THE CORRELATION BETWEEN GLAUCOMA AND AGING

Purnamandala

Introduction
Glaucoma comes from Greek word glaucos meaning aquamarine, giving the sensation of colour at pupil glaucoma patient. Glaucoma is eye disease which is marked by the increasing of intraocular pressure which is accompanied with minimizing of visual field. Almost 80.000 blind United States resident as result of glaucoma

Anatomy and Physiology of Aqueous humor drainage

Intraocular Pressure
Normal 15-18 mmhg IOP can be increased due to due to the flow resistance of Aquous Humor Open angle gloucoma It is due to decreased of trabekula meshwork permeability Close angle gloucoma It is due to the narrow of anterior chamber

Glaucoma
Glaucoma is a name given to a group diseases in which the intraocular pressure (IOP) is sufficiently elevated to damage vision. Glaucoma is currently defined as a disturbance of the structural or functional integrity of the optic nerve that causes characteristic atrophic changes in the optic nerve, which may also lead to specific visual field defects over time. The generic term glaucoma should only be used in reference to the entire group of glaucomatous disorders as a whole, because multiple subsets of glaucomatous disease exist.

 There are two type of glaucoma :

1.Primary angle closure glaucoma

2. Primary angle open glaucoma

Primary angle closure glaucoma

Primary angle closure glaucoma (PACG) is a condition in which obstruction to aqueous outflow is brought about solely by closure of the angle by the peripheral iris. It occurs in anatomically predisposed eyes, and is frequently bilateral. The disease affects approximately 1 in 1000 individuals over the age of 40 years, affecting females more commonly than males by a ratio of four to one.

Predisposing factors 1. Anatomical

Positive family history for angle closure Age over 40-50 years Woman History of angle closure symptoms Hypermetropia Pseudoexfoliation Racial group (eskimo > asian > caucasian = african

Eyes with PACG characterized by: A relatively anterior location of the iris-lens diaphragm A shallow anterior chamber depth & narrow entrance to the chamber angle The proximity of peripheral iris to cornea enables angle closure to occur more easily than in normal eye

2. Physiological

Dilator muscle theory

Dilator muscles contraction exerts a posterior vector increases amount of apposition between iris & the anteriorly located lens & enhances degree of physiological pupillary block Simultaneous dilatation pupil renders peripheral iris more flaccid Relative puppilary block causes pressure in posterior chamber & peripheral iris bow anteriorly (iris bombe) The angle becomes obstructed by peripheral iris & IOP Pupils spinhter prime culprit in precipitating angle closure. Pupillary blocking force the spinchter greatest when pupils diameter 4 mm not understood

Spinchter muscle theory

Emotional

 Lens induced PACG lens size (phacomorphic) & lens position (phacotopic) lens passes against the posterior surface of the iris and ciliary body or indirectly when the increased lens-iris contact hastens the pupillary block component. Shorter eye of a hypertropic person in middle to old age continually growing lens may be sufficiently anterior to impede the flow of aqueous through the pupil and produce a pupillary block results in the development of a pressure gradient across the iris that causes the iris to bow forward (iris bombe) mechanically cover the trabecular meshwork IOP

 Pupillary block a pressure gradient exists between the anterior & posterior iris surfaces the pressure in the posterior chamber greater than anterior chamber. Absolute pupillary block there is no aqueous flow through the pupil as in occlusion pupillae as a result of posterior synechiae (iris to lens). Relative pupillary block some degree of resistance to forward aqueous flow exists between the surfaces of the anterior capsule & the posterior iris.

Iris induced PACG plateau iris mechanism results from iridotrabecular contact when the pupil is dilated. Also referred to as angle crowding occur when any or all of the following occur: oTissue of the peripheral iris is thick (peripheral iris roll) oIris base inserts anteriorly and leaves only a very narrow ciliary band, or inserts into the scleral spur oCiliary processes are displaced anteriorly in the posterior chamber and push the iris base forward into the angle recess

Primary angle open glaucoma

Primary open-angle glaucoma (POAG) is described distinctly as a multifactor optic neuropathy that is chronic and progressive with a characteristic acquired loss of optic nerve fibers POAG is a major worldwide health concern, because of its usually silent, progressive nature, and because it is one of the leading preventable causes of blindness in the world

Intraocular pressure also can be elevated through obstruction of aqueous humor drainage. This occurs through a structure called the trabecular meshwork and appears to be the main mechanism by which intraocular pressure becomes elevated In Elderly people,the trabecula meshwork will degenerate

Mechanism of Open Angle Glaucoma

Major Risk Factors: These tend to be related to the mechanical theory of damage to the optic nerve.
Age: 40 years and older History of elevated intraocular pressure Family history of glaucoma Ethnicity: African American and Hispanic Myopia (nearsightedness)

Discussion
Age affects the occurrence of glaucoma, where increasing age affects the anatomy of the eye The lens in elderly people will be thicker, and then it makes higher degree of hypermetropia. High degrees of hypermetropia are strongly related to angle closure glaucoma. Aging also can cause drainage channels in the trabecular meshwork to shrink or narrow, which slows the outflow of fluid from the eye.

CONCLUSION
Glaucoma is a name given to a group diseases in which the intraocular pressure (IOP) is sufficiently elevated to damage vision.In primary angle closure glaucoma, The lens in elderly people will be thicker, and then it makes higher degree of hypermetropia. Lens induced angle closure glaucoma results directly when a lens passes against the posterior surface of the iris and ciliary body or indirectly when the increased lens-iris contact hastens the pupillary block component. In the angle closure glaucoma the obstruction to aqueous outflow is caused by closure of the chamber angle by the peripheral iris.In primary open-angle glaucoma, Aging also can cause drainage channels in the trabecular meshwork to shrink or narrow, which slows the outflow of fluid from the eye.

REFERENCES
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