Glaucoma

Glaucoma Ocular Pathology & Microbiology Dr Ian Pacey UNIVERSITY OF BRADFORD

Definition ,[object Object],[object Object],[object Object]

Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],Primary Open Angle Glaucoma Angle-Closure Glaucoma

Background ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Definition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],secondary = no more on angle POAG

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Effectively the ability of O 2 etc to go BV to nerve ? reduced prod of aqu but overall incr IOP

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],i.e. NTG. But IOP still relevant ACG & >30 affects appearance of disc & visual field more later SWAP, motion

How relevant? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],?true - not counted

How relevant? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],not great deal of data

How relevant? ,[object Object],[object Object],[object Object],from Baltimore study why this point? all dead?

The Case History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],sometimes ‘something not right’

The Case History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],‘ mum went blind’ - 4x risk of getting POAG most quote 8-10x risk good ‘cos unbiased population study

The Case History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Therefore probably <2.8 but still there cold hands/feet/nose/ears & migraine

The Case History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],‘ dippers’ those who’s BP drops dramatically at night. often recently Tx systemic hypertensives initially incr BP helps perfusion, but not when secondary vascular changes have occured

Intra-Ocular Pressure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Intra-Ocular Pressure ,[object Object],[object Object],[object Object],[object Object]

Intra-Ocular Pressure DO NOT use as diagnosis on its own measure on all pts: increase over time = suspect

Ocular Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],made up?! ie after 10 years 1/10th will have converted

Optic Nerve Head - normal ,[object Object],[object Object],[object Object],[object Object]

Optic Nerve Head - normal ,[object Object],Afro-Caribbean higher prevalence of POAG due to larger discs & cups  more susceptible to damage

Optic Nerve Head - normal ,[object Object],[object Object],[object Object],I S N T

Optic Nerve Head - normal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],possibly absent in small discs

Optic Nerve Head - normal ,[object Object],[object Object],many pallor=cupping. glauc cupping increases & pallor same (?ageing too). if pallor>cup suspect neurological lesion ?

Optic Nerve Head - normal ,[object Object],[object Object],C:D = ?? 1.5mm 1mm

Optic Nerve Head - normal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Optic Nerve Head - normal ,[object Object],[object Object]

Optic Nerve Head - POAG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],weak diagnostic tool

Optic Nerve Head - POAG ,[object Object],nearly end stage Not ISNT: Sup thinning? PPA

Optic Nerve Head - POAG ,[object Object],Not ISNT: Sup thinning?

Optic Nerve Head - POAG ,[object Object]

Optic Nerve Head - POAG ,[object Object],[object Object],[object Object],[object Object]

Optic Nerve Head - POAG ,[object Object],[object Object],[object Object]

Optic Nerve Head - POAG ,[object Object],[object Object],[object Object],[object Object],[object Object]

Nerve Fibre Layer (NFL) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Optic Nerve Head - normal ,[object Object],splinter haem

Heidelberg Retinal Tomograph (HRT)

Visual Fields ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Visual Fields ,[object Object]

Visual Fields ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Visual Fields ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medical Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],original

Medical Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],newer

Medical Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],newer

Surgical Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical Management ,[object Object]

Summary ,[object Object],CH: remember Age, Race, FH Exam: need to measure IOP, do Fields and carefully examine the disc Use ALL THREE to decide to refer Counsel the Pt that it is usually a very slow progression

References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],+ numerous others

Glaucoma

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Glaucoma