Pearls in Glaucoma Therapy Tanuj Dada, Parul Ichhpujani, George L Spaeth
INDEX
A
Acetazolamide 61
Acidosis 86
Adrenergic agonists 62
Adrenocortical insufficiency 83
Advanced glaucoma intervention study 11
Agranulocytosis 86
Alpha agonists 78
Amino acids 4
Anorexia 86
Antihypertensive medications 123
Anticardiolipin antibody 37
Antiglaucoma medications 61
Anxiety 128
Aplastic anemia 86
Apraclonidine 78, 79
Aspartate 4
Asthenia 86
Atypical band keratopathy 98
B
Benzalkonium chloride 74, 96
Beta-blockers 72
Betaxolol 72
Bimatoprost 61, 62
Biochemical theory 4
Blood
dyscrasia 86
flow 3
pressure 3, 5
charting 37
viscosity 3
Brimonidine 61, 78, 79
Brinzolamide 61
C
Caffeine 125
Carbonic anhydrase inhibitors 62, 82
Cardiovascular
accident 8
disease 13
Carotid Doppler testing 36
Carteolol 72
Central
corneal thickness 2, 10, 12, 19
nervous system 75
Cetrimide 97
Chlorhexidine digluconate 97
Chlorobutanol 97
Cholesterol 8
Cholinergics 62
Chronic
angle closure glaucoma 115
hyperemia secondary to latanoprost 65
Closed angle on gonioscopy 21
Collaborative
initial glaucoma treatment study 11
normal tension glaucoma study 120
Color vision disorder 86
Concept of glaucoma colored graph 40
Confusion 86
Congenital glaucoma 90
Conjunctival
changes 97
hyperemia 64
Continuous positive airway pressure therapy 125
Coronary heart disease 8
Cystoid macular edema 66
D
Deconsanoids 62
Decrease in blood supply to optic nerve head 2
Decreased libido 86
Depression 86, 128
Diabetes 5
mellitus 13
Dipivefrin 61
Direct acting cholinergic agents 89
Disc
damage likelihood scale 23, 24
hemorrhage 24
OD 26
OS 27
Distribution of IOP 9
Diurnal fluctuation of IOP 51
Dorzolamide 61
E
Early manifest glaucoma
treatment study 127
trial 10
Epinephrine 61
Erythema 86
multiforme 86
Extracellular matrix 3
Eye drops 113
Eyebrows 86
F
Factors influencing target IOP 50
First line therapy 104
Follicular conjunctivitis 98
G
Gastrointestinal disorder 86
Glaucoma 1, 123
colored graph 40
continuum 39
in pregnant and lactating patients 116
Glaucomatous
neuropathy 50
optic
nerve 9, 51
neuropathy 5
Globus hystericus 86
Glutamate 4, 5
mediated toxicity 4
Glycerin 93, 94
Glycerol 93
Glycosuria 86
Goldmann tonometer 19
Gonioscopy 20
Green zone 41
H
Heidelberg retinal tomography 26, 58
HRT
OD 53
OS 28, 54
printout 35
Humphry matrix FDP perimetry 34
Hypertension 8, 13
Hypertrichosis 65
Hypotension 13
Hypotensive lipids 62
I
Indirect acting anti-cholinesterase agents 89
Inferior RNFL defect 43
Inflammatory glaucomas 89
Intracranial hemorrhage 93
Intraocular pressure 1, 2, 19, 38, 123
Intrinsic sympathomimetic activity 74
IOP related damage 2
Iris color changes 65
Iritis 86
L
Latanoprost 61, 62
Level of IOP 9
Levobunolol 61, 72
Loss of eyelashes 86
Low
perfusion pressure 13
systemic blood pressure 4
systolic BP 13
tension glaucoma 36, 120
Lumigan 62
Lyell's syndrome 86
M
Malaise syndrome 86
Malignant glaucoma 90
Maximal tolerable medical therapy 104
Mechanical theory 2, 3
Methazolamide 86
Metipranolol 72
Migraine 13
Mild disease 51
Miotics 89
Mitochondrial metabolism 5
Moderate disease 51
Monoamine oxidase inhibitors 80
Monocular therapeutic trial 103
Multi drug therapy 99
Myocardial infarction 8
N
Natural history of glaucoma 39
Nausea 86
Necktie wear 127
Neovascular glaucoma 89, 119
