1. Glaucoma Madhav Vempali Vempali Medical Ltd

2. Glaucoma The healthy eye Light rays enter the eye through the cornea, pupil and lens. These light rays are focused directly onto the retina, the light-sensitive tissue lining the back of the eye. The retina converts light rays into impulses sent through the optic nerve to your brain, where they are recognized as images. 1 Eye anatomy

3. Glaucoma What is glaucoma? Glaucoma is a disease of the optic nerve. When damage to the optic nerve fibers occurs, blind spots develop; blind spots usually go undetected until the optic nerve is significantly damaged. Glaucoma is one of the leading causes of blindness in the United States. Early detection and treatment are the keys to preventing vision loss from glaucoma. 2 Normal vision Vision as it might be with glaucoma

4. Glaucoma Anatomy of glaucoma Clear liquid called aqueous humor circulates inside the front portion of the eye. To maintain a healthy level of pressure within the eye, a small amount of aqueous humor is produced constantly, while an equal amount flows out of the eye through a microscopic drainage system — the trabecular meshwork. 3

5. Glaucoma Anatomy of glaucoma With glaucoma, aqueous humor does not flow through the trabecular meshwork properly. Over time, eye pressure increases, damaging the optic nerve fibers. 4

6. Glaucoma How the eye works 5

7. Glaucoma Types of glaucoma Two main categories of glaucoma: Open-angle glaucoma: the most common form of glaucoma. Closed-angle glaucoma: a less common and more urgent form of glaucoma. 6

8. Glaucoma Types of glaucoma Open-angle glaucoma Trabecular meshwork becomes less efficient at draining aqueous humor. Intraocular pressure (IOP) builds up, which leads to damage of the optic nerve. 7 Open-angle glaucoma

9. Glaucoma Types of glaucoma Open-angle glaucoma Damage to the optic nerve occurs at different eye pressures among different patients. Typically, glaucoma has no symptoms in its early stages. 8

10. Glaucoma Open-angle glaucoma 9

11. Glaucoma Types of glaucoma Closed-angle glaucoma The drainage angle of the trabecular meshwork becomes blocked by the iris (the colored part of the eye). IOP builds up very quickly. 10 Closed-angle glaucoma

12. Glaucoma Types of glaucoma Closed-angle glaucoma Symptoms include severe eye or brow pain, redness of the eye, decreased or blurred vision. Must be treated as a medical emergency — see your ophthalmologist immediately. 11

13. Glaucoma Closed-angle glaucoma 12

14. Glaucoma Glaucoma risk factors Risk factors for glaucoma include: Age Family history Elevated eye pressure (IOP) Nearsightedness or farsightedness African, Hispanic or Asian ancestry Diabetes Previous eye injury Thin cornea Low blood pressure 13

15. Glaucoma Detecting glaucoma Regular eye examinations by your ophthalmologist are the best way to detect glaucoma. Glaucoma screening that checks only eye pressure is not sufficient to detect glaucoma. 14 Ophthalmoscope examination

16. Glaucoma What happens during an exam? Tonometry measures eye pressure (IOP). High tonometry reading is often one of the first signs of glaucoma. 15 Tonometry examination

17. Glaucoma What happens during an exam? Gonioscopy inspects the drainage angle of aqueous humor. It allows the ophthalmologist to determine the type of glaucoma (open- or closed- angle). 16 Gonioscopic image of the eye

18. Glaucoma What happens during an exam? Optic nerve exam, in which ophthalmologist dilates your pupils to detect optic nerve damage Subtle changes of the optic nerve reveal early signs of glaucoma. 17 Normal optic nerve Optic nerve damaged by glaucoma

19. Glaucoma What happens during an exam? Imaging of the optic nerve and/or nerve fiber layer Special pictures may be taken to document the appearance of the optic nerve 18

20. Glaucoma The optic nerve 19

21. Glaucoma What happens during an exam? A visual field exam, testing for blank spots in peripheral vision 20 Visual field exam Visual field test results: Left is normal; right shows vision loss

22. Glaucoma Visual field 21

23. Glaucoma Treating glaucoma Treatment for glaucoma depends on:  the specific type of glaucoma;  the severity of the glaucoma; and  how the glaucoma responds to treatment. 22

24. Glaucoma Treating glaucoma Open-angle glaucoma Medication  Eyedrops are most common treatment Laser Surgery 23 Instilling eyedrops for open-angle glaucoma

25. Glaucoma Instilling eyedrops 24

26. Glaucoma Treating glaucoma Glaucoma surgery Laser trabeculoplasty: stimulates the trabecular meshwork (drainage angle) to function more efficiently. 25 Laser trabeculoplasty

27. Glaucoma Laser trabeculoplasty 26

28. Glaucoma Treating glaucoma Glaucoma surgery Trabeculectomy: creates new drainage channel for the eye Goal: to stabilize disease and prevent further damage/vision loss Does not reverse damage to the optic nerve Performed on an outpatient basis 27 Trabeculectomy

29. Glaucoma Trabeculectomy 28

30. Glaucoma Treating glaucoma Glaucoma surgery Aqueous shunt or seton:  A small plastic tube drains fluid from front of eye to lower eye pressure (IOP).  It is performed in eyes at high risk for failure with trabeculectomy. 29

31. Glaucoma Setons 30

32. Glaucoma Treating glaucoma Closed-angle glaucoma Laser iridotomy: creates a small hole in the iris to improve flow of aqueous humor into drainage angle 31 Laser iridotomy

33. Glaucoma Laser iridotomy 32

34. Glaucoma Glaucoma is controllable Vision loss from glaucoma usually can be prevented if detected and treated early. If you are prescribed eyedrops for glaucoma, you must take them regularly. If you are at risk for glaucoma, visit your ophthalmologist regularly. 33

35. Glaucoma Adults with no signs or risk factors for eye disease should get a baseline eye disease screening at age 40 — the time when early signs of disease may start to occur. Based on the screening, an ophthalmologist will prescribe the necessary intervals for follow-up exams. Preserve good vision with regular eye exams 34

36. Glaucoma People at any age with symptoms of or at risk for eye disease, such as those with a family history of eye disease, diabetes or high blood pressure, should see an ophthalmologist to determine how frequently your eyes should be examined. Preserve good vision with regular eye exams 35