Glaucoma Notes

POAG

Treatment

Goal of ttt of glaucoma is to reduce IOP 

at least 30%

Medications - first line

Laser - initial if poor compliance to medications, significat posterior TM pigmentations

Surgery - Initial if advanced 

Other surgeries if the above ttt is not working:

medications:

Start with one type of drop in one eye 

 (Monocular therputic trail)

- Prostaglandin agonists 

- beta blockers 

- Selective alpha2 receptor agonists 

- Topical CAI

-Miotics

- Sympathomimetics 

-Systemic CAI

To reduce Systemic absorption;

Close the punctum

cloas the eyelid for a couple of minutes without blinking 

Follow up: 

-Reexamination: 4-6 weeks after medications and laser  

- Close monitoring 1-3 days if damage is severe and IOP is high 

- Once IOP is reduced - reevaluate 3-6 month for IOP and Optic n 

-Gonioscopy yearly 

-Dilated retinal exam - yearly 

- VF and optic nerve imaging from -6 month

Trabeculectomy - Filtration surgery animation

SLT

Low pressure POAG (Normal pressure glaucoma)

Normal IOP

Greater liklihood of optic disc hge

VF defects are denser, mora localized and closer to fixation

dense nasal paracentral defect is typical

Average CCT 510-50 microns


 IOP plays an important role in normal pressure glaucoma

vascular dysregulation


Work up:

- History: vasospasm, hypotensive crisis, anemia, HD, corticosteroids use, trauma, uveitits, GCA, cardiovascular RF

- Color plates 

-Gonioscopy

- Obtain diurnal curve of IOP

- Carotid dopplers to evaluate ocular blood flow

- CT or MRI


Treatment

- lowering IOP - 30% lower than the level of the progressive damage.( the same therpies of POAG)

- Managment of cardiovascular RF is benifical for general hralth but not for glaucoma.
( Avoid use of antihypertensive drugs at bedtime and use it in the morning)

-Systemic CAI may improve the capillary perfusion for the optic nerve. 



Ocular HTN


IOP >3 mmhg above the average (15 mmHg)
normal apperaing AC angle
normal gonioscopy 
normal optic nerve and VF