Purpose To bring together information concerning the epidemiology and the economic and individual burdens of glaucoma. Design Interpretive essay. Methods Review and synthesis of selected literature ...published from 1991 through December 2010. Results An estimated 3% of the global population over 40 years of age currently has glaucoma, the majority of whom are undiagnosed. Vision loss from glaucoma has a significant impact on health-related quality of life even in the early stages of disease. The overall burden increases as glaucomatous damage and vision loss progress. The economic burden of glaucoma is significant and increases as the disease worsens. Conclusions Early identification and treatment of patients with glaucoma and those with ocular hypertension at high risk of developing vision loss are likely to reduce an individual's loss of health-related quality of life as well as the personal and societal economic burdens.
Central corneal thickness (CCT) is an important parameter in the assessment of any potential glaucoma patient. While it affects prognosis in ocular hypertension, its value in patients diagnosed with ...glaucoma is less certain. There are several biological factors and genetic components that may influence glaucoma progression, which have been associated with thinner CCT. The CCT itself can be affected by several factors including ethnicity, age, sex, glaucoma medications, genetics, and the subtype of glaucoma. Besides, there is variability in the measurement of CCT between difference types of devices. These factors need to be considered in the evaluation of glaucoma patients' CCT and its effect on interpretation of intraocular pressure levels and risk stratification.
Brimonidine tartrate and brinzolamide eye drops are often used as third and fourth line treatment options to reduce intraocular pressure (IOP) in the management of glaucoma and ocular hypertension. ...Better tolerated, more effective topical agents requiring once daily instillation including prostaglandin analogues and beta-blockers usually are preferred as initial therapy, unless there are contraindications. Brimonidine and brinzolamide are often required owing to progressive glaucoma or intolerances to or ineffectiveness of front-line agents. Areas covered: We review the safety of formulations containing brimonidine tartrate and/or brinzolamide. Safety considerations for these agents in higher risk populations are highlighted. Expert opinion: Each class of ocular hypotensive eye drop has a unique set of possible side effects. Brimonidine might have neuro-protective capabilities and offer reasonable IOP control, but its use is limited by a relatively high rate of ocular allergy, hyperemia and discomfort. Brinzolamide is generally well tolerated, but often lacks efficacy. The introduction of brimonidine/brinzolamide fixed combination suspension improves adherence (by simplifying the medical regimen) and reduces preservative load on the ocular surface. New drug delivery systems incorporating brimonidine and brinzolamide are in development and promise to improve the safety profiles of both drugs.
Glaucoma is a term describing a group of ocular disorders with multi‐factorial etiology united by a clinically characteristic intraocular pressure‐associated optic neuropathy. It is not a single ...entity and is sometimes referred to in the plural as the glaucomas. All forms are potentially progressive and can lead to blindness. The diverse conditions that comprise glaucoma are united by a clinically characteristic optic neuropathy: glaucomatous optic neuropathy (GON). Evidence suggests that the primary site of neurological injury is at the optic nerve head. This fact enables the conditions to be grouped, irrespective of the causal mechanism(s). The term experimental glaucoma implies model resemblance to the human condition. We propose that ‘experimental glaucoma’ be restricted to animal models with demonstrable features of GON and/or evidence of a primary axonopathy at the optic nerve head. A fundamental inadequacy in this framework is any reference to the pathogenesis of GON, which remains unclear.
Current management of glaucoma Lusthaus, Jed; Goldberg, Ivan
Medical journal of Australia,
March 2019, Letnik:
210, Številka:
4
Journal Article
Recenzirano
Summary
Glaucoma is an irreversible progressive optic neuropathy, for which the major proven treatment is to lower the intraocular pressure (IOP).
Five groups of IOP‐lowering eye drops have varying ...mechanisms of action. Some drops, such as β‐blockers and α‐2 agonists, have potentially serious systemic side effects. Acetazolamide is the only available oral agent; it is effective at lowering IOP, but significant side effects relegate its use usually to refractory glaucoma.
Two new eye drops, netarsudil and latanoprostene bunod, have recently been approved by the United States Food and Drug Administration. Both have novel IOP‐lowering mechanisms and target the conventional aqueous outflow system.
Selective laser trabeculoplasty is a gentle treatment that enhances conventional aqueous outflow. It may be used as an initial treatment, as a substitute for eye drops, or to delay glaucoma drainage surgery.
Recent advancements in glaucoma surgery have seen an influx of minimally invasive glaucoma surgery devices, which are being used more frequently and earlier on in the treatment paradigm. As limited long term data are available, trabeculectomy remains the gold standard IOP‐lowering procedure. Improvements in drug delivery are on the horizon. Drug‐eluting devices and implants are able to deliver the drug closer to the receptors for an extended period of time. This will improve treatment adherence and efficacy, which are major limitations with current medical therapy.
Primary open-angle glaucoma (POAG) is a major cause of irreversible blindness worldwide. We performed a genome-wide association study in an Australian discovery cohort comprising 1,155 cases with ...advanced POAG and 1,992 controls. We investigated the association of the top SNPs from the discovery stage in two Australian replication cohorts (932 cases and 6,862 controls total) and two US replication cohorts (2,616 cases and 2,634 controls total). Meta-analysis of all cohorts identified three loci newly associated with development of POAG. These loci are located upstream of ABCA1 (rs2472493G, odds ratio (OR) = 1.31, P = 2.1 × 10(-19)), within AFAP1 (rs4619890G, OR = 1.20, P = 7.0 × 10(-10)) and within GMDS (rs11969985G, OR = 1.31, P = 7.7 × 10(-10)). Using RT-PCR and immunolabeling, we show that these genes are expressed within human retina, optic nerve and trabecular meshwork and that ABCA1 and AFAP1 are also expressed in retinal ganglion cells.
