Series Editors Ashok Garg MS PhD FIAO(Bel) FRSM FAIMS ADM FICA
International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre 235-Model Town, Dabra Chowk
Hisar-125005 (India)
Emanuel Rosen MD
Medical Director Rosen Eye Associates
Harbour City, Salford Quays M50 3 BH UK
Editors Shlomo Melamed MD PhD
Professor of Ophthalmology Sackler Medical School Tel-Aviv University Head and Chairman Sam Rothberg Glaucoma Centre
Tel HaShomer, Israel
Tanuj Dada MD
Associate Professor of Clinical Ophthalmology, Dr RP Centre for Ophthalmic Sciences AIIMS, Ansari Nagar
New Delhi-110029 India
Ahmed K Khalil MD PhD
Professor of Ophthalmology, Medical Director Saridar Clinic Tower, Apt 67-C, 92, Tahrir St. Dokki Square,
Cairo, Egypt-12411
Foreword Robert N Weinreb
Jitendar P Vij
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Instant Clinical Diagnosis in Ophthalmology (Glaucoma)
© 2009, Editors
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2009
9788184484533
Typeset at JPBMP typesetting unit
Printed at Ajanta Press
5Dedicated to
- My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings and motivation.
- My Respected Parents, teachers, my wife Dr Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work.
- My dear friend Dr. Amar Agarwal, a renowned International Ophthalmologist for his constant support, guidance and expertise.
— Ashok Garg
- The memory of my step daughter Nicola Ross whose enjoyed benefits from refractive surgery were cut short by a tragic fatal illness.
— Emanuel Rosen
- To my loving wife Shuvit.
— Shlomo Melamed
- The Revered Sufi Saint Hazoor Maharaj Gurmeet Ram Rahim Singh Ji, Dera Sacha Sauda Ashram, Sirsa, Haryana, India.
— Tanuj Dada
- To the memory of great father, whose open mindedness and guidance will always be there.
- To my mother, my first teacher and supporter, to my wife for her encouragement and patience, to my sons, Hassan and Omar with love.
— Ahmad K Khalil
7Contributors
- Ahmed Mostafa Abdelrahman md frcs
- Assistant Professor Ophthalmology
- Cairo University
- 8-Morad Street (Morad Tower)
- Apart 409, Giza, Egypt
- Ahmed Galal md phd
- Vissum/Instituto Oftalmologico
- De Alicante, Alicante, Spain
- Ahmad K Khalil md phd
- Associate Professor of Ophthalmology
- Saridar Clinic Tower
- 92, Tahrir St, Dokki, Cairo, Egypt
- Andre Mermoud md
- Prof of Ophthalmology
- Jules Gonin Eye Hospital
- CH-1004, Lausanne, Switzerland
- Ashok Garg ms phd frsm
- Medical Director
- Garg Eye Institute and Research
- Centre, 235-Model Town
- Dabra Chowk, Hisar-125005
- India
- Bojan Pajic md
- Chief, Cornea and Refractive Surgery
- Deptt, Vision Care, Klinik Pallas
- Louis Giroud Str. 20, 4600 Olten
- Switzerland
- Boris Malyugin md phd
- Chief of Department of Contract and
- Implant Surgery, Dy. Director General
- S. Fyodorov Eye Microsurgery
- Complex State Institution
- 127486 Moscow
- Beskudnikovsky blvd 59A
- Russia
- Cyres K Mehta ms fsvh fage
- Director and Consultant
- Mehta International Eye Institute
- Seaside, 147, Colaba Road
- Mumbai-400005
- India
- Daljit Singh ms dsc
- Director
- Dr Daljit Singh Eye Hospital
- 57, Joshi Colony, Amritsar-143001
- India
- Ehud I Assia md
- Deptt of Ophthalmology
- Meir Hospital, Sapir Medical Centre
- Tsharnihovski St., 44281, Kafar, Saba
- Israel
- Emanuel Rosen md frcs
- Rosen Eye Associates
- Harbour City, Salford Quays
- M50 3 BH
- UK
- G Marchini md
- Head of Eye Clinic
- Deptt of Neurological and Visual Sciences
- University of Verona
- Borgo Trento Hospital
- P.Ie. A. Stefani, 1, 37126 Verona
- Italy
- Guillermo Avalos Urzua md
- Terranova No. 676-101
- Col. Providencia
- Guadalajara, Jal,
- Jens Funk md
- Prof of Ophthalmology
- Augenklinik-Universitatsklinikum
- Killianstr. 5, 79106 Freiburg
- Germany
- Jerome Bovet md
- Consultant Ophthalmic Surgeon
- FMH Clinique de I'oeil
- 15, Avenue du Bois-de-la-Chapelle
- CH-1213 Onex
- Switzerland
- Jes Mortensen md
- Consultant, The Eye Deptt.
