Professional Documents
Culture Documents
age (glaucoma
becomes more
likely as you get
older) in the UK,
chronic openangle glaucoma
affects up to two in
every 100 people
over 40 years old
and around five in
every 100 people
over 80 years old
Risk Factors
ethnic
origin people of African
or Afro-Caribbean origin are
at increased risk of
developing chronic openangle glaucoma and people
of Asian origin are at
increased risk of developing
acute angle-closure
glaucoma
short
sightedness
(myopia) people
who are short-sighted
are more likely to
develop chronic openangle glaucoma
ocular
hypertension (OHT raised
pressure in the eye) your
optometrist will be able to diagnose
OHT (see diagnosing glaucoma),
which increases your risk of
developing chronic open-angle
glaucoma
medical
history people
with diabetes may be at
increased risk of
developing glaucoma
family history if
you have a close
relative, such as a
parent, brother or sister
who has glaucoma, you
are at increased risk of
developing the condition
yourself
Symptoms
chronic open-angle
glaucoma the most common
type which oftenhas few
symptoms
usually no noticeable
symptoms because the
condition develops very slowly
the first part of the eye to be
affected is the outer field of
vision (peripheral vision).
intense pain
redness of the eye
headache
tender eye area
seeing halos or 'rainbow-like' rings around
lights
misty vision
loss of vision in one or both eyes that
progresses very quickly
secondary glaucoma
caused by other conditions or
eye treatments
misty vision
rings or halos around lights.
Causes
What causes the pressure in your eye to
increase isnt always known. However,
doctors believe one or more of these
factors may play a role:
dilating eye drops
blocked or restricted drainage in your
eye
medications, such as corticosteroids
poor or reduced blood flow to your optic
nerve
high or elevated blood pressure
References
Kimble, M.A.K. et al. 2008. Applied
Therapeutics: The Clinical Use of Drugs.
Philadelphia: Lippincott Williams & Wilkins.
Burn, M.A.C. et al. 2007. Pharmacotherapy
Principles and Practice. USA: The McGraw
Hill Companies.
Dipiro, J.T. et al. 2002. Pharmacotherapy: A
Pathophysiologic Approach. USA: The
McGraw Hill Companies.
TREATMENT OF
GLAUCOMA
PRINCIPLE OF GLAUCOMA
TREATMENT :
I. to maintain the patients quality of life at a
sustainable cost
II. reduction of intra ocular pressure,
III. improvement of ocular blood flow,
IV. direct neuroprotection
THERAPY
Medical
Miotics
Beta-blockers
Carbonic anhydrase
inhibitors
Prostaglandin
analogues
Alpha-2 agonists
Surgical
Argon laser trabeculoplasty
Trabeculectomy
Filtering procedure
Cyclocryotherapy
Cyclolaser ablation
Iridotomy
GLAUCOMA ALGORITHM
Prostaglandin analogues:
Action: increase aqueous outflow via the uveoscleral route.
Contra-indications: active uveitis, pregnancy and breast-feeding.
Caution: brittle or severe asthma, aphakia (patient with no lens),
pseudophakia (patient with artificial lens); do not take within five
minutes of using thiomersal-containing preparations.
Common ocular side-effects: change in eye colour: brown
pigmentation, thickening and lengthening of eye lashes; more
rarely: uveitis, ocular pruritus, photophobia and keratitis.
Systemic side-effects: rarely - hypotension, bradycardia.
Examples
(Lumigan)
include
latanoprost
(Xalatan)
and
bimatoprost
Beta-blockers:
Action: reduce aqueous secretion by inhibiting betaadrenoceptors on the ciliary body.
Contra-indications: bradycardia, heart block, uncontrolled
heart failure, asthma and history of chronic obstructive
pulmonary disease (COPD).
Caution: depression, myasthenia gravis, possible
interactions with other medication such as verapamil.
Common ocular side-effects: irritation, erythema, dry eyes,
blepharo-conjunctivitis and allergy anaphylactic reaction
possible
Common
systemic
side-effects:
bronchospasm,
bradycardia, exacerbation of heart failure, nightmares.