To report the relative frequencies of childhood and early onset glaucoma subtypes and their genetic findings in a large single cohort.
Retrospective clinical and molecular study.
All individuals with ...childhood glaucoma (diagnosed 0 to <18 years) and early onset glaucoma (diagnosed 18 to <40 years) referred to a national disease registry.
We retrospectively reviewed the referrals of all individuals with glaucoma diagnosed at <40 years of age recruited to the Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG). Subtypes of glaucoma were determined using the Childhood Glaucoma Research Network (CGRN) classification system. DNA extracted from blood or saliva samples underwent sequencing of genes associated with glaucoma.
The phenotype and genotype distribution of glaucoma diagnosed at <40 years of age.
A total of 290 individuals (533 eyes) with childhood glaucoma and 370 individuals (686 eyes) with early onset glaucoma were referred to the ANZRAG. Primary glaucoma was the most prevalent condition in both cohorts. In the childhood cohort, 57.6% of individuals (167/290, 303 eyes) had primary congenital glaucoma (PCG), and 19.3% (56/290, 109 eyes) had juvenile open-angle glaucoma. Juvenile open-angle glaucoma constituted 73.2% of the early onset glaucoma cohort (271/370, 513 eyes). Genetic testing in probands resulted in a diagnostic yield of 24.7% (125/506) and a reclassification of glaucoma subtype in 10.4% of probands (13/125). The highest molecular diagnostic rate was achieved in probands with glaucoma associated with nonacquired ocular anomalies (56.5%). Biallelic variants in CYP1B1 (n = 29, 23.2%) and heterozygous variants in MYOC (n = 24, 19.2%) and FOXC1 (n = 21, 16.8%) were most commonly reported among probands with a molecular diagnosis. Biallelic CYP1B1 variants were reported in twice as many female individuals as male individuals with PCG (66.7% vs. 33.3%, P = 0.02).
We report on the largest cohort of individuals with childhood and early onset glaucoma from Australasia using the CGRN classification. Primary glaucoma was most prevalent. Genetic diagnoses ascertained in 24.7% of probands supported clinical diagnoses and genetic counseling. International collaborative efforts are required to identify further genes because the majority of individuals still lack a clear molecular diagnosis.
Abstract Glaucoma filtration surgery is performed to reduce intraocular pressure (IOP) in patients for whom maximal tolerable pharmacologic IOP-lowering therapy and/or laser surgery fail to lower IOP ...sufficiently and/or fail to prevent optic nerve damage or visual field deterioration. For decades, the most widely utilized procedure for glaucoma filtration surgery has been trabeculectomy. Although this approach reliably provides long-term IOP reduction in many patients, the postoperative complication rate is high. This has driven the development of alternative approaches to reduce IOP surgically. The EX-PRESS glaucoma filtration device was developed to mimic IOP control by trabeculectomy and to have a better safety profile. This non-valved, medical-grade stainless steel device diverts aqueous humor from the anterior chamber to an intrascleral space. Despite the widespread use of the EX-PRESS device, only a few studies compare its efficacy and safety with that of trabeculectomy. We analyze available data regarding the safety and efficacy of the EX-PRESS device, particularly in comparison with trabeculectomy.
Intraocular pressure (IOP) correlates with progressive loss of visual field in patients with glaucoma. Decreasing IOP has been proven to reduce progressive loss of the visual field. This is true both ...for glaucoma patients with IOPs above or within the normal range. For individuals with ocular hypertension (high IOP but no evidence of glaucomatous neuropathy), lowering IOP may reduce the risk of developing glaucoma. This article reviews scientific evidence that supports the importance of lowering IOP in patients with glaucoma or ocular hypertension.
To appraise primary open-angle glaucoma (POAG) practice guidelines critically and to compare these guidelines' major recommendations.
Evaluation of clinical practice guidelines and their development ...process.
Glaucoma fellowship-trained ophthalmologists.
The POAG clinical practice guidelines published by the American Academy of Ophthalmology (AAO), European Glaucoma Society (EGS), and South East Asia Glaucoma Interest Group (SEAGIG) were evaluated by independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.
Domain scores using the AGREE instrument.
Critical appraisal using the AGREE instrument demonstrated that the AAO guidelines scored favorably (>60%) in the domains of scope and purpose, rigor of development, and clarity and presentation, while scoring unfavorably (<60%) in the domains of stakeholder involvement, applicability, and editorial independence. The Terminology and Guidelines for Glaucoma and the Asia Pacific Glaucoma Guidelines respectively developed by EGS and SEAGIG scored favorably in the domains of scope and purpose and clarity and presentation, but scored unfavorably in the domains of stakeholder involvement, applicability, and editorial independence. The major recommendations regarding diagnosis and management of POAG were similar among the 3 guidelines, although the level of detail varied considerably.
Although the clinical practice guidelines from the AAO, SEAGIG, and EGS have contributed to developing evidence-based guidelines for glaucoma management, there is variability in the quality of the guideline development process and how it is reported as evaluated by a standardized instrument. The adoption of common standards in developing clinical practice guidelines in ophthalmology should improve their consistency and quality.
Proprietary or commercial disclosure may be found after the references.
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