- Orebro University Hospital
- SE-70185, Orebro
- Sweden
- Jorge L Alio md phd
- Director
- Instituto Oftalmologico De Alicante
- Avda. Denia 111, 03015
- Alicante
- Spain
- Jose L Rodriguez Prats md
- Instituto Oftalmologico De Alicante
- Avda. Denia 111, 03015
- Alicante
- Spain
- JT Lin phd
- Professor Institute of Electro Optics
- National Taiwan University
- 268-1 (11F)
- Han Sheng E Rd
- Banciao
- Taiwan-22066
- Kaweh Mansouri md
- Jules Gonin Eye Hospital
- Lausanne
- Switzerland
- Keiki R Mehta ms do fios
- Chairman and Medical Director
- Mehta International Eye Institute
- 147, Shahid Bhagat Singh Road
- Colaba Road
- Mumbai-400005
- India
- KP Takhchidi md
- Director General
- S. Fyodorov Eye Microsurgery
- Complex State Institution
- 127486 Moscow
- Beskudnikovsky blvd 59A
- Russia
- Kiranjit Singh ms
- Dr Daljit Singh Eye Hospital
- 57, Joshi Colony, Amritsar-143001
- India
- Madhu Nagar ms frcoph
- Consultant Ophthalmologist
- Clayton Eye Hospital
- Wakefield, West Yorkshire
- UK
- Maria da Leiz Freitas md
- R Crasto, 708-4050-243, Porto
- Portugal
- Mordechai Goldenfeld md
- The Sam Rothberg Glaucoma Centre
- Goldschleger Eye Institute
- Sheba Medical Centre
- Tel-Hashomer
- M Marraffa md
- Deptt of Neurological and Visual
- Sciences
- University of Verona
- Borgo Trento Hospital
- P.Ie. A. Stefani, 1, 37126 Verona
- Italy
- Mona Pache md
- Augenklinik-Universitatsklinikum
- Killianstr. 5, 79106 Freiburg
- Germany
- Nicola Freeman md
- Sr. Consultant Ophthalmic Surgeon
- Deptt of Ophthalmology
- Faculty of Health Sciences
- University of Stellenbosch
- Tygerberg Academic Hospital
- Cape Town
- South Africa
- Nikolay N Ereskin md
- Consultant
- SN Fyodorov Eye Microsurgery
- Complex, Moscow
- Russia
- Pascal Rozot md
- Consultant Ophthalmic Surgeon
- Clinique Moniticelli, Marsilles,
- France
- P Ceruti md
- Deptt of Neurological and
- Visual Sciences
- University of Verona,
- Borgo Trento Hospital,
- P.Ie. A. Stefani, 1, 37126 Verona
- Italy
- Peter WT de Waard md
- The Rotterdam Eye Hospital
- Schiedamse Vest 180
- 3011-BH-Rotterdam
- Netherlands
- Ranjit S Dhaliwal MS
- Director, Eye Infirmary, Hira Mahal
- Radha Soami Marg, Nabha-147201
- India
- Ranjit H Maniar ms
- 17, Vithal Court, 6th Floor, 151, August
- Kranti Marg, Mumbai-400036
- India
- RC Nagpal ms
- Professor of Ophthalmology
- Himalayan Institute of Medical
- Sciences, Swami Ram Nagar
- Jolly Grant, Dehradun-248140
- Uttaranchal, India
- R Morbio md
- Deptt of Neurological and Visual
- Sciences
- University of Verona
- Borgo Trento Hospital, P.Ie. A. Stefani
- 1, 37126 Verona, Italy
- Roberto G Carassa md
- Director Glaucoma Service
- Deptt of Ophthalmology and
- Visual Sciences, University Hospital
- S. Raffaele via Olgettina 60
- 20132 Milano, Italy
- Shalini Mohan md
- Senior Registrar
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, Ansari Nagar,
- New Delhi-110029
- Shibal Bhartiya md
- Senior Research Associate,
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, Ansari Nagar, New Delhi
- India
- Shlomo Melamed md
- Prof of Ophthalmology
- Sackler Medical School
- Tel Aviv University
- Head and Chairman
- Sam Rothberg Glaucoma Centre
- Goldschleger Eye Institute,
- Sheba Medical Centre, Tel-Hashomer
- Israel
- Shweta Jindal md
- Resident
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, Ansari Nagar
- New Delhi-110029
- India
- Tanuj Dada md
- Associate Professor
- Clinical Ophthalmology
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, Ansari Nagar
- New Delhi-110029
- India
- Vivek Kadambi md doms
- Director
- Laser Vision Netralaya
- Chinmaya Hospital
- CMH Road
- Bangalore-560038
- India
- V Velayutham ms
- Regional Institute of Ophthalmology
- Government Ophthalmic Hospital
- Egmore
- Chennai
- India
It seems like yesterday that I began a career in glaucoma and first contemplated what might transpire during the ensuing decades. At times, it has seemed that what has been learned through basic research has been inadequate to justify it's time and effort. Also the pace of translational clinical research often has appeared to be so slow, and certainly not fast enough to have a major impact on glaucoma blindness. There still are fundamental issues relating to glaucoma that have to be addressed, including some very basic ones. The absence of a clear definition of glaucoma is the one that most consistently irks me. It is, perhaps, the most basic of issues in glaucoma and is at the core of what we do in the laboratory. More significantly, it is central to how we daily diagnose and manage our glaucoma patients. Plus ca change, plus la meme chose? Or are we on the precipice of paradigm changes for both diagnosis and treatment that will impact significantly the prognosis for retaining vision and quality of life with glaucoma. From my vantage point, I suspect that it is the latter.
