Pre-perimetric glaucoma David Kinshuck |
|
|
Introduction |
Glaucoma is described here. Pre-perimetric glaucoma is essentially early chronic open-angle glaucoma. It may be called
|
Glaucoma |
In glaucoma the optic nerve becomes damaged, and after sometime the sight becomes reduced.
|
|
Pre-perimetric glaucoma |
If you have pre-perimetric glaucoma, your ophthalmologist believes that you are developing glaucoma or have early glaucoma. But by definition your visual fields will be full, and your sight very good. But if the condition was untreated, the optic nerve would become more damaged and, the visual fields would shrink, and then the sight reduced. So generally treatment will be needed to stop further damage to the optic nerve. It is diagnosed using the latest tests etc
The treatment is generally drops to lower the eye pressure, such as
Check ups will be needed about 3 months of starting the drops to check the pressure is low enough, and every year after that. At the check ups,
Your ophthalmologist tries to achieve a low eye pressure
The main cause of the condition is the blocked drain, see. But sometimes the condition is poor blood flow to the optic nerve etc see.
|
|
These are some notes from the glaucoma page that may be relevant:
Genes and your relations |
Glaucoma is much commoner as we get older but tends to run in families.
Genes control the blockage of the drain (the 'trabecular meshwork'). The relations of patients with glaucoma should all be checked for the condition. If you have glaucoma and you are 70y, then all the relations (mainly children and sisters and brothers) should be checked from the age of 50y. If you have glaucoma age 30y, then even the children related to you should be checked (again: sons/daughters/brothers/sisters). See. |
The sight in glaucoma |
At first the sight is normal, but it if the glaucoma
is severe, the sight may get progressively worse as opposite. |
![]() At first the sight is normal,
then a small area of poor vision may develop.
or nearly all the sight.
A common type of loss of vision in glaucoma. |
How does the doctor or optometrist know you have glaucoma? |
Glaucoma is found by an ophthalmologist or optometrist by
|
Treatment for chronic glaucoma in adults |
Chronic glaucoma is treated with |
|
Drops |
Drops are described in more detail. In practice the maximum combination of drops that can be used
with few side effects are these 3 drops combined, such as xalatan
at night, timolol LA morning, and azopt 2-3 times a day. |
Laser | Laser may help a little in older patients, see. Argon laser trabeculoplasty is the main operation available, but selective laser trabeculoplasty may be more effective. |
Surgery | With new drops such as Xalatan this is needed less often. However, it is occasionally necessary, especially for younger patients. See some notes here. See animation. Here are Good Hope mitomycin results. Some wonderful videos and other information here. Some patients, especially older patients or those who have had previous trabeculectomy, may need cyclodiode laser. |
Will the sight get worse? |
Once the pressure reaches a satisfactory level the glaucoma should not
A satisfactory pressure if the optic nerve is healthy is 18-20mmHg, if the nerve is slightly damaged 14-16, and if considerably damaged 10-12 would be ideal. (The pressure level needed also depends on your type of glaucoma. People with 'low tension glaucoma' need a lower pressure, for instance.) People who have a pressure of 14 that never rises above 14 usually notice little progression. Effectively research has shown that if a pressure is 10mmHg, hardly any eye will be further damaged from pressure, if 11mmHg, then 10% of eyes/patients will notice a deterioration, and so on up to 20mmHg. It is very hard for an ophthalmologist to tell which eyes will get worse, but
At 20mmHg most eyes will deteriorate. But in practice the
risks of treatment, such as having to use lots of drops,
and particularly that of diamox tablets or surgery, have
to be balanced against the ideal of seeking a pressure of
10 for all patients. In practice accepting a higher pressure
in a particular patient may still mean very few patients
notice much deterioration, and is the best option. Indeed,
in an elderly patient using 2 or 3 drops there may be no
safe alternative, especially if this includes xalatan (or
lumigan or travaprost). |
Tests each visit |
At each visit these results will be analysed
|
Your general health in glaucoma/intraocular hypertension |
Remember that your general health and lifestyle have a major impact on glaucoma and your sight.
|
The address of this site ('org' changing to 'nhs') is changing from http://www.goodhope.org.uk/departments/eyedept/ to http://www.goodhope.nhs.uk/departments/eyedept/ |
|