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glaucoma

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: 1) 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] 2) risk factors: a) increased intraocular pressure b) age > 60 c) most common cause of blindness in African-Americans - black adults twice as likely as white adults to be affected [19] d) family history - 40 % prevalence among 1st degree relatives e) diabetes mellitus f) myopia g) previous eye surgery or trauma h) history of cataracts i) alcohol consumption j) prolonged mechanical ventilation - uncommon k) glucocorticoids 3) leading cause of irreversible blindness worldwide [19] Pathology: 1) increased pressure of the fluid in the eye 2) damage to the small internal blood vessels &/or optic nerve fibers 3) optic nerve fiber destruction & partial or complete loss of vision 4) degeneration of retinal ganglion cells 5) higher intraocular pressure variability may be associated with faster structural changes in patients with glaucoma [16] Clinical manifestations: 1) onset is insidious & often not recognized by the patient until late in the course of the disease 2) peripheral vision is lost 1st as the optic nerve degenerates Special laboratory: 1) ophthalmoscopy a) increases in cup/disk ratio of > 0.6 consistent with glaucoma b) asymmetry in size or contour of the cup is suspicious for glaucoma 2) gonioscopy 3) tonometry 4) perimetry 5) image analysis a) aids in evaluating optic disk to neuroretinal rim area changes seen before loss of vision b) diagnosis of low & normal tension glaucoma c) 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 a) open-angle glaucoma b) closed-angle glaucoma c) acute angle-closure glaucoma d) infantile glaucoma Clinical trials: - clinical trials of glaucoma therapy can be completed within 18 months [13]

Related

ophthalmoscopic findings suggestive of glaucoma visual field loss

Specific

combined mechanism glaucoma (CMG) primary glaucoma secondary glaucoma

General

chronic eye disease (chronic ophthalmopathy)

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 66-67
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
  3. Mangione C. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. Prescriber's Letter 18(11): 2011 Drugs That Cause or Exacerbate Glaucoma Detail-Document#: 271124 (subscription needed) http://www.prescribersletter.com
  5. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  6. Razeghinejad MR, Katz LJ. Steroid-induced iatrogenic glaucoma. Ophthalmic Res. 2012;47(2):66-80. Review. PMID: 21757964
  7. Razeghinejad MR, Pro MJ, Katz LJ. Non-steroidal drug-induced glaucoma. Eye (Lond). 2011 Aug;25(8):971-80. Review. PMID: 21637303
  8. Razeghinejad MR, Myers JS, Katz LJ. Iatrogenic glaucoma secondary to medications. Am J Med. 2011 Jan;124(1):20-5. Review. PMID: 21092926
  9. Alward WL. Medical management of glaucoma. N Engl J Med. 1998 Oct 29;339(18):1298-307. Review. PMID: 9791148
  10. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014 May 14;311(18):1901-11. Review. PMID: 24825645 Free PMC Article
  11. Inoue K. Managing adverse effects of glaucoma medications. Clin Ophthalmol. 2014 May 12;8:903-13. Review. PMID: 24872675 Free PMC Article
  12. Stein JD, Khawaja AP, Weizer JS Glaucoma in Adults - Screening, Diagnosis, and ManagementA Review. JAMA. 2021;325(2):164-174. Jan 12 PMID: 33433580 https://jamanetwork.com/journals/jama/fullarticle/2774838
  13. 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: 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: 34110379 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2780940
  14. 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: 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: 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: 34940798 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2787499
  15. 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: 35730426 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17903
  16. 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: 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: 36301536 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2797835
  17. 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: 38153708 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2813168
  18. 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: 37839560 https://www.aaojournal.org/article/S0161-6420(23)00756-X/fulltext
  19. Ehrlich JR, Burke-Conte Z, Wittenborn JS et al Prevalence of Glaucoma Among US Adults in 2022. JAMA Ophthalmol. 2024 Oct 17. PMID: 39418040 https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2824476
  20. National Eye Institute: Glaucoma https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma