Open-angle glaucoma
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Open-angle glaucoma On the Web |
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American Roentgen Ray Society Images of Open-angle glaucoma |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]
Overview
Historical Perspective
Glaucoma has been known in medicine since Antiquity. In Greek 'glaukos' a word appearing in the works of Homer where it seems to mean a sparkling silver glare. Later the word was used for colours such as sky-blue or green.The word entered ophthalmology when Hippocrates, in his “Aphorisms”, lists among the infirmities of the aged a condition he called “glaucosis” which he associated with “dimness of vision”.[1] The implied meaning is that of a clouded or blue-green hue of the cornea in end stage forms that may result in corneal edema and/or coinciding cataract. The Hippocratic writings make no clear distinction between cataract and glaucoma. Both Classical and Alexandrian Greeks did not recognize the specific disease which we now call glaucoma.
The definition of glaucoma has changed drastically since its introduction around the time of Hippocrates in approximately 400 BC.[1] The first recognition of a disease associated with a rise in intraocular pressure and thus corresponding to what is now known as glaucoma occurred in the Arabian writings, “Book of Hippocratic treatment”, of At-Tabari (10th century).[2] In European writings, it was Richard Bannister (1622), an English oculist and author of the first book of ophthalmology in English, who recognized glaucoma as a disease with four features: increased intraocular pressure, long duration of the disease, the absence of perception of light and the presence of a fixed pupil. However, throughout the 18th century the term glaucoma was still merely a label applied to an inflamed eye wherein the pupil appeared greenish-blue and the visual prognosis was bad, but the tension of the eye was not stressed.[3]
It was only after the careful description by Antoine-Pierre Demours (1818) that the central concept of a rise in intraocular pressure became fully established. G.J. Guthrie (1823) and William McKenzie, a Scottish clinician (1835) confirmed these findings. Donders (1862) described an incapacitating increased eye tension occurring without any inflammatory symptoms as "simple glaucoma". In 1973 Drance provided for the first time the definition of glaucoma as an optic neuropathy caused by increased intraocular pressure and other associated risk factors.[3]
The first patient in the United States federal government's Compassionate Investigational New Drug program, Robert Randall, was afflicted with glaucoma and had successfully fought charges of marijuana cultivation because it was deemed a medical necessity (U.S. v. Randall) in 1976.[4]
Classification
| Open-angle Glaucoma | |
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| Primary open-angle glaucoma (POAG) (H40.11) |
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| Normal-tension glaucoma (H40.12) |
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| Juvenile open-angle glaucoma |
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| Glaucoma suspect (H40.0) |
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| Secondary open-angle glaucoma
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Pathophysiology
Causes
Differentiating Any Disease from other Diseases
Epidemiology and Demographics
Primary open-angle glaucoma (POAG) poses a significant public health problem. The estimated prevalence of POAG in the United States in individuals older than 40 years is 1.86% (95% confidence interval, 1.75%–1.96%), based on a meta-analysis of population-based studies. Applied to data from the 2000 US census, this percentage translates to nearly 2.22 million Americans affected.[5] The number of POAG patients is estimated to increase by 50%, to 3.36 million in 2020.
The World Health Organization (WHO) undertook an analysis of the literature to estimate the prevalence, incidence, and severity of the different types of glaucoma on a worldwide basis. The data collected predominantly in the late 1980s and early 1990s, it was estimated the global population of persons with high IOP (>21 mm Hg) to be 104.5 million.[6] The incidence of POAG was estimated at 2.4 million persons per year. Blindness prevalence for all types of glaucoma was estimated at more than 8 million persons, with 4 million cases caused by POAG. Glaucoma was theoretically calculated to be responsible for 12.3% of blindness. This makes glaucoma the second leading cause of blindness worldwide, following cataract.
