INTRODUCTION TO GLAUCOMA Glaucoma Day: Research into New Treatments Saturday 6th September 2014

Glaucoma overview Glaucoma is a chronic ‘progressive’ irreversible damage to the optic nerve 2% of over 50s; 5% of over 80s 6% of those with glaucoma are blind from glaucoma at the end of life Worse initial field High IOP variability Non-compliance Additional risk factors (eg pseudoexfoliation syndrome) Oliver Am J Ophthalmol. 2002;133:764-72; Chen PP. Ophthalmology. 2003;110:634–5; Forsman J Glaucoma. 2007;16:313-9

Glaucoma causes "The excavation of the disc in glaucoma is not a purely mechanical result of exalted pressure; it is, in part at least, an atrophic condition which, though primarily due to pressure, includes vascular changes and impaired nutrition of the substance of the optic disc which may possibly progress even though all excessive pressure be removed." Priestly Smith, 1879

flow of aqueous humour through the pupil drainage angle ciliary body cornea iris lens

cornea retina iris sclera optic nerve optic nerve head lens conjunctiva pupil

cornea retina iris sclera optic nerve optic nerve head lens conjunctiva pupil

nerve fibres optic cup neuro-retinal rim pores in lamina cribrosa

loss of nerve fibres enlarged optic cup narrowed neuro-retinal rim patchy loss of vision

What does visual field loss mean? NO OVERLAP OVERLAP MAY CAUSE FALL Courtesy of Ananth Viswanathan MD

Management goals Maintain sufficient vision to enable normal activities and participation in society

Concepts Health Condition (disorder/disease) Body function & structure (Impairment) Activities (Limitation) Participation (Restriction) Health Condition (disorder/disease) Environmental Factors Personal Factors International Classification of Functioning, Disability, and Health

Eye-Hand Co-ordination Do patients have deficits in visually guided task of reaching and grasping? A variety of measurements general kinematics reach dynamics grasp dynamics

Eye-Hand Co-ordination Do patients have deficits in visually guided task of reaching and grasping? Results: patients with glaucoma exhibit slower movement onset slower and more variable reach dynamics no difference in grasp movements vs controls

Eye-Hand Co-ordination Do patients have deficits in visually guided task of reaching and grasping? …performance seems dependent on the location of the visual field defect…. Fine Poor Results: patients with glaucoma exhibit slower movement onset slower and more variable reach dynamics no difference in grasp movements vs. controls

red dots : controls blue dot: single patient

red dots : controls blue dot: single patient

Integrated Visual field Crabb DP et al (2004). Br J Ophthalmol 88: 1191-6.

Management goals Maintain sufficient vision to enable normal activities and participation in society

Research into New Treatments Better Delivery Drugs and Devices in Glaucoma Sir Peng Tee Khaw New Technologies for Glaucoma Surgery Nick Strouthidis/Lydia Chang Stem Cells and Cell Regeneration in Glaucoma Astrid Limb Protecting Cells in the Eye at Risk of Damage from Glaucoma David (Ted) Garway-Heath