glaucoma
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Introduction
Although most forms of glaucoma occur with increased intraocular pressure, normal-pressure glaucoma* is a recognized entity.
* The pathophysiology is not well understood.
Etiology
- see specific form
- pharmaceuticals
- glucocorticoids (open-angle glaucoma)[8]
- certain antineoplastic agents (open-angle glaucoma)[8]
- NSAIDs (angle-closure glaucoma)[7]
- parasympatholytics (angle-closure glaucoma, pupillary block)[8]
- adrenergic agents (angle-closure glaucoma, pupillary block)[8]
- sulfa drugs (angle-closure glaucoma, non-pupillary block)[8]
Epidemiology
- prevalence: 2-5% age > 60, 10% age > 80
- 4.22 million people in the US (1.62% of adults) in 2022
- 1.49 million people (0.57% of adults) with vision-affecting glaucoma in 2022[19]
- risk factors:
- increased intraocular pressure
- age > 60
- most common cause of blindness in African-Americans
- black adults twice as likely as white adults to be affected[19]
- family history - 40 % prevalence among 1st degree relatives
- diabetes mellitus
- myopia
- previous eye surgery or trauma
- history of cataracts
- alcohol consumption
- prolonged mechanical ventilation - uncommon
- glucocorticoids
- leading cause of irreversible blindness worldwide[19]
Pathology
- increased pressure of the fluid in the eye
- damage to the small internal blood vessels &/or optic nerve fibers
- optic nerve fiber destruction & partial or complete loss of vision
- degeneration of retinal ganglion cells
- higher intraocular pressure variability may be associated with faster structural changes in patients with glaucoma[16]
- higher mean blood pressure & higher variablity of blood pressure are associated with faster visual field progression[20]
Clinical manifestations
- onset is insidious & often not recognized by the patient until late in the course of the disease
- peripheral vision is lost 1st as the optic nerve degenerates
Diagnostic procedures
- ophthalmoscopy
- increases in cup/disk ratio of > 0.6 consistent with glaucoma
- asymmetry in size or contour of the cup is suspicious for glaucoma
- gonioscopy
- tonometry
- perimetry
- image analysis
- aids in evaluating optic disk to neuroretinal rim area changes seen before loss of vision
- diagnosis of low & normal tension glaucoma
- equipment is expensive
Complications
- no association between either prevalent or incident glaucoma & cognitive impairment[15]
- increased risks for Alzheimer's disease (RR=1.4), vascular dementia (RR=1.7), & all-cause dementia, (RR= 1.6) when diagnosed with glaucoma at age >= 70 years[18]
- risks are not elevated with glaucoma diagnosis < 60 years
- glaucoma, cataracts, & age-related macular degeneration may increase risk of falls in the elderly[17]
Management
- see more specific type
Clinical trials
- clinical trials of glaucoma therapy can be completed within 18 months[13]
More general terms
More specific terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 66-67
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
- ↑ Mangione C. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Prescriber's Letter 18(11): 2011 Drugs That Cause or Exacerbate Glaucoma Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271124&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Razeghinejad MR, Katz LJ. Steroid-induced iatrogenic glaucoma. Ophthalmic Res. 2012;47(2):66-80. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21757964
- ↑ 7.0 7.1 Razeghinejad MR, Pro MJ, Katz LJ. Non-steroidal drug-induced glaucoma. Eye (Lond). 2011 Aug;25(8):971-80. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21637303
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Razeghinejad MR, Myers JS, Katz LJ. Iatrogenic glaucoma secondary to medications. Am J Med. 2011 Jan;124(1):20-5. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21092926
- ↑ Alward WL. Medical management of glaucoma. N Engl J Med. 1998 Oct 29;339(18):1298-307. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9791148
- ↑ Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014 May 14;311(18):1901-11. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24825645 Free PMC Article
- ↑ Inoue K. Managing adverse effects of glaucoma medications. Clin Ophthalmol. 2014 May 12;8:903-13. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24872675 Free PMC Article
- ↑ Stein JD, Khawaja AP, Weizer JS Glaucoma in Adults - Screening, Diagnosis, and ManagementA Review. JAMA. 2021;325(2):164-174. Jan 12 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33433580 https://jamanetwork.com/journals/jama/fullarticle/2774838
- ↑ 13.0 13.1 Proudfoot JA, Zangwill LM, Moghimi S et al Estimated Utility of the Short-term Assessment of Glaucoma Progression Model in Clinical Practice. JAMA Ophthalmol. Published online June 10, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34110362 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2780934
Anderson DR, Vanner EA. Planning Clinical Research and Clinical Care for Different Rates of Glaucoma Progression. JAMA Ophthalmol. Published online June 10, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34110379 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2780940 - ↑ Bicket AK, Le JT, Azuara-Blanco A et al Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma: An Overview of Cochrane Systematic Reviews and Network Meta-analysis. JAMA Ophthalmol. 2021 Sep 1;139(9):983-989. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34264292
Sarkisian SR, Jr Cochrane Reviews Regarding Minimally Invasive Glaucoma Surgical Techniques - Validity of Conclusions May Be Limited by Incomplete Evidence. JAMA Ophthalmol. Published online December 23, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34940786 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2787500
Bicket AK, Le JT, Azuara-Blanco A et al Review of Cochrane Reviews Regarding Minimally Invasive Glaucoma Surgical Techniques - Validity of Conclusions May Be Limited by Incomplete Evidence - In Reply JAMA Ophthalmol. Published online December 23, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34940798 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2787499 - ↑ 15.0 15.1 Kolli A, Kabeto M, McCammon R et al Glaucoma and cognitive function trajectories in a population-based study: Findings from the health and retirement study. J Am Geriatr Soc 2022. Oct;70(10):2827-2837. Epub 2022 Jun 22 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35730426 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17903
- ↑ 16.0 16.1 Nishida T, Moghimi S, Chang AC et al Association of Intraocular Pressure With Retinal Nerve Fiber Layer Thinning in Patients With Glaucoma. JAMA Ophthalmol. Published online October 27, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36301523 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2797830
Palmberg PF What Is It About Intraocular Pressure That Matters in Glaucoma Progression? JAMA Ophthalmol. Published online October 27, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36301536 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2797835 - ↑ 17.0 17.1 Tsang JY et al. Risk of falls and fractures in individuals with cataract, age-related macular degeneration, or glaucoma. JAMA Ophthalmol 2023 Dec 28; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38153708 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2813168
- ↑ 18.0 18.1 Crump C, Sundquist J, Sieh W, Sundquist K. et al Risk of Alzheimer's Disease and Related Dementias in Persons with Glaucoma. A National Cohort Study. Ophthalmology. 2024 Mar;131(3):302-309. ePub: 2023. Oct. 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37839560 https://www.aaojournal.org/article/S0161-6420(23)00756-X/fulltext
- ↑ 19.0 19.1 19.2 19.3 Ehrlich JR, Burke-Conte Z, Wittenborn JS et al Prevalence of Glaucoma Among US Adults in 2022. JAMA Ophthalmol. 2024 Oct 17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39418040 https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2824476
- ↑ 20.0 20.1 Dotinga R Higher BP Linked to Faster Visual Field Progression in Glaucoma. Ophthalmologists say findings emphasize the importance of adhering to medication regimens. MedPage Today November 15, 2024 https://www.medpagetoday.com/ophthalmology/glaucoma/112944
Pham VQ, Nishida T, Moghimi S et al Long-Term Blood Pressure Variability and Visual Field Progression in Glaucoma. JAMA Ophthalmol. 2024 Nov 14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39541129 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2826006 - ↑ National Eye Institute: Glaucoma https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma