Primary open-angle glaucoma: everyone's business (original) (raw)

Glaucoma: Past, Present, and Future

Revista Brasileira De Oftalmologia, 2020

P rimary open-angle glaucoma (POAG) is an age-old disease that remains enigmatic. Millions of people worldwide still lose their sight due to POAG and the prediction is that, with longer life expectancy, more people will be diagnosed with it. (1) Over the years, glaucoma has undergone changes in concept, workup and treatment. Up to now, the concept of this disease is not consensual. (2) Would it be a brain disease? Initially, glaucoma was synonymous with elevated intraocular pressure (IOP). The elevated IOP would cause the excavation of the optic disc (glaucomatous excavation) (3) and visual field (VF) loss, characterizing the glaucoma triad. (2) Conceptual changes occurred in 1996 when glaucoma was defined as an optic neuropathy being the elevated IOP its main risk factor. (4) Since then, optic neuropathy and VF loss characterize the manifest glaucoma. However, some patients may have an elevated IOP without VF loss nor retinal nerve fiber layer (RNFL) loss-ocular hypertension (OH). (5) Others may present preperimetric glaucoma characterized by RNFL loss detected by optical coherence tomography (OCT) in the absence of VF loss. (6) It is surprising that elevated IOP, the only known modifiable condition, has been considered as the principal risk factor taking in view that, for avoiding glaucoma progression, the treatment is the IOP normalization even when IOP is statistically normal. It is a big mistake to think that the IOP level is important for POAG and normal tension glaucoma treatment, but at the same time, not as a criterion for its diagnosis. It is known that elevated IOP is the result of impairment of drainage of the aqueous humor (AH) independently of the type of glaucoma. Uncontrolled IOP causes glaucoma progression with irreversible and progressive loss of RNFL and VF. This implies that elevated IOP seems to be or is a fundamental part of the disease and needs a detailed investigation. Taking into consideration that IOP is a highly dynamic parameter with many influence factors, it is an absurd to manage glaucoma with single IOP measurement. The major challenge is to find out the target IOP for each preperimetric or glaucomatous patient. Workup The workup of glaucoma has also changed over time. New tonometers have appeared, but none of them has overcome the gold standard Goldmann applanation tonometer since 1957. (7) In 1997, the measurement of central corneal thickness (CCT) was introduced, but there is no algorithm that directly relates it to the value of IOP. (8,9) Also, the role of corneal hysteresis (CH) in glaucoma has not been fully elucidated. CH may be more significantly associated with glaucoma than CCT. (10) OCT and OCT angiography (OCTA) have been used in last decades. (11,12) Diniz-Filho et al. reported that "higher levels of IOP during follow-up were associated with faster rates of RNFL loss over time measured by SD OCT". (10) OCTA allows for simultaneous in vivo imaging of the morphology and vasculature of the eye. (12) IOP assessment The 24-hour IOP investigation still remains a challenge. It is performed for detecting IOP peaks but it is not performed by most ophthalmologists around the world because of expense and inconvenience. (12) Many provocative and functional tests have been used to diagnose early glaucoma. The water-drinking and ibopamine tests failed to diagnose early POAG because of high rates of false-positive and false-negative results. (13,14) Some authors have monitored 24-hour IOP with the SENSIMED Triggerfish contact lens, but the results are not convincing yet. (15) Corneal hysteresis (CH) and lamina cribrosa Although there are some controversies about CH in glaucoma, some authors reported that lower CH measurements were significantly associated with increased risk of developing glaucomatous visual field defects over time.(10) Studies using Swept-Source OCT (SS-OCT) have demonstrated that the lamina cribrosa is likely biomechanically active and that significant changes occur in glaucoma. (16) VF examination In the past, blue-yellow perimetry was performed for early glaucoma diagnosis. This technique was completely abandoned. (14) Frequency-doubling perimetry (FDP) has been less used than in thepast, presenting a tendency of abandon. (14) Nowadays, all scientific works use the 24-2 test VF. Recently, some authors have advised performing the 10-2 test could be essential for some glaucoma patients. (17) Other authors reported that further studies are needed to determine the potential advantages of the 10-2 test in relation to the 24-2. (18)

Epidemiology of glaucoma: what's new?

