optometry.naija: Glaucoma Week Series- episode 10 (Glaucoma Managem...: "Optom Managing Glaucoma tends to be a long term thing. The first thing that should always come to mind when faced with Glaucoma prospect i..."
Optom
optometry is discussed here, eye diseases and disabilities are highlighted and management of such ocular conditions enumerated.
Friday, 22 April 2011
Glaucoma Week Series- episode 10 (Glaucoma Management)
Optom
Managing Glaucoma tends to be a long term thing. The first thing that should always come to mind when faced with Glaucoma prospect is to differentiate between the types of Glaucoma, because the various types require quite a different approach in management. The next question is to start treating versus monitoring! Is it necessary to commence treatment if the symptoms are not there while there is a strong cause of suspicion, like a cupped disk without pressure or a high pressure without a cupping etcThe clinician is faced with the option of either comencement of treatment or close monitoring the patient, but I often start a low grade management @ the slight suspicion of Glaucoma! Such as educating the patient very well about the syndrome & in some cases prescribing gutt: Timolol meleate 0.5 percent i bds. The patient should be returning to the clinic monthly for a close follow up which includes checking intra ocular pressure, measuring the size of the disk (is there any excavation? Has the cup gone beyond 0.5 threshold? etc).If patients comes in with an already established Glaucoma, treatment with drugs comences immediatly! I monitor patient's visual acuity, do refraction, use ophthalmoscope to rule out a secondary cause or any other eye disease while establishing glaucomaas the cause of the impairment (most often a very poor vision in one eye that keeps degenerating and tends towards the other eye or recently changed glasses that no longer effective or even diminishing vision towards evening could be the reason of visit!)I then check patient's I.O.P with schiotz tonometer ( its out-dated though, but desperate times always call for desperate measures!). I always puntuate my tests with patient's education, this is one of the most important pearl in managing Open Angle Glaucoma especially in the rural communities. We send patients to the city to do central visual field tests with either the Humphrey analyser, the Octopus visual field analyser or any automated visual field analyser periodically, which is often attached in the patient's report for analysis and education! We have tried severally to inroduce co-management with Ophthalmologists in the city but seem to leave the patient vulnerable.It should be known that various medications are used in the management of Glaucoma, but I always pay attention to the cost burden on the patients! This is to avoid creating a psycholgical backlash which often times discourages the patient & hence mounts this person's handicap!After establishing that systemically, the patient is not @ risk of any pulmonary disease I give him/her a starting therapy of gutt: Timolol 0.5 percent bds x 1/12. (a beta blocker). I add postalglandin analog like, Latanoprost or travatan or xalatan 1 noct. x 1/12 in the course of management. Recently Alphagan (Brimodimine, an Alpha agonist) has attracted my interest while I no longer use miotics like Pilocarpine as it has been widely reported to have very serious side effects like retinal deterchments etc Alphagan could be combined with either a beta blocker or a postalglandin analog to promote efficacy of management. Note, a beta blocker reduces aqueous production, an alpha blocker promotes outflow and has been hypotesised to contain neuro-protectors to maintain the integrity of neuro-retinas which often suffers in Glaucoma process. On the other hand, a postalglandin analog promotes uveo-scleral flow (this contributes 10 percent of outflow). Acetozolamide (diuretics), Slow K (reduces the clearance of potasium in the body) are adjunts in managing Glaucoma. In some cases, the use of surgery is advised especially in the closed angle type of glaucoma! We shall discuss this mode of treatment/management in subsequent blog! Happy Good Friday! Be responsible for your eyes!To be continued...Dr Ezebuiroh Okwudiri Victor.
