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Upon completion of the chapter, the reader will be able to:
Identify risk factors for the development of primary open-angle glaucoma (POAG) and acute angle-closure glaucoma.
Recommend a frequency for glaucoma screening based on patient-specific risk factors.
Compare and contrast the pathophysiologic mechanisms responsible for open-angle glaucoma and acute angle-closure glaucoma.
Outline the clinical presentation of chronic open-angle glaucoma and acute angle-closure glaucoma.
List the goals of managing patients with POAG suspect, POAG, and acute angle-closure glaucoma.
Choose the most appropriate therapy based on patient-specific data for open-angle glaucoma, glaucoma suspect, and acute angle-closure glaucoma.
Develop a monitoring plan for patients on specific pharmacologic regimens.
Counsel patients about glaucoma, drug therapy options, ophthalmic administration techniques, and the importance of adherence to the prescribed regimen.
Glaucoma refers to a spectrum of ophthalmic disorders characterized by neuropathy of the optic nerve and loss of retinal ganglion cells, which typically leads to permanent deterioration of the visual field (peripheral vision) initially and potentially total vision loss (including central vision). It is often, but not always, eye pressure related.1-3 Table 61–1 describes the general classification of glaucoma. Glaucoma Suspects are patients with a higher than average risk of developing glaucoma because of the presence of certain clinical findings, risk factors, family history, or racial background. Glaucoma suspects can be further classified as open-angle glaucoma suspects or angle-closure glaucoma suspects.
Primary Open-Angle Glaucoma (POAG) and Primary Angle-Closure Glaucoma (PACG) represent the most common types of glaucoma and therefore are the focus of this chapter. PACG can present clinically as acute angle-closure crisis (AACC). AACC is the sudden obstruction of the trabecular meshwork, which leads to a rapid increases in IOP resulting in pressure-induced optic neuropathy if untreated.1-4 In contrast, patients with POAG typically have a slow, insidious loss of vision which is often asymptomatic until the latter stage of the disease process. This is contrasted by the course of AACC, which can lead to rapid and painful vision loss that develops over hours to days.
Table 61–1Glaucoma Classifications3,4 ||Download (.pdf) Table 61–1 Glaucoma Classifications3,4
|Classification ||Description |
|Primary glaucoma ||Glaucoma that cannot be attributed to a preexisting ocular or systemic disease |
|Secondary glaucoma ||Glaucoma that can be attributed to preexisting ocular or systemic disease. Examples include pigment dispersion syndrome, neovascular glaucoma, and pseudoexfoliative syndrome. |
|Open-angle glaucoma ||Glaucoma characterized by normal anterior-chamber angles and glaucomatous changes of the optic disc. Can be further classified as primary or secondary. |
|Angle-closure glaucoma ||Glaucoma characterized by the obstruction of the anterior chamber angle resulting in either intermittent or progressive elevated IOP with subsequent damage to the optic nerve. Can be further classified as primary or secondary. |