Journal of Current Glaucoma Practice

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2012 | September-December | Volume 6 | Issue 3

EDITORIAL

Winston Churchill

‘If you have knowledge, let others light their candles with it.’

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/jocgp-6-3-vii  |  Open Access |  How to cite  | 

PERSPECTIVE

Colin I Clement

Initial Treatment: Prostaglandin Analog or Selective Laser Trabeculoplasty

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:5] [Pages No:99 - 103]

Keywords: Prostaglandin analogs, Selective laser trabeculoplasty, Glaucoma therapy, Compliance

PDF  |  DOI: 10.5005/jp-journals-10008-1114  |  Open Access |  How to cite  | 

Abstract

Prostaglandin analogs (PGA) have been the initial treatment of choice in many patients with glaucoma. However, there is an increasing awareness that non adherence and disruption of the ocular surface may limit PGA utility and tolerability respectively in some patients. In an eye with an open iridocorneal angle, these issues can potentially be addressed with the use of laser trabeculoplasty (LT). This therapy can achieve long-term intraocular pressure reduction following 1 to 2 treatment sessions without the ongoing need to apply medication (and preservatives) to the ocular surface. Whether PGAs or LT should be used in a given individual will also be influenced by other important factors including efficacy, response rate, tolerability, complications, cost and accessibility. This review examines these issues in relation to the initiation of primary therapy.

PERSPECTIVE

Y Louati, T Shaarawy

Controversy: Is Benzalkonium Chloride Necessary in Antiglaucoma Drops?

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:4] [Pages No:104 - 107]

Keywords: BAK, Ocular surface disease and glaucoma, Bioavailability, Preservatives in glaucoma medication, Preservative free glaucoma medication

PDF  |  DOI: 10.5005/jp-journals-10008-1115  |  Open Access |  How to cite  | 

Abstract

Medical therapy is the first-line option in glaucoma management, with benzalkonium chloride (BAC) being the most frequently used preservative in antiglaucoma medications. Its use is however, known to be associated with deleterious effects on the ocular surface. This review is an attempt to critically evaluate whether BAC really is indispensable for better bioavailability of antiglaucoma drugs and consequently, better IOP control.

Original Article

Parul Ichhpujani, Shibal Bhartiya, Manisha Kataria, Prateek Topiwala

Knowledge, Attitudes and Self-care Practices associated with Glaucoma among Hospital Personnel in a Tertiary Care Center in North India

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:5] [Pages No:108 - 112]

Keywords: Attitude, Awareness, Glaucoma, Intraocular pressure, Knowledge

PDF  |  DOI: 10.5005/jp-journals-10008-1116  |  Open Access |  How to cite  | 

Abstract

Purpose: To determine the level of correct knowledge about glaucoma and attitudes toward blindness prevention and treatment and how these factors influence self-care practices among hospital personnel. Methods: In this tertiary hospital based, cross-sectional study, a random sample of 119 staff members including 23 physicians (nonophthalmologists) and 96 nursing staff were administered a self-designed knowledge, attitudes, practice (KAP) questionnaire about glaucoma Results: All 119 personnel [34 (28.57%) males; 85 (71.42%) females] were aware of glaucoma. Most physicians (80.76%) and nurses (65.26%) understood that glaucoma was associated with a high intraocular pressure and had an effect on the optic nerve. Twenty-four percent of physicians and nurses did not know that it is important for family members of glaucoma patients to be more concerned about getting the disease. As regards ‘treatment priority’ between cataract, glaucoma and diabetic retinopathy; 76.91% physicians and 60% nurses placed glaucoma first. Out of total blindness, stroke or paralysis, cancer, schizophrenia and heart disease, blindness prevention was first priority for 9 (34.60%) physicians and 15 (15.78%) nurses. A recent visit to an eye practitioner (p = 0.012) was a significant predictor of knowledge of glaucoma as a blinding disease. Conclusion: Educating hospital workers on the symptoms of glaucoma and visual impairment can be an important step toward preventive ophthalmic care.