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2012

Globally, there are an estimated 60 million people with glaucomatous optic neuropathy and an estimated 8.4 million people who are blind as the result of glaucoma. These numbers are set to increase to 80 million and 11.2 million by 2020. Glaucoma is the second leading cause of blindness globally. The highest prevalence of open-angle glaucoma occurs in Africans, and the highest prevalence of angle-closure glaucoma occurs in the Inuit. Population-based screening for open-angle glaucoma is not recommended. Screening for angle-closure may be feasible. À l'échelle mondiale, l'on estime à 60 millions le nombre de personnes atteintes d'une neuropathie optique glaucomateuse et à 8,4 millions le nombre de cécités dues au glaucome. Ces données s'apprêtent à augmenter jusqu'à 80 millions et 11,2 millions en 2020. Le glaucome est la deuxième cause principale de cécité dans le monde. La prévalence la plus élevée du glaucome à angle ouvert se situe chez les Africains et la prévalence la plus élevée du glaucome à angle fermé se situe chez les Inuits. Le dépistage des populations pour le glaucome à angle ouvert n'est pas recommandé. Le dépistage à angle fermé peut être faisable.

Glaucoma: Risk Factors and Prevalence: A Review

International Journal Of Community Health And Medical Research

In recent time, the concept and definitions of glaucoma have changed from a single pathologic entity to a group of disorders with different clinical pictures. Glaucoma can be defined as a multifactorial optic neuropathy which may or may not be associated with angle abnormality in the presence or absence of any cause for the disease. Irrespective of the manifestation; glaucoma is the second leading cause of blindness worldwide, with preponderance in females, blacks and Asians. Various classifications have been proposed from time to time with the most basic classification system involves separation of angle-closure glaucoma from open-angle glaucoma. This review highlights the clinical features, classification and recent factors related to glaucoma.

Vecino.2011.Glaucoma - Basic and clinical concepts

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Changing views on open-angle glaucoma : the Rotterdam study

1999

Purpose: To quantify in a masked way the prevalence of determinants of openangle glaucoma (OAG) and their influence on the overall OAG prevalence. Methods: A total of 6781 subjects aged 55 years or over pmticipated in this population-based study (6293 independently living subjects and 488 living in nursing homes). The criteria for the diagnosis of OAG were based on semiautomated measurements of the optic disc (vertical cup-to-disc ratio (VCDR), minimal width of neural rim, or asymmetry in VCDR between both eyes) and visual field testing with kinetic Goldmann perimetry. All separate criteria for the diagnosis of OAG were assessed independently of each other. Results: Mean VCDR was 0.49, and the 97.5 'h percentile was 0.70. The prevalence of visual field defects compatible with OAG and without other causes was 1.5%. Overall prevalence of OAG in the independently living subjects was 0.9% (95% Cl 0.6, I.l; 56 cases). Prevalence of OAG was almost three tilnes higher in men than in wo...

Clinical and epidemiological study in patients with primary open-angle glaucoma

Revista Brasileira de Oftalmologia, 2018

Objective: To evaluate the clinical and epidemiological profile of patients with primary open-angle glaucoma. Methods: This is a quantitative study with cross-sectional and analytical design, which sample consisted of 425 patients treated in an unit of Specialized Care in Ophthalmology, located in the northern state of Minas Gerais, from 2004 to 2015. We collected the data using formularies that addressed demographic and clinical aspects, risk factors and the presence of undercurrent diseases. We conducted an ophthalmological examination to evaluate anatomical and functional changes. We used statistical analysis, and the results are presented by mean, standard deviation and percentiles 25, 50 and 75. Results: Females predominate (56.8%), the age group of 60 years or older (44%) and mixed skin (81.7%). A minority of participants present risk factors such as high myopia (6.3%) and diabetes mellitus (17.9%). Regarding the clinical examination, there is a prevalence of increased optic nerve excavation (≥ 0.8) and low thickness of the corneas (≤ 535 microns). Conclusion: Most people develop advanced glaucoma, with increased optic nerve excavation and changed visual fields. Other common risk factors are: family history of glaucoma, decreased thickness of the cornea and hypertension. Early diagnosis and treatment can prevent vision loss. Primary care physicians should consider referring patients who have glaucoma risk factors, for an ophthalmologic examination.