glaucoma. And Ocular Hypertension and treatment

About the eye
There increase ocular pressure

1. GLAUCOMA

2. Introduction
Glaucoma refers to a collection of diseases whereby increased intraocular
pressureadversely impacts the optic nerve, and subsequently, the visual field. 1
Normal Tension Glaucoma-Normal IOP (10-21mmHg)
Have in common a characteristic progressive optic neuropathy
Eventual development of distinctive irreversible structural and functional visual
dysfunction

3. Cassonet al 2012
“agroupofoculardisordersofmultifactorialaetiologyunitedbyaclinically
characteristicopticneuropathywithpotentiallyprogressive,clinicallyvisiblechanges
attheopticnervehead(ONH),comprisingfocalorgeneralizedthinningofthe
neuroretinalrimwithexcavationandenlargementoftheopticcup,representing
neurodegenerationofretinalganglioncellaxonsanddeformationofthelamina
cribrosa;correspondingdiffuseandlocalizednerve-fibre-bundlepattern,visualfield
lossmaynotbedetectableinearlystages;whilevisualacuityisinitiallyspared,
progressioncanleadtocompletelossofvision;theconstellationofclinicalfeatures
isdiagnostic”.2

4. Epidemiology
Third leading cause of blindness (<3/60)
Fourth leading cause of all vision loss worldwide
Leading cause of irreversible vision loss. 3
Global prevalence 2.2-3.54% (40-80yrs). 4,5
19.4 percent ofblindness (<3/60) in Ghana. 6
76 million -2020.
122 million –2040. 5
2381 new cases of glaucoma out of 19445 OPD attendance at the eye clinic -
12.24%.

5. Two main class
1.Open –Angle Glaucoma
2.Close –Angle Glaucoma
It can be
Primary
Secondary
Common –Primary Open Angle Glaucoma (POAG)

6. Pathophysiology

7. Pathophysiology

9. Mechanical theory
elevated IOP leads to the compression of the nerve fibrebundle
Ischemic / Vascular theory
Hemodynamic alterations may act independently from, or in conjunction with,
raised IOP to cause damage at the site of the ONH

10. Glaucoma continuum

13. Symptoms
POAG is asymptomatic in its early stage
Visual field loss starts from the periphery to central
Can lead to complete loss of vision

15. Risk Factors
High Intraocular Pressure (>21mmHg)*
Ethnicity –Africans (4.2%), Europeans (2.1%), Asian (1.4%)7
Increasing age (>40yrs).
Positive family Hxof glaucoma
Refractive Status-high myopia
Central corneal thickness
Diabetes and Hypertension –weak association

16. Diagnosis-workup
Funduscopy
Gonioscopy*
Tonometry
Optical coherence tomography (OCT)
Visual field Test (VFT)
Pachymetry*

17. Management
Medication
Beta blockers –reduce production
Alpha agonist -reduce production
Carbonic Anhydrous Inhibitors -reduce production
Cholinergic Agonist –increase drainage
Prostaglandin analogues –increase drainage

18. Surgery
-Trabeculectomy
-SIGS/ MIGS
-Glaucoma Implant Surgery

19. Laser
-Trabeculoplasty
-Iridotomy

20. CONCLUSION
The statistic are not good
Enormous Global financial burden-Global cost of productivity losses
$244 billion –uncorrected myopia
$25.4 billion –presbyopia
(WHO FACTS SHEET)

21. 1.NavidMahabadi; Lisa A. Foris; KoushikTripathy. Open Angle Glaucoma,
StatPearlsPublishing; 2022 Jan
2.CassonR, ChidlowG, Wood J, CrowstonJ, Goldberg I (2012) Definition of
glaucoma: clinical and experimental concepts. ClinExpOphthalmol40:341–
349. doi:10.1111/j.1442-9071.2012.02773.x
3.WHO, fact sheets, blindness and vision impairment 14 Oct 2021
4.Genetics of glaucoma. WiggsJL, Pasquale LR.Hum MolGenet.2017;26:0.
5.Yih-Chung Tham,Xiang Li,Tien Y Wong,Harry A Quigley,Tin Aung,Ching-Yu
Cheng, Global prevalence of glaucoma and projections of glaucoma burden
through 2040 a systemic review and meta-analysis. Ophthalmology 2014; 121:
2081-2090
6.Ghana Blindness and Visual Impairment Study 2015; 25
7.Leske, M.C Open-Angle Glaucoma-An epidemiologic overview, ophthalmic
epid, 2007 14(4); p 166-172

22. Thank You