1. Mr. A. Waldock MD BMed Sci (Hons) BM BS FRCOphth Consultant Ophthalmic Surgeon Ophthalmology Training Programme Director, East of England Deanery

2. Glaucoma Glaucoma thought to derive from the ancient Greek word… Glaukos… To glow or shine; blue-green; owl “Glaucosis” first documented by ancient Greeks in 400BC as a “blinding disease occurring most commonly in the elderly” “A group of diseases that have as a common end point a characteristic optic neuropathy which is determined by both structural change and functional deficit”

3. Classic glaucomatous optic neuropathy

4. Classic glaucomatous visual functional deficit

5. The Dilemma with Glaucoma Asymptomatic “Screening” by optometrists highlights “glaucoma” due to RAISED intra-ocular pressure (IOP) Prevalence of OAG in the UK estimated 1.2% In L&D catchment area, ~ 4000 patients Glaucoma <30% Eye Dept workload Diagnosing earlier and living longer

6. Management of Glaucoma Multidisciplinary approach Provide high quality diagnostic service Provide comprehensive treatment service offering:- A) Complete range of medications (eyedrops) B) Several laser treatments C) Modern glaucoma filtration surgery Multiple audits over last 10 years illustrate outcomes better than National Standard

7. Early Diagnosis and Accurate Monitoring of Glaucoma

8. Digital Imaging of Optic Nerve Head (ONH)

9. 3-dimensional image illustrating ONH shape

10. Quantitative Analysis of Optic Nerve Head

11. Structural Change Analysis of Optic Nerve Head

12. Modern Laser Treatment for Mild Glaucoma

13. Selective Laser Trabeculoplasty (SLT)

14. SLT Audit / Outcomes Preliminary audit to confirm safety and efficacy Mean lowering of IOP = 4mmHg (20%) Range from 0% to 60% lowering of IOP from pre- treatment values 2:5 eyes had a >20% IOP lowering effect 1:7 non-responders 3% transient intra-ocular inflammation post-laser Summary: SLT is safe and effective

15. Definitive Modern Glaucoma Filtration Surgery for eyes not reaching target intra-ocular pressures

16. 0.01mg/ml Mitomycin C trabeculectomy

17. MMC Trabeculectomy Audit / Outcomes 5 year follow up MMC Trabeculectomy outcomes IOP is lowered by 12mmHg (46%) at 5 years 30% no eyedrops at 5 years, rest on 1 medication Equates to a 91% success rate at 5 years 25% develop mild cataract, may require surgery MMC Trabeculectomy is safe & effective

18. Combined MMC Phaco-Trabeculectomy Audit / Outcomes 2 year follow up MMC Phaco-Trabeculectomy IOP is lowered by 10mmHg (45%) at 2 years 80% no eyedrops at 2 years, rest on 1 medication 47% demonstrate improvement in visual function Equates to a 85% success rate at 2 years MMC Phaco-Trabeculectomy is safe & effective

19. Cyclodiode Laser Treatment for Advanced Glaucoma and Painful Blind Eyes

20. Cyclodiode laser for advanced glaucoma

21. Cyclodiode Laser Audit / Outcomes Mean lowering of IOP = 8mmHg (28%) 3:4 eyes greater than 20% IOP lowering effect 50% required only single treatment session 3:5 painful eyes comfortable after one treatment 60% reduced eyedrops by 2 or more medications 8% complication rate (inflammation; loss of vision) Summary: Cyclodiode laser is safe and effective

22. The Glaucoma Time Plot Visual Functi on Age Patient diagnosed with glaucoma Normal Physiological Loss Significant visual impairment Birth 100 yrs Full Nil Aim of the glaucoma specialist: Not to manage blindness Preserve vision throughout life Do no harm!

23. Thank you for your attention