The estimated prevalence varies widely as per different studies population-based samples; the Rotterdam Study (northern European population) showing a prevalence of 0.8% and the Barbados Eye Study (Caribbean population) showing a prevalence of 7% in individuals older than 40 years.[7][8] In these studies, there is an increase in the prevalence of glaucoma in older individuals, with estimates for persons in the 7th decade being generally 3 to 8 times higher than those for persons in their 4th decade.
Among whites aged 40 years and older, a prevalence of between 1.1% and 2.1% has been reported based on population-based studies performed throughout the world. The prevalence among black persons and Latino persons is up to 4 times higher compared to the prevalence among whites. Black individuals are also at greater risk of blindness from POAG, and this risk increases with age: in persons aged 46–65 years, the likelihood of blindness from POAG is 15 times higher among blacks than that among whites.
Risk Factors
- Age : The risk increases with the increase in age.The visual field defects were 7 times more likely to progress in patients aged 60 years or older than in those younger than 40 years. Although increased lOP with age has been observed in many populations and may account for part of the relationship between age and glaucoma, studies in Japan have shown a relationship between glaucoma and age even with no increase in lOP in the population.[9]
- Race : The prevalence of POAG is 3 to 4 times greater in black persons and Hispanic persons than in non-Hispanic white individuals. Blindness from glaucoma is at least 4 times more common in blacks than in whites. Glaucoma is more likely to be diagnosed at a younger age and likely to be at a more advanced stage at the time of diagnosis in black patients than in white patients.The Baltimore Eye Survey found that the prevalence of glaucoma increases dramatically with age, particularly among black persons, exceeding 11% in those aged 80 years or older.[10]
- Family History: A positive family history is also a risk factor for POAG. The relative risk of POAG is increased approximately 3.7-fold for individuals who have a sibling with POAG.[11]
- Myopia : The evidence supports an association between POAG and myopia. The concurrence of POAG and myopia cause difficulty in diagnosis and management of POAG. There is an increased difficulty in evaluation of the optic disc is particularly complicated in highly myopic eyes that have tilted discs or posterior Staphyloma. The magnification of the disc due to the myopic refractive error interferes with optic disc evaluation. Myopia-related retinal abnormalities can cause visual field defects apart along with glaucoma. High refractive error may also make it difficult to perform accurate perimetric measurement and to interpret visual field abnormalities.
- Diabetes Mellitus : The role of diabetes mellitus in causing POAG is still controversial. Though some studies have found diabetes plays a significant role in the disease, other studies have not found diabetes to be major risk factor.[12]
- Hypertension : The systemic hypertension is associated with a low risk of the presence of glaucoma in younger patients and with an increased risk in older (>65 years) patients. It is considered that with advancing age, the adverse effects of chronic hypertension on the optic nerve microcirculation may lead to the nerve's susceptibility to the development of glaucomatous optic neuropathy. Many studies demonstrate that lower ocular perfusion pressure is a strong risk factor for the development of glaucoma, independent of lOP alone. Some research groups define ocular perfusion pressure as blood pressure (systolic, diastolic, or mean arterial) minus lOP. The overtreatment of systemic hypertension may be a contributing factor to glaucoma progression in some cases and hence, should be avoided.[12]
- Retinal vein occlusion : The patients with central retinal vein occlusion may lead to an elevated lOP and glaucoma. In some case, there may be presentation of preexisting POAG or other types of glaucoma. After CRVO, patients may develop angle-closure glaucoma or, at a later stage, neovascular glaucoma. The comorbidity is due to elevated lOP in susceptible individuals, thus are at risk of developing CRVO.
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- Raynaud Phenomenon
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Ocular Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
Case Studies
- ↑ 1.0 1.1 "GLAUCOMA, MESSENGER, AND HIPPOCRATES". Archives of ophthalmology (Chicago, Ill. : 1960). 71: 879–80. 1964. ISSN 0003-9950. PMID 14133878.
|first1=missing|last1=in Authors list (help) - ↑ Leffler, Christopher T.; Hadi, Tamer; Salman, Ali; Vasuki, Vivek; Schwartz, Stephen (2015). "The early history of glaucoma: the glaucous eye (800 BC to 1050 AD)". Clinical Ophthalmology. Dove Medical Press Ltd.: 207. doi:10.2147/opth.s77471. ISSN 1177-5483.