Neuro-retinal rim 21
Normal
intraocular pressure 9
pressure glaucoma 36
tension glaucoma 2, 4
O
Obesity 8
OCT 29, 55
Ocular
beta-blockers 72
cicatricial pemphigoid 98
hypertension 2
treatment study 10
hypotensive medications 61
surface health 129
Open
angle
glaucoma 61
on gonioscopy 21
anterior chamber angles 2
disc 1
color and red free photos 32
nerve
damage 59
head evaluation 21
Optical coherence tomography 26
Oral carbonic anhydrase inhibitors 61
P
Paresthesia 86
Pathogenesis of glaucoma 2
Pediatric glaucomas 116
Perfusion pressure 3
Periocular dermatitis 99
Periorbital
dermatitis with brimonidine 80
skin hyperpigmentation 65
Physostigmine 61
Pilocarpine 61
Pilocarpus microphyllus 89
Polypharmacy era 61
Polyuria 86
Pregnancy 66
Preperimetric glaucoma 2
Pressure-cornea-vascular index 20
Pressure-to-cornea index 19
Primary
angle closure
disease 1
glaucoma 115
open angle glaucoma 1, 2
Progression of glaucomatous optic neuropathy 25
Progressive optic neuropathy 2
Prostaglandin analogs 61, 62
Prostamide 62
R
Red zone 41
Refractive error 13
Renal disorder 86
Retinal
ganglion cells 2
nerve fiber 1, 40
RNFL defect 43
S
Scanning laser polarimetry 26
Severe disease 51
Shirshasana yoga posture 128
Significant respiratory disease 83
Sleep
apnea 5
disordered breathing 125
Somnolence 86
Squamous metaplasia 97
STAR calculator 15
Stevens-Johnson syndrome 86
Subconjunctival fibrosis 98
Subepithelial fibrosis 97
Synechial angle closure 48
Systemic disease 13
T
Tafluoprost 62
Tenon's capsule 98
Tentatively assigned target pressure 51
Thrombocytopenia 86
Timolol 61, 72
Topical carbonic anhydrase inhibitors 61
Travoprost 61, 62, 67
U
Unoprostone 61
isopropyl 62
Urolithiasis 86
Urticaria 86
Uveitic glaucoma 118
V
Vascular theory 4
Visual field
abnormalities 51
loss 39
OD 30, 46, 56
OS 31, 33, 47, 57
testing 25
Vomiting 86
W
Weight loss 86
White-on-white perimetry 25
X
Xovatra 67
Y
Yellow zone 41
Yoga 127
×
Chapter Notes

Save Clear


1Pearls in Glaucoma Therapy2
3Pearls in Glaucoma Therapy: (A Practical Manual with Case Studies)
Tanuj Dada Additional Professor Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences (AIIMS) New Delhi, India Parul Ichhpujani Assistant Professor Department of Ophthalmology Government Medical College and Hospital Chandigarh, India George L Spaeth Louis J Esposito Research Professor Wills Eye Institute/Jefferson Medical College Philadelphia, Pennsylvania, USA
4Published by
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24, Ansari Road, Daryaganj, New Delhi 110 002, India
Phone: +91-11-43574357, Fax: +91-11-43574314
Offices in India
Overseas Offices
Pearls in Glaucoma Therapy
© 2011, Jaypee Brothers Medical Publishers
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 authors and the publisher.
First Edition: 2011
9789350253915
Typeset at JPBMP typesetting unit
Printed in India
5
To our brave soldiers who have performed the supreme sacrifice for the nation
“When you go home, tell them of us and say for your tomorrow, we gave our today”
6
7Preface
It is a great paradox that although we have the latest technology to diagnose glaucoma and a number of new medications/laser/surgical techniques to treat glaucoma, glaucoma remains the leading cause of irreversible blindness in the world.
