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

2. 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

3. 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

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

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

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

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

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

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

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

14. 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

15. 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

16. 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

17. 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

18. red dots : controls blue dot: single patient

19. red dots : controls blue dot: single patient

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

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

23. 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