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    Target Pressure in Glaucoma Management: Fitratul Ilahi

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    Elfi Risalma
    This document discusses target intraocular pressure (IOP) in glaucoma management. It notes that IOP is the main risk factor for glaucoma development and progression. The goal of glaucoma treatment is to lower IOP enough to prevent further vision loss and maintain quality of life. Target IOP ranges depend on the stage of glaucoma and risk level, with more advanced cases requiring greater IOP reduction. IOP fluctuations also increase risk of progression. First-line treatment involves prostaglandin drugs, which provide 24-hour IOP control and high responder rates with minimal side effects. The overall aim is finding an IOP level that stops glaucomatous damage from worsening.

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    Target Pressure in Glaucoma Management: Fitratul Ilahi

    Uploaded by

    Elfi Risalma
    26 views24 pages
    This document discusses target intraocular pressure (IOP) in glaucoma management. It notes that IOP is the main risk factor for glaucoma development and progression. The goal of glaucoma treatment is to lower IOP enough to prevent further vision loss and maintain quality of life. Target IOP ranges depend on the stage of glaucoma and risk level, with more advanced cases requiring greater IOP reduction. IOP fluctuations also increase risk of progression. First-line treatment involves prostaglandin drugs, which provide 24-hour IOP control and high responder rates with minimal side effects. The overall aim is finding an IOP level that stops glaucomatous damage from worsening.

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    Target Pressure

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    This document discusses target intraocular pressure (IOP) in glaucoma management. It notes that IOP is the main risk factor for glaucoma development and progression. The goal of glaucoma treatment is to lower IOP enough to prevent further vision loss and maintain quality of life. Target IOP ranges depend on the stage of glaucoma and risk level, with more advanced cases requiring greater IOP reduction. IOP fluctuations also increase risk of progression. First-line treatment involves prostaglandin drugs, which provide 24-hour IOP control and high responder rates with minimal side effects. The overall aim is finding an IOP level that stops glaucomatous damage from worsening.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pptx, pdf, or txt
    26 views24 pages

    Target Pressure in Glaucoma Management: Fitratul Ilahi

    Uploaded by

    Elfi Risalma
    This document discusses target intraocular pressure (IOP) in glaucoma management. It notes that IOP is the main risk factor for glaucoma development and progression. The goal of glaucoma treatment is to lower IOP enough to prevent further vision loss and maintain quality of life. Target IOP ranges depend on the stage of glaucoma and risk level, with more advanced cases requiring greater IOP reduction. IOP fluctuations also increase risk of progression. First-line treatment involves prostaglandin drugs, which provide 24-hour IOP control and high responder rates with minimal side effects. The overall aim is finding an IOP level that stops glaucomatous damage from worsening.

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    of 24

    TA R G E T P R E S S U R E I N FITRATUL ILAHI

     GLAUCOMA SUB DIVISION


    GLAUCOMA
    MEDICAL FACULTY ANDALAS UNIVERSITY
    MANAGEMENT DR.M.DJAMIL HOSPITAL PADANG

    13th SOM 2018, Jambi


    Glaucoma Epidemiology

    AMERIKA

    EROPA

    AFRIKA ASIA
    50% POAG
    Undiagnosed
    4.5- 5.9 million
    Bilateral Blindness
    POAG

    PACG

    Stamper RL, 2009

    2
    KEY POINTS
    Intra ocular pressure (IOP) is the main
    risk factor in development and progression
    of glaucoma

    IOP is the only factor of glaucoma that can


    be treat

    Lowering IOP is the main strategy of


    glaucoma management to preserve Quality
    of life
    • MAINTAIN QUALITY OF
    LIFE

    • PREVENT VISUAL
    FIELD LOSS

    •GOAL OF
    • PREVENT GLAUCOMA
    G L A U C O M AT O U S P R O G R E S S
    ION
    T R E A T M E N T

    TARGET IOP ? < 21 MMHG ?


    Rate of Progression

    The Power of PowerPoint | thepopp.com 5


    • WHAT IS TARGET IOP ?
    Definition
    • THE EGS
    GUEDLINE
    “ ANESTIMATE OF THE
    MEAN IOP OBTAINED WITH
    THAT IS EXPECTED TO • AAO
    PREVENT FURTHER
    GLAUCOMATOUS DAMAGE “ “ A RANGE OF IOP
    • WGA
    ADEQUATE TO STOP
    “ AN ESTIMATE OF THE MEAN IOP AT PROGRESSIVE
    WHICH THE RISK OF DECREASED PRESSURE INDUCED
    VISION RELATED QUALITY OF LIFE INJURY “
    DUE TO GLAUCOMA ”
    7
    Should lower Target ?