Examples include timolol (Betimol, Timoptic) and betaxolol
(Betoptic)
Miotics:
Action: open up the drainage channels in the trabecular meshwork by ciliary
muscle contraction.
Contra-indications: situations where pupillary constriction is undesirable (such
as uveitis), presence of retinal holes.
Caution: darkly pigmented irides require higher concentrations but
overdosage must be avoided, patients with retinal disease (especially
previous detachment), cardiac disease, hypertension, asthma, peptic
ulceration, urinary tract obstruction and Parkinson's disease.
Ocular side-effects: miosis - this can cause blurred vision which can affect
driving and other skilled tasks, especially in the presence of a cataract.
Accommodative spasm with brow ache (often causing intolerance in patients
over 40), localised discomfort, pupillary block.
Systemic side-effects: sweating, bradycardia, gastrointestinal disturbance.
Example is pilocarpine (Isopto Carpine)
GLAUCOMA
GLAUCOMA
Surgical treatment of glaucoma
Filtration
Procedures
creates an opening in the white
Laser beam to open clogged
of the eye (sclera) and removes
channels in the trabecular meshwork
part of the trabecular meshwork
Argon laser
Trabeculoplasty
hoelen
Source (Latin
Binomial)
Poria cocos
atractylode Atractylodes
s
macrocephala
polyporus
alisma
plantago
seed
pinellia
Part Used
whole
fungus
rhizome
whole
Polyporus umbellatus
fungus
Alisma orientale
Plantago asiatica
Pinellia ternata
rhizome
seeds
rhizome
Chinese
Name
(Pinyin)
Actions in Relation to
Glaucoma
fuling
promote diuresis,
eliminate dampness,
invigorate spleen,
alleviate phlegm retention
baizhu
zhuling
zexie
promote diuresis,
eliminate dampness, expel
heat
chequanzi
banxia
References
South African Glaucoma Society. 2006.
Glaucoma Algorithm And Guidelines For
Glaucoma. Available at
http://www.sags.co.za/docs/glaucoma_document
_and_algorithm.pdf
access on: 26.04.2016
Subhuti Dharmananda, Ph.D.,1997. Treatment
Of Glaucoma With Chinese Herbs. Institute for
Traditional Medicine, Portland, Oregon. Available
at http://www.itmonline.org/arts/glaucoma.htm
access on: 26.04.2016
Primary Open-angle Glaucoma. Available at
http://patient.info/doctor/primary-open-angle-g
laucoma
Treatment
TREATMENT EVALUATION
evaluation of
glaucoma
TONOMETRY
Tonometry is a test to measure the pressure
inside your eyes
The test is used to screen forglaucoma
Normal eye pressure range is 10to 21 mmHg
Urinary
incontinence
Prevention
and
monitoring
MONITORING (CONDITION)
If your healthcare professional thinks you're at risk of developing
glaucoma (whether you are having treatment or not), you should be
offered regular monitoring, using tests similar to those used to diagnose
glaucoma.
If consider high risk of glaucoma,You might have to take eye drops for
your treatment this is covered below. If you have just started taking eye
drops, or if you have recently changed your eye drops, your eye pressure
should also be tested 1 to 4 months after starting the new treatment
If you don't need to use eye drops, your healthcare professional should
still test your eyes regularly
If monitoring tests show that there is no deterioration in your eyes after 3
to 5 years (or earlier if tests confirm your eyes are normal), you may be
discharged because you do not have glaucoma. But you should still visit
your optician every year to be checked by the optometrist so that any
future changes can be detected.
(Nice.org,2009)
MONITORING
Regular glaucoma check-ups include two routine eye tests: tonometry and
ophthalmoscopy.
(Glaucoma.org,2013)
Tonometry
Tonometry measures the pressure within your eye.
During tonometry, eye drops are used to numb the eye
Then a doctor or technician uses a device called a
tonometer to measure the inner pressure of the eye. A small
amount of pressure is applied to the eye by a tiny device or
by a warm puff of air.
