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American Family Physician Apr 2016Glaucoma is a set of irreversible, progressive optic neuropathies that can lead to severe visual field loss and blindness. The two most common forms of glaucoma, primary... (Review)
Review
Glaucoma is a set of irreversible, progressive optic neuropathies that can lead to severe visual field loss and blindness. The two most common forms of glaucoma, primary open-angle glaucoma and primary angle-closure glaucoma, affect more than 2 million Americans and are increasing in prevalence. Many patients with glaucoma are asymptomatic and do not know they have the disease. Risk factors for primary open-angle glaucoma include older age, black race, Hispanic origin, family history of glaucoma, and diabetes mellitus. Risk factors for primary angle-closure glaucoma include older age, Asian descent, and female sex. Advanced disease at initial presentation and treatment nonadherence put patients with glaucoma at risk of disease progression to blindness. The U.S. Preventive Services Task Force has concluded that the evidence is insufficient to assess the potential benefits and harms of screening for glaucoma in the primary care setting. Regular eye examinations for adults are recommended by the American Academy of Ophthalmology, with the interval depending on patient age and risk factors. Diagnosis of glaucoma requires careful optic nerve evaluation and functional studies assessing a patient's visual field. The goal of treatment with eye drops, laser therapy, or surgery is to slow visual field loss by lowering intraocular pressure. Family physicians can contribute to lowering morbidity from glaucoma through early identification of high-risk patients and by emphasizing treatment adherence in patients with glaucoma.
Topics: Adrenergic alpha-Agonists; Adrenergic beta-Antagonists; Age Factors; Carbonic Anhydrase Inhibitors; Cholinergic Agonists; Diabetes Mellitus; Ethnicity; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Mass Screening; Practice Guidelines as Topic; Prostaglandins, Synthetic; Risk Assessment; Risk Factors
PubMed: 27175839
DOI: No ID Found -
British Journal of Hospital Medicine... Dec 2019Acute angle closure is an emergent ophthalmic condition that develops as a result of an obstructed outflow of aqueous humour between the anterior and posterior chambers... (Review)
Review
Acute angle closure is an emergent ophthalmic condition that develops as a result of an obstructed outflow of aqueous humour between the anterior and posterior chambers of the eye, leading to a sudden rise in intraocular pressure and secondary optic neuropathy if left untreated. The most common primary cause is a pupillary block in patients with pre-existing narrow angles, such as those who are long-sighted. However, awareness should be raised to identify secondary causes of angle closure, including the use of commonly prescribed medications. A detailed interrogation is essential to exclude other possible confounding disorders that present similarly, especially those originating in the CNS. Angle closure should be excluded in all patients presenting with sudden onset of red eye associated with pupillary dilation, dull pain and headache. Basic examination of the eye should include assessment of the anterior segment with a bright light, measurement of intraocular pressure and a full neurological exam. Immediate treatment must be initiated whenever there is high clinical suspicion of acute angle closure, with the administration of systemic ocular hypotensive therapy to prevent damage to the optic nerve and limit visual loss. An urgent referral to the ophthalmologist is mandatory to dictate definitive management.
Topics: Acute Disease; Age Factors; Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Risk Factors; Sex Factors
PubMed: 31822188
DOI: 10.12968/hmed.2019.80.12.C174 -
Progress in Retinal and Eye Research Mar 2017Primary angle-closure glaucoma (PACG) is a common cause of blindness. Angle closure is a fundamental pathologic process in PAGC. With the development of imaging devices... (Review)
Review
Primary angle-closure glaucoma (PACG) is a common cause of blindness. Angle closure is a fundamental pathologic process in PAGC. With the development of imaging devices for the anterior segment of the eye, a better understanding of the pathogenesis of angle closure has been reached. Aside from pupillary block and plateau iris, multiple-mechanisms are more common contributors for closure of the angle such as choroidal thickness and uveal expansion, which may be responsible for the presenting features of PACG. Recent Genome Wide Association Studies identified several new PACG loci and genes, which may shed light on the molecular mechanisms of PACG. The current classification systems of PACG remain controversial. Focusing the anterior chamber angle is a principal management strategy for PACG. Treatments to open the angle or halt the angle closure process such as laser peripheral iridotomy and/or iridoplasty, as well as cataract extraction, are proving their effectiveness. PACG may be preventable in the early stages if future research can identify which kind of angles and/or persons are more likely to benefit from prophylactic treatment. New treatment strategies like adjusting the psychological status and balancing the sympathetic-parasympathetic nerve activity, and innovative medicines are needed to improve the prognosis of PACG. In this review, we intend to describe current understanding and unknown aspects of PACG, and to share the clinical experience and viewpoints of the authors.
