illuminances )
  • 19.
    Impacts of oculardisease on patient:  Visual disorder: Anatomical changes in the visual organ caused by disease of the eye e.g. Glaucoma, cataract, ARMD  Visual impairment: Functional loss that results form visual disorder  Visual disability: Vision related changes in the skills and ability of an individual  Visually handicapped: Psychological and economical consequences of visual loss such loss of independence and inability to work
  • 20.
    LV Devices  TwoTypes  Optical  Non-Optical
  • 23.
    Rehabilitative management for Early andModerate Glaucoma  Electronic magnification system  CCTV  CPF  Minus lens or Reverse telescope  Prism system  Other Non-optical Devices
  • 25.
    Rehabilitative management for End StageGlaucoma  Cane  Sighted-guide
  • 27.