The range for normal pressure is 12-22 mm Hg (mm Hg
refers to millimeters of mercury, a scale used to record eye
pressure). Most glaucoma cases are diagnosed with pressure
exceeding 20mm Hg. However, some people can have
glaucoma at pressures between 12 -22mm Hg. Eye pressure
is unique to each person.
Ophthalmoscopy
This diagnostic procedure helps the doctor examine your optic nerve for
glaucoma damage.
Eye drops are used to dilate the pupil so that the doctor can see through
your eye to examine the shape and color of the optic nerve.
The doctor will then use a small device with a light on the end to light
and magnify the optic nerve.
Perimetry
Perimetry is a visual field test that produces a map of your complete
field of vision. This test will help a doctor determine whether your
vision has been affected by glaucoma
During this test, you will be asked to look straight ahead and then
indicate when a moving light passes your peripheral (or side) vision.
This helps draw a "map" of your vision.
After glaucoma has been diagnosed, visual field tests are usually done
one to two times a year to check for any changes in your vision.
Gonioscopy
This diagnostic exam helps determine whether the angle where the iris
meets the cornea is open and wide or narrow and closed
During the exam, eye drops are used to numb the eye. A hand-held
contact lens is gently placed on the eye. This contact lens has a mirror that
shows the doctor if the angle between the iris and cornea is closed and
blocked (a possible sign of angle-closure or acute glaucoma) or wide and
open (a possible sign of open-angle, chronic glaucoma).
Pachymetry
Pachymetry is a simple, painless test to measure the thickness of your
cornea -- the clear window at the front of the eye. A probe called a
pachymeter is gently placed on the front of the eye (the cornea) to
measure its thickness
Pachymetry can help your diagnosis, because corneal thickness has the
potential to influence eye pressure readings.
(Glaucoma.org,2013)
Prevention
But self-care can help you detect it early, limit vision loss or slow its progress.
PREVENTION
Know your
family's eye health
regular eye exams
history
Prevention
Exercise
PREVENTION
Regular eye exams
. are the best form of prevention against significant glaucoma
damage.
. Early detection and careful, lifelong treatment can maintain vision
in most people. In general, a check for glaucoma should be done:
. before age 40, every two to four years
. from age 40 to age 54, every one to three years
. from age 55 to 64, every one to two years
. after age 65, every six to 12 months
. Anyone with high risk factors should be tested every year or two
after age 35. Those at higher risk include people of African descent,
people with diabetes, and people with a family history of glaucoma.
You are at increased risk if you have a parent or brother or sister
with glaucoma.
1.
(Robert,2012)
REFERENCE
Nice.org,2009, Glaucoma: diagnosis and management,
published on april 2009, Available on (
https://www.nice.org.uk/guidance/CG85/ifp/chapter/Moni
toring-and-treatment-for-people-with-ocular-hypertensi
on-or-suspected-glaucoma
)
Robert.L.Stamper, MD, 2012, What Can I Do to Prevent
Glaucoma?. Available on (
http://www.glaucoma.org/gleams/what-can-i-do-to-prev
ent-glaucoma.php
)
Glaucoma.org, 2013, Five Common Glaucoma Tests,
Available on
(http://www.glaucoma.org/glaucoma/diagnostic
STUDY CASE
Skenario
Pak Taufik, usia 60 tahun, datang ke apotek dengan
membawa salinan resep. Pak Taufik berkonsultasi
dengan apoteker dan meyakini bahwa salah satu obat
yang ia konsumsi mempengaruhi penglihatannya. Ia
meminta Anda sebagai seorang apoteker untuk
mengidentifikasi obat tersebut yang menyebabkan
gangguan penglihatan yang dialaminya.
Pak Taufik pernah menderita Chronic Obstructive
Pulmonary Disease (COPD) dan inkontinensia urin.
Pada catatan pengobatannya diketahui Pak Taufik
menggunakan tetes mata Latanoprost untuk
mengobati glaukoma yang telah diberikan selama 6
bulan yang lalu.