Managing Glaucoma tends to be a long term thing. The first thing that should always come to mind when faced with Glaucoma prospect is to differentiate between the types of Glaucoma, because the various types require quite a different approach in management. The next question is to start treating versus monitoring! Is it necessary to commence treatment if the symptoms are not there while there is a strong cause of suspicion, like a cupped disk without pressure or a high pressure without a cupping etcThe clinician is faced with the option of either comencement of treatment or close monitoring the patient, but I often start a low grade management @ the slight suspicion of Glaucoma! Such as educating the patient very well about the syndrome & in some cases prescribing gutt: Timolol meleate 0.5 percent i bds. The patient should be returning to the clinic monthly for a close follow up which includes checking intra ocular pressure, measuring the size of the disk (is there any excavation? Has the cup gone beyond 0.5 threshold? etc).If patients comes in with an already established Glaucoma, treatment with drugs comences immediatly! I monitor patient's visual acuity, do refraction, use ophthalmoscope to rule out a secondary cause or any other eye disease while establishing glaucomaas the cause of the impairment (most often a very poor vision in one eye that keeps degenerating and tends towards the other eye or recently changed glasses that no longer effective or even diminishing vision towards evening could be the reason of visit!)I then check patient's I.O.P with schiotz tonometer ( its out-dated though, but desperate times always call for desperate measures!). I always puntuate my tests with patient's education, this is one of the most important pearl in managing Open Angle Glaucoma especially in the rural communities. We send patients to the city to do central visual field tests with either the Humphrey analyser, the Octopus visual field analyser or any automated visual field analyser periodically, which is often attached in the patient's report for analysis and education! We have tried severally to inroduce co-management with Ophthalmologists in the city but seem to leave the patient vulnerable.It should be known that various medications are used in the management of Glaucoma, but I always pay attention to the cost burden on the patients! This is to avoid creating a psycholgical backlash which often times discourages the patient & hence mounts this person's handicap!After establishing that systemically, the patient is not @ risk of any pulmonary disease I give him/her a starting therapy of gutt: Timolol 0.5 percent bds x 1/12. (a beta blocker). I add postalglandin analog like, Latanoprost or travatan or xalatan 1 noct. x 1/12 in the course of management. Recently Alphagan (Brimodimine, an Alpha agonist) has attracted my interest while I no longer use miotics like Pilocarpine as it has been widely reported to have very serious side effects like retinal deterchments etc Alphagan could be combined with either a beta blocker or a postalglandin analog to promote efficacy of management. Note, a beta blocker reduces aqueous production, an alpha blocker promotes outflow and has been hypotesised to contain neuro-protectors to maintain the integrity of neuro-retinas which often suffers in Glaucoma process. On the other hand, a postalglandin analog promotes uveo-scleral flow (this contributes 10 percent of outflow). Acetozolamide (diuretics), Slow K (reduces the clearance of potasium in the body) are adjunts in managing Glaucoma. In some cases, the use of surgery is advised especially in the closed angle type of glaucoma! We shall discuss this mode of treatment/management in subsequent blog! Happy Good Friday! Be responsible for your eyes!To be continued...Dr Ezebuiroh Okwudiri Victor.
Tuesday, 19 April 2011
Glaucoma Week Series -episode 9 (Identifying closed angle Glaucoma in a rural setting)
Optom
Closed angle glaucoma is often an emergency eye challenge. Its always acute and often present with epiphora in the ipsilateral eyes. Another classic outlook of closed Angle Glaucoma is monocularity in pathogenesis but often assumes binocularity @ an unpredicted pace! This type of Glaucoma, which most times is accompanied by a secondary or predisposing factor, can affect individuals of any age group.
The following triads are cornerstone gems for suspecting closed Angle Glaucoma in a rural setting-
In Adults
1)sudden onset of pain in one eye and necessarily much epiphora.
2)Redness with corneo-scleral limbal injection, not related to ocular infections, but the cornea is relatively clearer on early presentation.
3)Mid-dilated ipsilateral pupil with sluggish or unreactive pupil to light.
In children
1) Epiphora
2) corneal edema
3)Exophthalmos.
These classical triads are often accompanied with photophobia. The pressure of the eye is visibly high and on external examination one can reveal engorged vessels. The patient can misinterpret the throbbing in the eyeball for a generalized headache. It often does not lead to blindness because of the highly symptomatic nature of Angle closure Glaucoma. In children it almost always binocular in pathogenesis. It is not common to Africa, but an important eye challenge to Asians. Glaucoma is no respecter of sight...lets not play with it! Go for an eye test today, it can make the difference!
To be continued....
Dr Ezebuiroh Victor Okwudiri.
Closed angle glaucoma is often an emergency eye challenge. Its always acute and often present with epiphora in the ipsilateral eyes. Another classic outlook of closed Angle Glaucoma is monocularity in pathogenesis but often assumes binocularity @ an unpredicted pace! This type of Glaucoma, which most times is accompanied by a secondary or predisposing factor, can affect individuals of any age group.
The following triads are cornerstone gems for suspecting closed Angle Glaucoma in a rural setting-
In Adults
1)sudden onset of pain in one eye and necessarily much epiphora.
2)Redness with corneo-scleral limbal injection, not related to ocular infections, but the cornea is relatively clearer on early presentation.
3)Mid-dilated ipsilateral pupil with sluggish or unreactive pupil to light.
In children
1) Epiphora
2) corneal edema
3)Exophthalmos.