Topics: Diagnostic Techniques, Ophthalmological; Disease Management; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Sympathetic Nervous System
PubMed: 28039061
DOI: 10.1016/j.preteyeres.2016.12.003 -
Medicina (Kaunas, Lithuania) Dec 2022Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and... (Review)
Review
Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic balance between the angiogenic and antiangiogenic factors. High concentrations of vasogenic substances such as vascular endothelial growth factor (VEGF) induce neovascularization of the iris (NVI) and neovascularization of the angle (NVA) that limits the outflow of aqueous humor from the anterior chamber and increases the IOP. NVG clinical, if untreated, progresses from secondary open-angle glaucoma to angle-closure glaucoma, leading to irreversible blindness. It is an urgent ophthalmic condition; early diagnosis and treatment are necessary to preserve vision and prevent eye loss. The management of NVG requires the cooperation of retinal and glaucoma specialists. The treatment of NVG includes both control of the underlying disease and management of IOP. The main goal is the prevention of angle-closure glaucoma by combining panretinal photocoagulation (PRP) and antiangiogenic therapy. The aim of this review is to summarize the current available knowledge about the etiology, pathogenesis, and symptoms of NVG and determine the most effective treatment methods.
Topics: Humans; Glaucoma, Neovascular; Vascular Endothelial Growth Factor A; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Intraocular Pressure
PubMed: 36557072
DOI: 10.3390/medicina58121870 -
Indian Journal of Ophthalmology Apr 2018Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering... (Review)
Review
Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target" IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having - mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. "Target" IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a "Target" IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.
Topics: Antihypertensive Agents; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Iridectomy
PubMed: 29582808
DOI: 10.4103/ijo.IJO_1130_17 -
Die Ophthalmologie Nov 2022Angle-closure glaucoma is a rare form of glaucoma characterized by a narrow or an occlusion of the anterior chamber angle and subsequently an obstruction of the...
Angle-closure glaucoma is a rare form of glaucoma characterized by a narrow or an occlusion of the anterior chamber angle and subsequently an obstruction of the outflow of aqueous humor resulting in an increase in intraocular pressure. Symptoms can include severe eye pain and/or headache, blurred vision, a medium-sized and rigid pupil, conjunctival hyperemia, and nausea. Treatment options include pressure-lowering topical and systemic medications as well as surgical interventions, especially cataract surgery and laser iridotomy. Besides parasympathomimetics (pilocarpine), all topical antiglaucoma medications can principally be used (beta-receptor antagonists, carbonic anhydrase inhibitors, alpha‑2 selective adrenergic antagonists, prostaglandins and prostaglandin analogues). Carbonic anhydrase inhibitors and osmotic agents (e.g., mannitol) can be systemically used.
Topics: Humans; Glaucoma, Angle-Closure; Carbonic Anhydrase Inhibitors; Intraocular Pressure; Glaucoma; Anterior Chamber
PubMed: 36303042
DOI: 10.1007/s00347-022-01745-w -
Klinische Monatsblatter Fur... Aug 2023Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can...
Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can lead to severe visual disturbances and even blindness within a short time. It is divided into primary and secondary forms and can be further categorized depending on the presence of a pupillary block. In all cases, therapy is initially based on resolving the cause of the angle-closure and treating any underlying disease that may be present. In addition, intraocular pressure reduction must be achieved. This can be effectuated conservatively or surgically. Depending on the specific subtype of angle-closure, different treatments are promising.
Topics: Humans; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Blindness; Pupil Disorders; Europe; Intraocular Pressure
PubMed: 37236235
DOI: 10.1055/a-1812-4381 -
Lancet (London, England) Apr 2019Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects.
METHODS
In this randomised controlled trial, bilateral primary angle closure suspects aged 50-70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099.
FINDINGS
Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95% CI 0·30-0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up.
INTERPRETATION
Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended.
FUNDING
Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China.
Topics: Aged; China; Female; Glaucoma, Angle-Closure; Humans; Intention to Treat Analysis; Intraocular Pressure; Iridectomy; Kaplan-Meier Estimate; Lasers, Solid-State; Male; Middle Aged; Prophylactic Surgical Procedures
PubMed: 30878226
DOI: 10.1016/S0140-6736(18)32607-2 -
Eye (London, England) Dec 2022
Topics: Humans; Glaucoma, Angle-Closure; Intraocular Pressure
PubMed: 35725765
DOI: 10.1038/s41433-021-01881-8 -
The New England Journal of Medicine Mar 2018
Topics: Acute Disease; Eye; Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Middle Aged
PubMed: 29514027
DOI: 10.1056/NEJMicm1712742