Short overview of glaucoma

1. Glaucoma Review
Cesar Perez Jr MD DPBO

2. Asia Pacific
Glaucoma Guidelines
3rd ed

3. Outline
• definition
• history
• examination
• diagnostics
• treatment
• follow up

4. glaucoma
• group of optic nerve diseases
• progressive
• loss of retinal ganglion cells
(thinned out RNFL) —> visual
field loss
• irreversible

5. history
• family history
• trauma
• steroid usage
• age
• refraction
• systemic

6. examination
• complete eye exam
• tonometry
• gonioscopy
• slit lamp
• funduscopy

7. gonioscopy
• mandatory on initial exam
• dark room, short beam, high magnification
• mirror image of iris and angles
• document, 360 degrees

8. gonioscopy

9. gonioscopy

10. slit lamp
• corneal : pigments, clarity, striae, diameter
• anterior chamber: depth, cells, hyphema
• iris: pupil, rubeosis, atrophy, iridotomy
• lens: PEX, glaukomflecken, donesis

11. optic nerve
• examine every visit
• disc: size, shape, tilt
• cup: shape, depth
• peripapillary atrophy
• neuro retinal rim (ISNT rule)
• hemorrhages

12. diagnostics
• perimetry
• optic nerve analysis

13. perimetry
• functional status
• progression status

14. optic nerve analysis
• structural status
• quantitative monitoring
of progression

15. goal of treatment
• risk factor reduction
• lower IOP
• angle control
• treat predisposing reason

16. target IOP

17. target IOP

18. target IOP

19. target IOP

20. target IOP

21. lower IOP
• medications
• laser
• surgery

22. medications
• greatest chance of reaching target IOP
• best safety and tolerability profiles
• minimal inconvenience
• affordable
• maximal adherence

24. medications
• prostaglandin analogues
• beta blockers
• alpha 2 adrenergic agonists
• carbonic anhydrase inhibitors
• others

25. laser
• outflow enhancement: selective laser trabeculoplasty
• inflow reduction: cyclophotocoagulation
• pupil block relief: laser iridotomy
• iris contour modification: iridoplasty

26. angle control
• goal: deepen anterior chamber
• iridotomy
• iridoplasty
• lens extraction

27. surgery
• trabeculectomy
• deep sclerectomy
• viscocanalostomy/canaloplasty
• glaucoma drainage device
• iridectomy/iridotomy
• lens extraction
• goniosynechialysis
• trabeculotomy/goniotomy
• minimally invasive glaucoma surgery (MIGS)

28. treat predisposing reason
• manage underlying primary reason for glaucoma
• diabetes
• uveitis

29. follow up visit
• to implement glaucoma management plan
• to detect progression and rate of change
• to detect change in risk profile

30. summary
• good history —> risk factors
• complete examination —> optic nerve, IOP, angles
• diagnostics
• proper individualized treatment plan
• monitor progression