GLAUCOMA

Speaker: Lim Poh Lai

B.S.(Hons) Optometry, UKM

Lim Poh Lai

• Graduated from National University of Malaysia, 2001.

• Exco of Association of Malaysian Optometrists, Community Service Division (2004-2006)

• Consultant of Malaysia Glaucoma Society (2010-2013)

• Co-founder & trainer of Vision Guardian Project (Organized VGP in Hanoi, Kalimantan, Kapit, UNHCR)

• Visiting Clinical Supervisor, NUM (2007- )

Eye Care Practitioner

Eye Specialist

Ophthalmologist

Secondary Eyecare

Medical Doctor

Vision Specialist

Optometrist

Primary Eyecare

University Trained

Vision:

Kids / Elderly

Contact Lens

Special Group

Eye Disease Screening

Binocular Vision

Vision Therapy:

Lazy Eye

Low Vision

Color Blindness

Optometrists

Glaucoma is a group of disorders in which there is damage to the optic nerve due mainly to the

effect of raised intraocular pressure

GLAUCOMA

• Most types of glaucoma can be controlled but rarely cured

• Poor control of glaucoma leads to blindness

Visual Fields

• Glaucoma results in loss of visual field, and visual acuity is only affected in the end-stage of uncontrolled disease

• Diagnosis and/or progression of glaucoma is typically assessed using static perimetry, such as the Humphrey Visual Field Analyser

Humphrey visual fields

Examination of the glaucoma patient

• Visual acuity

• Visual fields – confrontation testing with finger counting in four quadrants of each eye,(not very useful, Humphrey visual fields much better)

• Pupilary reactions – relative afferent pupilarydefect with marked optic nerve damage

Anterior chamber depthNormal – note light illuminating both sides of iris

Shallow – nasal side of iris is in darkness

Measurement of intraocular pressure (IOP)

• Normal IOP is 10-20mm Hg

• It is usually measured with Applanation tonometry / puff tonometry

• Digital tonometry (using fingers to gauge fluctuation) can only tell if pressures are very high

Primary open angle glaucoma (POAG) risk factors

• Raised intraocular pressure

• Affects 1 in 200 people over 40 years of age, and 1 in 10 over 80 years of age

• More common and more severe in African and Caribbean ancestry

• A primary family member with a history of POAG is associated with increased risk of the condition

Primary open angle glaucoma - symptoms

• It is a “silent” disease, and is therefore often diagnosed quite late

• Visual acuity may only be lost at the end stage of the disease whereas visual field has already gradually been lost throughout the disease process

• Treatment is aimed at stopping any further damage to the optic nerve – previous damage cannot be reversed

Surgical management of POAG

TrabeculectomyReserved for a minority of cases where the condition progresses in spite of maximal tolerable topical therapy

Selective laser trabeculoplasty SLT

Both above procedures increase outflow of acquous

Trabeculectomy

Note

1. cystic drainage bleb under upper lid

2. Peripheral iridectomy at 11oclock

Acute angle closure glaucoma

Symptoms

Ocular pain, often severe

Red eye

Blurred vision

Haloes around lights

Nausea/vomiting

Acute angle closure glaucoma

Signs

Dilated fixed pupil

Narrow anterior chamber angle

Hazy cornea due to oedema

Hard eye

Pupillary block

Acute angle closure glauucoma

Red eye

Hazy oedematous cornea

Semi dilated pupil

Retinal Camera

Eye Check

Visual Acuity

Visual Field

Eyeball Pressure

Retinal