Glaucoma Clinical features and management Dr (Maj) G Premnath MS (Ophthal) Clinical fellow- Glaucoma Asst. Professor Dept of Ophthalmology Vertical integration

Glaucoma Second leading cause of blindness worldwide. 8% of global blindness is due to glaucoma. Progresses slowly with few, if any, noticeable symptoms in the early stage. Glaucoma-related blindness is avoidable only with early detection and treatment. GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

Types Open angle Closed angle Congenital Acquired Primary Secondary Normal-Tension Glaucoma GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

Open Vs Closed angle OPEN CLOSED GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

Pseudo exfoliation glaucoma Acute angle closure Lens induced glaucoma Pseudo exfoliation glaucoma Neo vascular glaucoma GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

Pathophysiology 13.09.2018

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Signs & Symptoms Typically no early warning signs or symptoms. Initially PERIPHERAL VISION is lost. Visual acuity is maintained until late in the disease. By the time a patient is aware of vision loss, the disease is usually quite advanced. Vision loss from glaucoma is not reversible with treatment, even with surgery. GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

Signs & Symptoms Hazy or blurred vision Coloured halos Severe eye pain and head ache Nausea or vomiting Sudden sight loss GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

Visual fields

Vision in Advanced Glaucoma GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

Who are at risk ? Everyone is at risk for glaucoma. However, certain groups are at higher risk than others. Family Members with Glaucoma - increases risk of glaucoma four to nine times. People above the age of 40 yrs African Americans - six to eight times more common Asians People of Asian descent appear to be at increased risk for angle-closure glaucoma. Steroid Users- any form (Creams, Inhalers, Tablets etc) Eye Trauma http://www.glaucoma.org/glaucoma/are-you-at-risk-for-glaucoma.php GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

When to test eyes Before age 40, every two to four years Age 40 to age 54, every one to three years Age 55 to 64, every one to two years After age 65, every six to 12 months Anyone with high risk factors should be tested every year or two after age 35. GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

A Comprehensive Glaucoma Exam The inner eye pressure – Tonometry Optic nerve head- Ophthalmoscopy (dilated eye exam) The angle of anterior chamber - Gonioscopy GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

Field of vision – Perimetry Thickness of the cornea - Pachymetry Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy. GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

NON-CONTACT TONOMETRY GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

PACHYMETRY GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

GONIOSCOPY GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

FUNDUS PHOTOGRAPHY GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

PERIMETRY GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

OCT RNFL ANALYSIS GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

TREATMENT OPTIONS Medications- Eye drops Prophylactic LASER iridotomy Filtering surgeries Implants GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

TAKE HOME MESSAGE ! Screening for glaucoma is the only way to detect glaucoma early. Early detection is important in preventing blindness as treatment is more difficult and less effective in the advanced stages of glaucoma. Follow-up GLAUCOMA: NO PAIN, NO SYMPTOMS- SILENT THIEF OF SIGHT

THANK YOU! 13.09.2018