    8
    GLAUCOMA WITH HIGH 5-YEAR RISK FOR
    PROGRESSIVE VISUAL LOSS ( DECREASE IOP 40 % , 9-
    11MMHG)
    • MODERATE TO ADVANCED GON WITH
    CORRELATING VF LOSS
    DEMONSTRATED PROGRESSION OVER A SHORT
    TIME
    BILATERAL VF LOSS
    PIGMENTARY AND PXF GLAUCOMA
    VERY ADVANCED VF LOSS
    GLAUCOMA-RELATED VISUAL DISABILITY
    YOUNG AGE WITH ADVANCED DISEASE
    SECONDARY GLAUCOMA
    AACG 9
    GLAUCOMA WITH MODERATE 5-YEAR RISK FOR VISUAL
    LOSS OR GLAUCOMA SUSPECT WITH HIGH
    (DECREASE IOP 30 %, 11-15MMHG)

    • MILD GON WITH CORRELATING EARLY VF LOSS AND HIGHER


    IOP
    • MILD-TO-MODERATE GLAUCOMA WITH LOW IOP76
    • PAC WITH HIGH IOP AND PAS
    • YOUNGER AGE

    10
    Glaucoma Suspect at Moderate Risk for Visual Loss
    ( Decrease IOP 20 % , 15-19mmHg)

     Fellow of eye with established GON (excluding secondary


    unilateral glaucomas)
     OH with multiple risk factors (thin CCT, high IOP, suspicious
    disc)
     GLC gene mutations associated with severe glaucoma
     Recurrent optic disc haemorrhages
     PXF syndrome
     Younger age

    11
    IOP FLUCTUATIONS: GLAUCOMA

    Peak Peak Peak Peak

    Target IOP

    Trough Trough Trough Trough

    • Large fluctuations (>5 mm Hg) in IOP are a significant risk factor for disease progression
    in glaucoma patients
    • IOP fluctuations are an independent risk factor

    Fluctuating IOP has been shown to be a major


    factor in glaucoma progression
    Asrani S, Zeimer R, Wilensky J, et al. J Glaucoma. 2000;9:134-142.
    IOP FLUCTUATION: VISUAL FIELD PROGRESSION

    3.5 Progression of Visual Field Loss in Eyes with IOP Fluctuation


    <3 mm Hg vs ≥3 mm Hg
    3.0

    Change in AGIS Score


    2.5
    Standard Deviation
    2.0 of IOP (mm Hg)
    ≥3.0
    1.5
    <3.0
    1.0
    0.5
    0.0
    -0.5
    0 20 40 60 80 100
    Time (mo)
    • Significant progression was observed in eyes with high fluctuation

    Visual field loss progression is increased by 30% with each 1 mm Hg


    increase in IOP fluctuation
    Nouri-Mahdavi K, Hoffman D, Coleman AL, et al. Ophthalmology. 2004;111:1627-1635.
    AAO GUIDELINES: TARGET IOP

    40
    % reduction from baseline 40

    35
    30 30
    30
    Advance
    damage 25
    20
    20
    Mild
    NTG
    damage
    15

    OHT 10

    5
    Ref: Survey of Ophtalmology 2003;48 (suppl 1); 53-57
    Ref: Surveys of Ophthalmology 2003; 48 (suppl 1); 53-57
    0
    The Power of PowerPoint | thepopp.com 15
    The Power of PowerPoint | thepopp.com 16
    The Power of PowerPoint | thepopp.com 17
    The Power of PowerPoint | thepopp.com 18
    GREATEST CHANCE OF REACHING TARGET
    IOP
    HAVE RELATIVELY FLAT 24-HOUR
    HOW WE INTRAOCULAR PRESSURE CURVES

    C HOOS E I DEAL SAFETY


    GOOD TOLERABILITY
    M EDI C ATIO N MINIMAL CONCENTRATION , FREQUENCY
    MINIMAL INCONVENIENCE

    19
    • GLAUCOMA DRUG CLASSES
    PROSTAGLANDIN ; FIRST LINE TERAPI

    PGA Timolol

    IOP Reduction +

    24 Hour Circadian IOP Control +

    Responder Rate +

    Duration of Action +

    Systemic Side Effects +

    Local Side Effects +


    CONCLUSION

    • IOP IS MAIN RISK FACTOR OF GLAUCOMA


    • LOWERING IOP PREVENT GLAUCOMA DEVELOPMENT AND
    PROGRESSION
    • TARGET IOP DEPENDS ON GLAUCOMA STAGE
    • GLAUCOMA TREATMENT OBJECTIVE ARE TO MAINTAIN
    VISUAL FUNCTION AND QUALITY OF LIFE

    The Power of PowerPoint | thepopp.com 23


    THANK YOU SO MUCH

    Fakultas Kedokteran Universitas Andalas 24

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