These classical triads are often accompanied with photophobia. The pressure of the eye is visibly high and on external examination one can reveal engorged vessels. The patient can misinterpret the throbbing in the eyeball for a generalized headache. It often does not lead to blindness because of the highly symptomatic nature of Angle closure Glaucoma. In children it almost always binocular in pathogenesis. It is not common to Africa, but an important eye challenge to Asians. Glaucoma is no respecter of sight...lets not play with it! Go for an eye test today, it can make the difference!
To be continued....
Dr Ezebuiroh Victor Okwudiri.
Sunday, 17 April 2011
optometry.naija: Glaucoma Week Series 2011- episode 8 (Identifying ...
optometry.naija: Glaucoma Week Series 2011- episode 8 (Identifying ...: "Optom In continuation with Glaucoma, identifying this silent killer of sight, poses the most tricky challenge to even a well grounded profes..."
Optom
Optom
Glaucoma Week Series 2011- episode 8 (Identifying Open angle Glaucoma in a rural setting!)
Optom
In continuation with Glaucoma, identifying this silent killer of sight, poses the most tricky challenge to even a well grounded professional eye care specialist! Glaucoma is a syndrome which basically does not follow a particular pattern.
The following are some of the early signs of glaucoma- excavation of the optic nerve head, such that the integrity of both the lamina cribosa and the nerve fibres start the process of apoptosis and subsequent increased cupping of the disk (initially the central vision is not affected till the later stages); shrinking of the peripheral visual field as a result of programmed cell-death of the ganglion retinal fibres; and in some cases a rise in intraocular pressure of more than 21-23 mmHg!
In later stages, a form of night blindness ensues, especially when the peripheral nerve bundles of the retina have been badly affected, which of course affects the integrity of the retinal rods! A visible loss of peripheral field is also noticed , especially moving objects; reduced visual acuity accompanied by increased glare sensitivity and poor contrast sensitivity is noticed in patients with confirmed mid-stage glaucoma; these patients tend towards myopia and often times develop an Astigmatism skewed towards the superior-inferior cup-disc excavation (its hardly a with-the rule Astigmatism, more common is an against-the-rule Astigmatism and any form of oblique Astigmatism!). The pupil develops a mid-dilated stare with negative Macus Gunn pupillary reflex and sometimes seldom react to light, the two pupils are not always of equal size (it should be noted that the Edinger Welpher Nucleus which sympathetically innervates the pupils is choked in the Glaucoma process, hence those pupillary changes in this stages!). The fact is that open Angle Glaucoma is very subtle to be detected early enough in a rural setting where the prospect of using Slit-Lamp & accessories, OCT scanning system, pachymeters etc are very limited, hence its best to always advice people staying with you in your area to come for vision screening from time to time! Glaucoma is dangerous, dont play with it!
To be continued...
Dr Ezebuiroh Victor Okwudiri.
In continuation with Glaucoma, identifying this silent killer of sight, poses the most tricky challenge to even a well grounded professional eye care specialist! Glaucoma is a syndrome which basically does not follow a particular pattern.
The following are some of the early signs of glaucoma- excavation of the optic nerve head, such that the integrity of both the lamina cribosa and the nerve fibres start the process of apoptosis and subsequent increased cupping of the disk (initially the central vision is not affected till the later stages); shrinking of the peripheral visual field as a result of programmed cell-death of the ganglion retinal fibres; and in some cases a rise in intraocular pressure of more than 21-23 mmHg!
In later stages, a form of night blindness ensues, especially when the peripheral nerve bundles of the retina have been badly affected, which of course affects the integrity of the retinal rods! A visible loss of peripheral field is also noticed , especially moving objects; reduced visual acuity accompanied by increased glare sensitivity and poor contrast sensitivity is noticed in patients with confirmed mid-stage glaucoma; these patients tend towards myopia and often times develop an Astigmatism skewed towards the superior-inferior cup-disc excavation (its hardly a with-the rule Astigmatism, more common is an against-the-rule Astigmatism and any form of oblique Astigmatism!). The pupil develops a mid-dilated stare with negative Macus Gunn pupillary reflex and sometimes seldom react to light, the two pupils are not always of equal size (it should be noted that the Edinger Welpher Nucleus which sympathetically innervates the pupils is choked in the Glaucoma process, hence those pupillary changes in this stages!). The fact is that open Angle Glaucoma is very subtle to be detected early enough in a rural setting where the prospect of using Slit-Lamp & accessories, OCT scanning system, pachymeters etc are very limited, hence its best to always advice people staying with you in your area to come for vision screening from time to time! Glaucoma is dangerous, dont play with it!
To be continued...
Dr Ezebuiroh Victor Okwudiri.
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