Transcript Glaucoma – The Silent Thief of Sight

Glaucoma –
The Silent Thief of Sight
Prof. S. Melamed
Director, The Sam Rothberg
Glaucoma
Center, Sheba Hospital, Tel Hashomer
Tel Aviv University
Definition of Glaucoma
Optic Nerve Disease with typical
nerve damage and visual field
loss
** Elevated IOP is a causative risk
factor
Glaucoma and Blindness
* Still reason # 2 for Blindness in the
developed world !!
* Reason # 1 for Blindness in most 3rd world
countries !!
Eye Anatomy
• The optic nerve is a
bundle of nerve
fibers
• It carries visual
information from
the retina to the
brain
Fluid Circulation
• The eye has an
internal fluid
circulation system
• Fluid is produced at
the base of the iris
Fluid Circulation
• The fluid flows
through the pupil to
the front of the iris
Irido-Corneal Angle
CB-TM-SC Relationship
Scleral Spur
Inner Wall of SC
“Self Cleaning Filter”
Trabecular Cells Are:
• Phagocytic
• Secrete Proteo-Glycans
• Are constantly moving
• Retain Conductivity of TM
• Remove blocking Particles
Normal
Glaucoma
End- Stage Glaucoma
In Glaucoma
Due to Obstruction/Malfunction of Drainage
* IOP is Elevated
* It causes damage to Optic Nerve and
Visual Field
Normal Visual Field Healthy Optic Nerve
Damaged Visual Field
Sick Optic nerve
Elevated
IOP
In the Normal Population
* IOP is 12-20 mm Hg
* 8% have elevated IOP – “OHT”
* The OHT group has more
chances for conversion to
Glaucoma
Risk Factors for Conversion to
Glaucoma
*Family History of Glaucoma
*Thin Corneas
*Myopia
*Black race
*Vaso-occlusive diseases
What do we recommend
* With risk factors OHT patients should be
treated
* All people above age of 40 should be
checked regularly, every year, by an eye
doctor
* People with family history of glaucoma
should be checked earlier
Why do we call Glaucoma
“The Silent Thief of Sight”??
* Because high IOP causes a gradual damage to
nerve and visual field WITHOUT pain,
discomfort or loss of Central Vision
* The Damage is IRREVERSIBLE and can cause
BLINDNESS
* So, there are no “alarming signs” in most cases,
and many people are diagnosed too late
Symptoms of Primary Open
Angle Glaucoma
• POAG develops gradually and painlessly and
has no initial symptoms
Vision is normal in
the early stages
Symptoms of Primary Open
Angle Glaucoma
• If untreated, peripheral or side vision is slowly
lost
Tunnel vision
Symptoms of Primary Open
Angle Glaucoma
• Eventually, all vision may be lost
Glaucoma Tests:
Slit Lamp & Gonioscopy
• A special microscope called a slit lamp is used to
examine the structures of the eye
• A gonioscopy lens may be used to view the
drainage angle
Glaucoma Tests:
Ophthalmoscopy
• Eye drops may be placed in the eyes to dilate the
pupils
• Special magnifying lenses are used to examine the
retina and optic nerve for damage
Normal Optic Nerve
Suspicious Optic Nerve
Glaucoma Tests:
Ophthalmoscopy
• Advances are being made in digital imaging of the
retina
Glaucoma Tests:
Tonometry
• Eye pressure is measured with an instrument
called a tonometer
• Three types that are commonly used are:
– Goldmann (Perkins)
– Non-contact (air puff)
Glaucoma Tests:
Visual Field Test
• Peripheral (side) vision is tested with a
perimeter
The patient responds to flashes of
light in different locations
Recent Developments
• Recent studies have found that patients with
thin corneas have a greater risk of developing
glaucoma
• Measurement of corneal thickness using an
instrument called a pachymeter will become
increasingly important
Recent Developments
• Laser technology can now be used to image
the retina and optic nerve and measure nerve
fiber layer thickness
End Stage Glaucoma – Severely
damaged nerve with Tubular vision
So, How can we treat Glaucoma
when Diagnosis is made??
Treatment is aimed at lowering
IOP to Normal Level
* A variety of drugs (drops, pills)
* Laser Treatment – Safe and
Easy
* Surgery – Filters, Valves, Shunts
Glaucoma Medications
•
•
Medications are usually
the first type of treatment
used
Eyedrops or pills are
used to either decrease
the fluid production or to
increase the fluid
drainage
What is new in Glaucoma Therapy?
* New medications
* New laser Treatments (SLT – The
“Homeopatic Laser”)
* New surgical methods – Drainage
implants, Gold Shunts
SLT-New Laser Treatment
Spot size comparison:
ALT SLT
50µm
SLTALT
ALT
SLT
50 micron
SPOT SIZE
400 micron
500 – 1,000 mW
ENERGY OUTPUT
0.8 – 1.5 mJ
10 ms
PULSE DURATION
3 ns
60,000 mJ/cm2
FLUENCE
600 mJ/cm2
6Latina
MA, Tumbocon JA. Selective Laser Trabeculoplasty: The Evolution of Laser Treatment for
Open Angle Glaucoma
SLT
* The easiest and Safest Laser
* Very efficient in lowering IOP
* 5 minutes procedure in office
* No pain, No complications
* Now offered as a primary
treatment before Drugs
When Laser and Medications fail
or non-sufficient..
Glaucoma Surgery is
recommended..
*Trabeculectomy
*Drainage Devices
*Gold Shunt
Gold Shunt
A Miniature Shunt
Gold Shunt Implantation
Gold Shunt
GMS
GMS+
40
35
AGV
IOP - mmHg
30
25
20
15
10
5
0
0
1
Pre-
2
3
1 week
1 month
3
4
65
6
Early Detection and
Treatment
• Regular eye health examinations are
important to detect glaucoma early so that
treatment can be started and vision loss
can be prevented
Thank You