Never before have we had better tools to elucidate glaucoma pathophysiology, as well as to better diagnose, better monitor progression, and better treat glaucoma. And never before have we had the desire and commitment to do so. New instruments for imaging the optic disk, retinal nerve fiber layer and anterior segment have emerged that provide objective analyses that clearly are superior to subjective examinations of the past. There also has been the introduction into clinical practice of new medical and surgical therapies, albeit they all still have limitations.
Many of these advances are described in this text, particularly the innovative surgical approaches that promise to revolutionize our care.
Despite having all this new information so nicely packaged and available in this book, it still will be a daunting task for an interested reader to be constantly updating their knowledge and clinical skills. In addition to being grounded in the fundamentals of glaucoma, high quality glaucoma care requires access to timely and informed information. One needs then to critically evaluate the provided information, place it in the context of one's own clinical experience and translate it into clinical practice. Evidence-based medicine, consensus and clinical experience are all complementary for the most thoughtful clinicians.12
I congratulate Dr. Ashok Garg, editors and authors who have contributed to this timely book.
Dr Robert N Weinreb md
Distinguished Professor of Ophthalmology
Director
Hamilton Glaucoma Center
University of California, San Diego
La Jolla, California 92093
United States
Ph.: 001 858 534-8824.
e-mail: weinreb@eyecenter.ucsd.edu
13Preface
In modern day busy and fast life ophthalmologists are glued to their clinical and surgical practice and have little time to read large volume books. The need of hour is to have pocket size ready recokner enriched with complete and up-to- date information of the diseases in a most comprehensive manner. At present very few quality ready reference books are available at an International level.
After detailed research regarding the needs of ophthalmologists we have developed a series of 10 volume ready reference books termed as Instant Clinical Diagnosis in Ophthalmology. This series covers Oculoplastic and Reconstructive Surgery, Retina, Lens, Glaucoma, Refractive Surgery, Pediatric Ophthalmology, Strabismus, Anterior Segment Diseases, Cornea and Neuro-ophthalmology. Present series has been designed to provide up-to-date information of concerned disease in a comprehensive and a lucid manner along with high quality clinical photographs in an easy to read format. International masters of concerned subjects have contributed chapters in this series covering pathophysiology, clinical signs and symptoms, investigations, differential diagnosis, treatment and prognosis in a simplified manner.
This volume deals with important clinical entity, glaucoma, which is one of the major causes of blindness worldwide. This volume consists of latest information on various clinical glaucoma conditions, their diagnosis and management in an easy to ready format for the benefit of readers. A number of leading international glaucoma experts have shared their experiences in form of chapters covering all aspects of glaucoma. We are glad to provide complete and latest information of glaucoma in a comprehensive manner in this book for quick look and as a ready reckoner.
We are highly thankful to our publisher M/s Jaypee Brothers Medical Publishers Pvt. Ltd. especially Shri Jitendar P Vij (CEO), Mr. Tarun Duneja (Director, Publishing) and all staff members for their dedication and hard efforts put in the preparation of high quality series of Instant Clinical books.
We hope this 10 volume set of ready reference pocket size books shall provide complete and useful clinical information to ophthalmologists all around the world and shall help them to accurately and precisely diagnose, treat and manage their clinical cases confidently to the satisfaction and expectations of their valued patients. We also hope this ready reckoner shall serve as useful companion on every clinician desk.
Editors