CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 65, Glaucoma.
Primary open-angle glaucoma (POAG) or ocular hypertension is more prevalent outside Asia than primary angle-closure glaucoma (PACG).
In any form of glaucoma, reduction of intraocular pressure (IOP) is essential.
IOP is a very important risk factor for glaucoma, but the most important considerations are progression of glaucomatous changes in the back of the eye (optic disk and nerve fiber layer) and visual field changes when diagnosing and monitoring for POAG or ocular hypertension.
Optic nerve changes often occur before visual field changes are exhibited.
Recent studies demonstrate that reduction in IOP prevents progression or even onset of glaucoma.
Newer medications simplify treatment regimens for patients. Prostaglandin analogs are considered the most potent topical medications for reducing IOP and flattening diurnal variations in IOP.
Local adverse events are common with topical glaucoma medications, but patient education and reinforcing adherence are essential to prevent glaucoma progression.
Preclass Engaged Learning Activity
Watch the video from Dr Henry Jampel, a leading glaucoma specialist, entitled “Using Eye Drops to Treat Glaucoma” from The Wilmer Eye Institute https://tinyurl.com/vzeg9dh. Proper administration of eye drops is critical prior to discussing glaucoma medication with a patient. The video presents very common mistakes associated with eye drop administration, the proper technique for administering eye drops and frequently asked questions about using eye drops in glaucoma. It is a very useful tool for the student to help ensure that the proper use of eye drops in glaucoma in the ASSESS and IMPLEMENT steps for the Patient Care Process.
The glaucomas are a group of ocular disorders that lead to an optic neuropathy characterized by changes in the optic nerve head (optic disk) that is associated with loss of visual sensitivity and field. Increased intraocular pressure (IOP) is thought to play an important role in the pathogenesis of glaucoma, but it is not a diagnostic criterion for glaucoma. Consistently elevated IOP without signs or symptoms of glaucoma is called ocular hypertension (OHT).
Two major types of glaucoma have been identified: open angle and closed angle. Primary open-angle glaucoma (POAG) accounts for the great majority of cases in North America, while primary angle-closure glaucoma (PACG) is more prevalent in Asia. Either type can be a primary inherited disorder, congenital, or secondary to disease, trauma, or drugs and can lead to serious complications. Both primary and secondary glaucomas may be caused by a combination of open-angle and closed-angle mechanisms (Table 110-1 and Fig. 110-1). Patients with consistently high intraocular pressure, or patients with clinical findings suspicious of early glaucomatous changes are called “glaucoma suspects.”1–6
Table 110-1General Classification ...