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Glaucoma
Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for aqueous humor, fluid within the eye remains open, with less common types including closed-angle (narrow angle, acute congestive) glaucoma and normal-tension glaucoma. Open-angle glaucoma develops slowly over time and there is no pain. Peripheral vision may begin to decrease, followed by central vision, resulting in blindness if not treated. Closed-angle glaucoma can present gradually or suddenly. The sudden presentation may involve severe eye pain, blurred vision, mid-dilated pupil, redness of the eye, and nausea. Vision loss from glaucoma, once it has occurred, is permanent. Eyes affected by glaucoma are referred to as being glaucomatous. Risk factors for glaucoma include increasing age, high intraocular pressure, pressure in the eye, a family history of glaucoma ...
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Glaucoma Surgery
Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many glaucoma surgeries, and variations or combinations of those surgeries, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous humor. Procedures that facilitate outflow of aqueous humor Laser trabeculoplasty A trabeculoplasty is a modification of the trabecular meshwork. Laser trabeculoplasty (LTP) is the application of a laser beam to burn areas of the trabecular meshwork, located near the base of the iris, to increase fluid outflow. LTP is used in the treatment of various open-angle glaucomas. The two types of laser trabeculoplasty are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). As its name suggests, argon laser trabeculoplasty uses an argon laser to create tiny burns on the ...
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Normal-tension Glaucoma
Normal tension glaucoma (NTG) is an eye disease, a neuropathy of the optic nerve, that shows all the characteristics of primary open angle glaucoma except one: the elevated intraocular pressure (IOP) - the classic hallmark of glaucoma - is missing. Normal tension glaucoma is in many cases closely associated with general issues of blood circulation and of organ perfusion like arterial hypotension, metabolic syndrome, and Flammer syndrome. Clinical relevance Over many years, glaucoma has been defined by an intraocular pressure of more than 20 mm Hg. Incompatible with this (now obsolete) definition of glaucoma was the ever larger number of cases that have been reported in medical literature in the 1980s and 1990s who had the typical signs of glaucomatous damage, like optic nerve head excavation and thinning of the retinal nerve fiber layer, while these patients had an IOP that would generally have been regarded as "normal". It is now widely estimated that a larger percentage of patien ...
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Vision Loss
Visual impairment, also known as vision impairment, is a medical definition primarily measured based on an individual's better eye visual acuity; in the absence of treatment such as correctable eyewear, assistive devices, and medical treatment– visual impairment may cause the individual difficulties with normal daily tasks including reading and walking. Low vision is a functional definition of visual impairment that is chronic, uncorrectable with treatment or correctable lenses, and impacts daily living. As such low vision can be used as a disability metric and varies based on an individual's experience, environmental demands, accommodations, and access to services. The American Academy of Ophthalmology defines visual impairment as the best-corrected visual acuity of less than 20/40 in the better eye, and the World Health Organization defines it as a presenting acuity of less than 6/12 in the better eye. The term blindness is used for complete or nearly complete vision loss. In ...
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Vision Loss
Visual impairment, also known as vision impairment, is a medical definition primarily measured based on an individual's better eye visual acuity; in the absence of treatment such as correctable eyewear, assistive devices, and medical treatment– visual impairment may cause the individual difficulties with normal daily tasks including reading and walking. Low vision is a functional definition of visual impairment that is chronic, uncorrectable with treatment or correctable lenses, and impacts daily living. As such low vision can be used as a disability metric and varies based on an individual's experience, environmental demands, accommodations, and access to services. The American Academy of Ophthalmology defines visual impairment as the best-corrected visual acuity of less than 20/40 in the better eye, and the World Health Organization defines it as a presenting acuity of less than 6/12 in the better eye. The term blindness is used for complete or nearly complete vision loss. In ...
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Cup-to-disc Ratio
The optic cup is the white, cup-like area in the center of the optic disc. The ratio of the size of the optic cup to the optic disc (cup-to-disc ratio, or C/D) is one measure used in the diagnosis of glaucoma. Different C/Ds can be measured horizontally or vertically in the same patient. C/Ds vary widely in healthy individuals. However, larger vertical C/Ds, or C/Ds which are very different between the eyes, may raise suspicion of glaucoma. A C/D which enlarges vertically over months or years suggests glaucoma. Cup-to-disc ratio The ''cup-to-disc ratio'' (often notated ''CDR'') is a measurement used in ophthalmology and optometry to assess the progression of glaucoma. The optic disc is the anatomical location of the eye's "blind spot", the area where the optic nerve leave and blood vessels enter the retina. The optic disc can be flat or it can have a certain amount of normal cupping. But glaucoma, which is in most cases associated with an increase in intraocular pressure Int ...
