Pearls in Glaucoma Therapy

Περιεχόμενα

1. What is Glaucoma?…………………………………………………………………….1
• Magnitude of the problem 1
• Standard definitions 2
• Pathogenesis of glaucoma
– Mechanical theory 2
– Vascular theory 3
– Biochemical theory 4
2. What are the Risk Factors?…………………………………………………………8
• Risk assessment 8
• Analysis of risk factors for glaucoma 8
• Risk stratification 14
3. How to Work Up a Glaucoma Patient?………………………………………18
• Essential work up before initiating therapy 18
• History 18
• Examination 19
• Systemic investigations 36
4. When to Start Therapy?……………………………………………………………38
• Purpose of initiating therapy 38
• Application of the concept of “glaucoma continuum” 39
• Whom to treat and whom to watch? 40
• Concept of the glaucoma colored graph 40
• Structural and/or functional damage as the basis of treatment 43
• Common mistakes 45
5. How to Set Target IOP?…………………………………………………………….50
• What is target iop? 50
• Factors influencing target iop 50
• Setting up a specific target 51
• Simple algorithm to calculate target IOP 59
6. Ocular Hypotensive Medications……………………………………………….61
• History of antiglaucoma medications 61
• Hypotensive lipids (prostaglandin analogs) 62

• Beta-blockers 72
• Alpha agonists 78
• Carbonic anhydrase inhibitors 82
• Miotics 89
• Hyperosmotic agents 93
• Preservatives in glaucoma medications 96
7. How to Start Therapy?……………………………………………………………105
• Monocular therapeutic trial 105
• First line therapy 106
• Diurnal control 106
• When to switch or add therapy? 106
• Combination therapy 107
• Follow-up 108
8. How to Improve Compliance? ………………………………………………… 110
• Compliance, adherence, persistence 110
• Why do patients default? 110
• How to instill eye drops? 112
9. Special Situations…………………………………………………………………… 115
• Primary angle closure glaucoma 115
• Pediatric glaucomas 116
• Glaucoma in pregnant and lactating patients 116
• Uveitic glaucoma 118
• Neovascular glaucoma 119
• Normal tension glaucoma (ntg) 120
10. Looking Beyond IOP……………………………………………………………….123
• Why should we think beyond “intraocular pressure?” 123
• Factors other than iop 124
• Role of lifestyle modifications 126
• Effect of medications on surgical outcome 129
Index………………………………………………………………………………………………133