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
9Acknowledgments
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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
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”
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 |
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.
Tanuj Dada