INTRAOCULAR PRESSURE

NORMAL 14-21 mmHg GLAUCOMA

AG
But
Progressive optic neuropathy,
Normal Tension Glaucoma, Ocular with characteristic field defects,
Hypertension, Central Corneal Thickness, most commonly caused by
increased IOP.
Contact tonometry v. non-contact

VISUAL FIELDS
OPTIC DISC CUPPING
Arcuate scotomas, nasal steps, temporal
wedges, paracentral scotomas, NORMAL < 0.5

But
But

Steep learning curve, VA needs to be good, Physiological cupping, Look for symmetry,
rim thickness, ISNT rule, myopes ,
false negatives +positives, fixation losses
tilted discs

DIAGNOSTIC NIGHTMARE!

Complex disease process. IOP and vascular components

Risk Factors: Increasing Age, Race (African-Caribbean more frequent, younger, worse), Family History, NTG more
common with migraine, Raynaud’s, Japanese

Other glaucomas are available! Secondary glaucoma, Pigment dispersion, PXE, Trauma, Congenital malformations,
Rubeosis, Uveitis, Steroid responders, Acute angle closure glaucoma, Chronic angle closure glaucoma…..

TREATMENT

Aim to reduce IOP. Not to cure but to slow down progress. Treat OHT if IOP 28+ as increased risk of POAG

Medical Treatment: prostaglandin analogue, beta blockers, alpha agonists, carbonic anhydrase inhibitors

Laser or surgery: ALT, Trabeculectomy, Tube/shunt procedure

Anne Gobbett 2019 SEI