The main reasons for this being: patients are unaware of the disease, the disease is diagnosed at a very advanced stage, and hence, many times appropriate medical therapy is not initiated in time. In addition, ophthalmologists are not often aware of the fact that glaucoma may be the manifestation of a systemic disorder and they are dealing with a “sick eye in a sick body.”
Although there are voluminous textbooks available on glaucoma, it is often difficult to derive useful information which can be put to immediate clinical use and set preferred practice patterns based on these texts. There is an unmet need for a practical handbook which gives the basics for work up of a suspected glaucoma patient, outlines the setting of target intraocular pressure (IOP) and explains the principles of medical therapy which can provide easy-reference information to the clinician.
With these goals in mind, the authors present to you the Pearls in Glaucoma Therapy a handbook which we have tailored for use in everyday practice. The text outlines the scientific theories on the causation of glaucoma, incorporates the risk factors for disease and includes a detailed insight into the work up of glaucoma patients including both basic tests like gonioscopy/optic nerve head evaluation and advanced investigations of structure and function like the optical coherence tomography (OCT), glaucoma diagnosis (GDx) and Heidelberg retina tomography (HRT).
The main goal in glaucoma therapy is to set “Target IOP” and initiate medical therapy to preserve the health-related quality of life of the patient and this is clearly given in the text with the help of several case studies which will greatly benefit the reader. The protocol for starting therapy, details of each class of medications, changing or adding treatment, follow-up and methods to increase compliance are given along with a reference to special situations like pregnancy, congenital glaucoma, neovascular, uveitic glaucoma, etc. which require a modification of standard therapy. The last section of the book deals with the most important message of the book “Looking beyond IOP” which looks into the non-IOP dependent ocular and systemic factors like vascular dysregulation, lifestyle modifications and impact of glaucoma on the quality of life of the patient. At the end of each chapter, we have given key take-home messages for the reader.
We hope that these “Pearls of Wisdom” will be an asset to all ophthalmo-logists and residents in training and provide useful practical information which will help to improve the standard of care and ultimately alleviate the suffering caused by glaucoma.
Tanuj Dada
Parul Ichhpujani
George L Spaeth
8
9Acknowledgments
Writing a book is a team effort, although there are three names on the cover, this project involves the time, effort and encouragement of several people.
Words are not enough to thank my parents Drs Kamlesh and Vijay Kumar Dada for their unconditional love and support.
I wish to thank my soul mate Geeta and sister Reema for their help at all times and our little angel “Josya” for making it all worth.
I wish to express my heartfelt gratitude to my mentor and guide, Prof Anita Panda, and my teachers Prof SP Garg, Prof Vimla Menon, Prof Rasik B Vajpayee, Prof Pradeep Sharma, Prof Ramanjit Sihota and Prof Supriyo Ghose, Head of the RPC family.
I wish to thank Prof RV Azad, President and Dr Lalit Verma, Honorary General Secretary of the All India Ophthalmological Society for their leadership and encouragement.
A word of gratitude for my extended glaucoma family—The World Glaucoma Association, especially Prof Robert Weinreb and Prof Kuldev Singh, who have been a great source of inspiration.
A special word of thanks for my colleague Dr Tushar Agarwal who is a computer wizard and our “gadget guru” for his technical inputs.
Finally, I wish to acknowledge my core team comprising Mr Ajay Sharma, the chief technical officer of the world class glaucoma facility at our center, Dr Amit Sobti (Senior Resident) and Drs Vishal Arora and Bhaskar Jha (Junior Residents). It was their special effort which made this project possible.
Last but not the least, I wish to thank Mr Sanjeev Kumar (Lab Attendant) who is an exceptional worker and untiringly serves and helps many underprivileged glaucoma patients.
Ajay Sharma
Amit Sobti
Vishal Arora
Bhaskar Jha
Tanuj Dada