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Optic Cup (anatomical)
The optic cup is the white, cup-like area in the center of the optic disc. The ratio of the size of the optic cup to the optic disc (cup-to-disc ratio, or C/D) is one measure used in the diagnosis of glaucoma. Different C/Ds can be measured horizontally or vertically in the same patient. C/Ds vary widely in healthy individuals. However, larger vertical C/Ds, or C/Ds which are very different between the eyes, may raise suspicion of glaucoma. A C/D which enlarges vertically over months or years suggests glaucoma. Cup-to-disc ratio The ''cup-to-disc ratio'' (often notated ''CDR'') is a measurement used in ophthalmology and optometry to assess the progression of glaucoma. The optic disc is the anatomical location of the eye's "blind spot", the area where the optic nerve leave and blood vessels enter the retina. The optic disc can be flat or it can have a certain amount of normal cupping. But glaucoma, which is in most cases associated with an increase in intraocular pressure Int ...
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Visual Field Loss
The visual field is the "spatial array of visual sensations available to observation in introspectionist psychological experiments". Or simply, visual field can be defined as the entire area that can be seen when an eye is fixed straight at a point. The equivalent concept for optical instruments and image sensors is the field of view (FOV). In optometry, ophthalmology, and neurology, a visual field test is used to determine whether the visual field is affected by diseases that cause local scotoma or a more extensive loss of vision or a reduction in sensitivity (increase in threshold). Normal limits The normal (monocular) human visual field extends to approximately 60 degrees nasally (toward the nose, or inward) from the vertical meridian in each eye, to 107 degrees temporally (away from the nose, or outwards) from the vertical meridian, and approximately 70 degrees above and 80 below the horizontal meridian. The binocular visual field is the superimposition of the two monocula ...
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Intraocular Pressure
Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg). Physiology Intraocular pressure is determined by the production and drainage of aqueous humour by the ciliary body and its drainage via the trabecular meshwork and uveoscleral outflow. The reason for this is because the vitreous humour in the posterior segment has a relatively fixed volume and thus does not affect intraocular pressure regulation. An important quantitative relationship (Goldmann's equation) is as follows: :P_o = \frac + P_v Where: * P_o is the IOP in millimeters of mercury (mmHg) * F the rate of aqueous humour formation in microliters per minute (μL/min) * U the resorption of aqueous humour through the uveoscleral route (μL/min) * C is the facility of outflow in m ...
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Ophthalmology
Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a medical degree, a doctor specialising in ophthalmology must pursue additional postgraduate residency training specific to that field. This may include a one-year integrated internship that involves more general medical training in other fields such as internal medicine or general surgery. Following residency, additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology. Ophthalmologists prescribe medications to treat eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists provide both primary and specialty eye care - medical and surgical. Most ophthalmologists participate in academic research on eye diseases at some point in their training and many include research as ...
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Glaucoma Medication
Glaucoma medication is divided into groups based on chemical structure and pharmacologic action. The goal of currently available glaucoma therapy is to preserve visual function by lowering intraocular pressure (IOP), below a level that is likely to produce further damage to the nerve. The more advanced the glaucomatous process on initial presentation, the lower the target range generally needs to be to prevent further progression. This more aggressive target is meant to minimize the risk of progressive glaucoma damage and vision loss. Once the optic nerve is damaged, it is more likely to incur more damage, and if severe visual loss is present, there is greater impact on the patient from any additional damage that may occur. An initial reduction in the intraocular pressure of 20% from baseline is suggested. However, reduction of IOP to the target pressure range does not guarantee that progression will not occur. Therefore, the target pressure range needs to be constantly reassesse ...
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Optic Nerve
In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual information from the retina to the brain. In humans, the optic nerve is derived from optic stalks during the seventh week of development and is composed of retinal ganglion cell axons and glial cells; it extends from the optic disc to the optic chiasma and continues as the optic tract to the lateral geniculate nucleus, pretectal nuclei, and superior colliculus. Structure The optic nerve has been classified as the second of twelve paired cranial nerves, but it is technically part of the central nervous system, rather than the peripheral nervous system because it is derived from an out-pouching of the diencephalon (optic stalks) during embryonic development. As a consequence, the fibers of the optic nerve are covered with myelin produced by oligodendrocytes, rather than Schwann cells of the peripheral nervous sys ...
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Optometry
Optometry is a specialized health care profession that involves examining the eyes and related structures for defects or abnormalities. Optometrists are health care professionals who typically provide comprehensive primary eye care. In the United States and Canada, optometrists are those that hold a Doctor of Optometry degree. They are trained and licensed to practice medicine for eye related conditions, in addition to providing refractive (optical) eye care. In the United Kingdom, optometrists may also practice medicine (and provide refractive care) for eye related conditions. The Doctor of Optometry title can also be used in the UK for those that hold the postgraduate O.D. degree. Within their scope of practice, optometrists are considered physicians and bill medical insurance(s) (example: Medicare) accordingly. Moreover, many participate in academic research for eye related conditions and disease. Optometrists are the only health care professionals with a first professiona ...
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