Numerous therapies exist to control IOP, delay glaucoma progression

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By the 4th century BC, the word &#x201c;glaucosis&#x201d; was used in Aphorisms by Hippocrates to describe &#x201c;dimness of vision&#x201d; among the infirmities of the age. 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Koh, MBA OD, PhD, FAAO</i></h6> </div> <ul class="module user-tools"> <li id="main_0_maintwocolumnleft_0_ctl00_SocialTop_liComments" class="tools"><a href="/web/20141228172933/http://www.healio.com/optometry/glaucoma/news/print/primary-care-optometry-news/%7B0ebfef0b-9891-4b96-878d-3f86a3391595%7D/numerous-therapies-exist-to-control-iop-delay-glaucoma-progression/comments"><i class="fa fa-comment"></i> <span class="tool-text alt"> READ OR SUBMIT ARTICLE COMMENTS</span></a></li> <li class="tools"><a href="https://web.archive.org/web/20141228172933/mailto:/?subject=I saw this article on Healio.com and thought you might be interested in it&Body=http%3a%2f%2fgoo.gl%2fLBZrkZ"><i class="fa fa-envelope"></i><span class="tool-text"> EMAIL</span></a></li> <li class="tools"><a href="javascript:void(0)" onclick=" window.print(); "><i class="fa fa-print"></i><span class="tool-text"> PRINT</span></a></li> <li class="tools save"><a href="javascript:void(0)" onclick=" savedoc(); "><i class="fa fa-star"></i><span class="tool-text"> SAVE</span></a></li> <li> <button class="btn btn-xs btn-facebook" type="button" onclick=" window.open('https://web.archive.org/web/20141228172933/http://www.facebook.com/sharer/sharer.php?u=http%3a%2f%2fwww.healio.com%2foptometry%2fglaucoma%2fnews%2fprint%2fprimary-care-optometry-news%2f%7b0ebfef0b-9891-4b96-878d-3f86a3391595%7d%2fnumerous-therapies-exist-to-control-iop-delay-glaucoma-progression&t=Numerous+therapies+exist+to+control+IOP%2c+delay+glaucoma+progression', 'Facebook', 'width=640,height=300') "><i class="fa fa-facebook"></i></button> </li> <li> <button class="btn btn-xs btn-twitter" type="button" onclick=" window.open('https://web.archive.org/web/20141228172933/http://twitter.com/share?text=Numerous+therapies+exist+to+control+IOP%2c+delay+glaucoma+progression&url=http%3a%2f%2fgoo.gl%2fLBZrkZ&hashtags=healio&size=l&count=none', 'Twitter', 'width=640,height=300') "><i class="fa fa-twitter"></i></button> </li> <li> <button class="btn btn-xs btn-linkedin" type="button" onclick=" window.open('https://web.archive.org/web/20141228172933/http://www.linkedin.com/shareArticle?mini=true&url=http%3a%2f%2fwww.healio.com%2foptometry%2fglaucoma%2fnews%2fprint%2fprimary-care-optometry-news%2f%7b0ebfef0b-9891-4b96-878d-3f86a3391595%7d%2fnumerous-therapies-exist-to-control-iop-delay-glaucoma-progression&title=Numerous+therapies+exist+to+control+IOP%2c+delay+glaucoma+progression&source=Healio', 'Linked In', 'width=640,height=300') "><i class="fa fa-linkedin"></i></button> </li> <li> <button class="btn btn-xs btn-google-plus" type="button" onclick=" window.open('https://web.archive.org/web/20141228172933/https://plus.google.com/share?url=http%3a%2f%2fwww.healio.com%2foptometry%2fglaucoma%2fnews%2fprint%2fprimary-care-optometry-news%2f%7b0ebfef0b-9891-4b96-878d-3f86a3391595%7d%2fnumerous-therapies-exist-to-control-iop-delay-glaucoma-progression', '', 'menubar=no,toolbar=no,resizable=yes,scrollbars=yes,height=600,width=600'); "><i class="fa fa-google-plus"></i></button> </li> </ul> <script type="text/javascript"> if (typeof (savedoc) != "function") { function savedoc() { mustlogin(); } } </script> <div class="wyContent"> <p> </p> <p style="text-align: center;"><a href="https://web.archive.org/web/20141228172933/http://m1.wyanokecdn.com/e49d5772c317b723f18317996ee26c66.pdf"><em> Download and mail the CE quiz</em></a></p> <p>Glaucoma, a word derived from the Greek “glaukos,” appeared in the works of Homer around the 8th century BC, describing a sparkling silver glare. By the 4th century BC, the word “glaucosis” was used in Aphorisms by Hippocrates to describe “dimness of vision” among the infirmities of the age. Throughout the Roman era, the term glaucoma was used to describe a greenish or bluish hue (a dull sheen or “glaze”) of blindness, specifically a condition for what is now known as cataract.</p> <p>It was not until 1622 when Richard Bannister, MD, distinguished glaucoma from cataracts with clinical features of eye tension, a fixed pupil and blindness. However, it was more than 2 more centuries until Sir William Lawrence gave a complete description of glaucoma in his <em>A Treatise of Diseases of the Eye</em> in 1832. </p> <p>The modern era in the understanding and management of glaucoma truly began in the early 19th century with a clear definition from a few prominent ophthalmologists of the day such as William McKenzie, MD; Franciscus Cornelis Donders, MD; and Albrecht Von Graefe, MD, facilitated by the invention of the ophthalmoscope in 1851 by Hermann van Helmholtz. Interestingly, McKenzie was against the use of the ophthalmoscope because of its potential harmful effects to the retina, a light toxicity issue that is still being debated today.</p> <h4><section>What is glaucoma?</section></h4> <p>Current understanding defines glaucoma as a chronic, progressively degenerative optic neuropathy with multiple etiologies resulting in damage and death of ganglion cells, enlarging of the optic nerve cup and loss of vision. Typically, peripheral vision is affected first, followed by encroaching loss of central vision; however, complete blindness can occur if glaucoma is left untreated.</p> <p> </p> <div class="fig-wrap-1col float-left"> <div class="figure"> <img width="229" height="154" src="https://web.archive.org/web/20141228172933im_/http://m1.wyanokecdn.com/3cf45af3d494cdec1e00db4c6f05c6cd.jpg" alt="Right optic nerve of a 54-year-old Hispanic woman with POAG. "> <p class="figcaption">Right optic nerve of a 54-year-old Hispanic woman with POAG. </p> <p> </p> </div> <p class="image-source">Images: Koh LV </p> </div>   <p>Although glaucoma is no longer diagnosed solely on elevated intraocular pressure, the majority of glaucoma patients have abnormal IOP of above 21 mm Hg; therefore, tonometry remains one of the most important tests for glaucoma diagnosis and management. The normal range for IOP is between 10 mm Hg and 21 mm Hg. IOP of greater than 21 mm Hg is chosen as an indicator of high IOP because it is two standard deviations over the mean of 15.5 mm Hg. Normally, IOP is regulated by aqueous humor production from the ciliary body and the two outflow pathways, the major corneoscleral outflow and the minor uveoscleral outflow. The disruption or increased resistance to drainage systems is largely responsible for abnormally elevated IOP rather than an increase in aqueous humor production. In addition to maintaining the normal structure and pressure of the eye, aqueous humor production serves as a circulatory system for the anterior segment of the eye by providing essential nutrients to the crystalline lens, iris and cornea.</p> <p>As an optic neuropathy, glaucoma can be differentiated from other optic neuropathies by a few distinct clinical features such as a pink neuroretinal rim, rim thinning and optic nerve cupping. Optic nerve pallor and cupping are not often seen in other optic neuropathies, except cupping may be observed in rare cases of longstanding arteritic anterior ischemic optic neuropathy or giant cell arteritis.</p> <h4><section>Classification</section></h4> <p>Glaucoma is classified into two major categories based on the appearance of the iridocorneal angle: open-angle glaucoma (OAG) and closed-angle glaucoma (CAG). Although the angle or drainage pathway may appear open or normal, the aqueous flow is impeded by abnormalities in the trabecular meshwork. Glaucoma can be primary, when it arises spontaneously and is not associated with or caused by a known disease or injury, or secondary, when it is caused by an earlier disease, injury or event such as exfoliation, pigment dispersion, trauma or inflammatory cause.</p> <p>The age of glaucoma onset can also be part of the classification; for instance, congenital or developmental glaucoma is diagnosed at birth or within the first few years of life and often associated with syndromes such as aniridia or the Axenfeld-Rieger syndrome. Juvenile-onset glaucoma occurs between the ages of 3 and 40 years old. 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Numerous therapies exist to control IOP, delay glaucoma progression | Primary Care Optometry News