- ↑ 3.0 3.1 Leffler, Christopher T.; Schwartz, Stephen G.; Giliberti, Francesca M.; Young, Matthew T.; Bermudez, Dennis (2015). "Article Commentary: What was Glaucoma Called before the 20th Century?". Ophthalmology and Eye Diseases. SAGE Publications. 7: OED.S32004. doi:10.4137/oed.s32004. ISSN 1179-1721.
- ↑ "US v. Randall, 171 F. 3d 195 - Court of Appeals, 4th Circuit 1999". Google Scholar. Retrieved 2018-03-03.
- ↑ Friedman, DS; Wolfs, RC; O'Colmain, BJ; Klein, BE; Taylor, HR; West, S; Leske, MC; Mitchell, P; Congdon, N; Kempen, J (2004-04-01). "Prevalence of Open-Angle Glaucoma Among Adults in the United States". Archives of ophthalmology (Chicago, Ill. : 1960). American Medical Association (AMA). 122 (4): 532. doi:10.1001/archopht.122.4.532. ISSN 0003-9950. PMC 2798086165208 Check
|pmc=value (help). PMID 15078671. - ↑ Tham, Yih-Chung; Li, Xiang; Wong, Tien Y.; Quigley, Harry A.; Aung, Tin; Cheng, Ching-Yu (2014). "Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040". Ophthalmology. Elsevier BV. 121 (11): 2081–2090. doi:10.1016/j.ophtha.2014.05.013. ISSN 0161-6420.
- ↑ Leske, MC; Connell, AM; Schachat, AP; Hyman, L (1994). "The Barbados Eye Study. Prevalence of open angle glaucoma". Archives of ophthalmology (Chicago, Ill. : 1960). 112 (6): 821–9. ISSN 0003-9950. PMID 8002842.
- ↑ Hofman, Albert; Breteler, Monique M. B.; van Duijn, Cornelia M.; Krestin, Gabriel P.; Pols, Huibert A.; Stricker, Bruno H. Ch.; Tiemeier, Henning; Uitterlinden, André G.; Vingerling, Johannes R.; Witteman, Jacqueline C. M. (2007-10-23). "The Rotterdam Study: objectives and design update". European Journal of Epidemiology. Springer Nature. 22 (11): 819–829. doi:10.1007/s10654-007-9199-x. ISSN 0393-2990.
- ↑ Iwase, Aiko; Suzuki, Yasuyuki; Araie, Makoto; Yamamoto, Tetsuya; Abe, Haruki; Shirato, Shiroaki; Kuwayama, Yasuaki; Mishima, Hiromu K.; Shimizu, Hiroyuki; Tomita, Goji; Inoue, Yoichi; Kitazawa, Yoshiaki (2004). "The prevalence of primary open-angle glaucoma in Japanese". Ophthalmology. Elsevier BV. 111 (9): 1641–1648. doi:10.1016/j.ophtha.2004.03.029. ISSN 0161-6420. PMID 15350316.
- ↑ Tielsch, James M. (1991-07-17). "Racial Variations in the Prevalence of Primary Open-angle Glaucoma". JAMA. American Medical Association (AMA). 266 (3): 369. doi:10.1001/jama.1991.03470030069026. ISSN 0098-7484.
- ↑ "Primary Open-Angle Glaucoma (POAG) Clinical Presentation: History, Physical, Causes". Medscape Reference. 2017-12-01. Retrieved 2018-03-03.
- ↑ 12.0 12.1 Klaver, Caroline C. W. (1998-05-01). "Age-Specific Prevalence and Causes of Blindness and Visual Impairment in an Older Population". Archives of Ophthalmology. American Medical Association (AMA). 116 (5): 653. doi:10.1001/archopht.116.5.653. ISSN 0003-9950.