REVIEW ARTICLE

Brenda Nuyen, Kaweh Mansouri, Robert N Weinreb

Imaging of the Lamina Cribrosa using Swept-Source Optical Coherence Tomography

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:7] [Pages No:113 - 119]

Keywords: Glaucoma, Intraocular pressure, Swept-source optical coherence tomography

PDF  |  DOI: 10.5005/jp-journals-10008-1117  |  Open Access |  How to cite  | 

Abstract

The lamina cribrosa (LC) is the presumed site of axonal injury in glaucoma. Its deformation has been suggested to contribute to optic neuropathy by impeding axoplasmic flow within the optic nerve fibers, leading to apoptosis of retinal ganglion cells. To visualize the LC in vivo, optical coherence tomography (OCT) has been applied. Spectral domain (SD)-OCT, used in conjunction with recently introduced enhanced depth imaging (EDI)-OCT, has improved visualization of deeper ocular layers, but in many individuals it is still limited by inadequate resolution, poor image contrast and insufficient depth penetrance. The posterior laminar surface especially is not viewed clearly using these methods. New generation high-penetration (HP)-OCTs, also known as swept-source (SS)-OCT, are capable to evaluate the choroid in vivo to a remarkable level of detail. SS-OCTs use a longer wavelength (1,050 nm instead of 840 nm) compared to the conventional techniques. We review current knowledge of the LC, findings from trials that use SD-OCT and EDI-OCT, and our experience with a prototype SS-OCT to visualize the LC in its entirety.

REVIEW ARTICLE

Parul Ichhpujani

The Need to maintain Intraocular Pressure over 24 Hours

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:4] [Pages No:120 - 123]

Keywords: Diurnal variation, Fluctuation, Intraocular pressure, Phasing

PDF  |  DOI: 10.5005/jp-journals-10008-1118  |  Open Access |  How to cite  | 

Abstract

Glaucoma patients who appear to be stable based on daytime in-clinic intraocular pressure (IOP) measurements may not be fully controlled over each 24-hour period. Given that there is sufficient evidence that IOP fluctuation may impact progression, the aim of management of glaucoma thus, is to achieve a target IOP with minimal diurnal fluctuation.

REVIEW ARTICLE

Rajat Maheshwari, Nikhil S Choudhari, Manav Deep Singh

Tonometry and Care of Tonometers

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:7] [Pages No:124 - 130]

Keywords: Tonometry, Tonometers, Intraocular pressure

PDF  |  DOI: 10.5005/jp-journals-10008-1119  |  Open Access |  How to cite  | 

Abstract

Intraocular pressure (IOP) remains the only modifiable risk factor in the management of glaucoma. Hence, IOP and its appropriate measurement deserve our ongoing interest. Over the years, not only has our understanding of glaucoma changed but also has changed our approach to the measurement of the IOP. This review is an attempt to elucidate the commonly techniques of tonometry, and critically evaluate each of them, in current glaucoma practice.

Surgical Technique

Michael Coote, Jonathan Crowston

Revision Trabeculectomy: Pearls and Pitfalls

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:8] [Pages No:131 - 138]

Keywords: Bleb revision, Bleb failure, Trabeculectomy, Glaucoma surgery, Revision trabeculectomy

PDF  |  DOI: 10.5005/jp-journals-10008-1120  |  Open Access |  How to cite  | 

Abstract

Revision trabeculectomy is used to describe any surgical intervention subsequent to an existing trabeculectomy. Mostly, it is used to describe resurgery for failure of trabeculectomy, as defined by inadequate pressure control. Revision may also be performed for unsafe, uncomfortable or leaking blebs. Mostly bleb failure occurs within the subconjunctival space, although the flap and ostium may be involved or causative. Clear surgical principles, meticulous surgical technique and scrupulous postoperative care are key to successful revision surgery. This review is an attempt to elucidate the technique of bleb revision for bleb failure.

Surgical Technique

Stirbu Oana, Jorge Vila

Tube Exposure Repair

[Year:2012] [Month:September-December] [Volume:6] [Number:3] [Pages:4] [Pages No:139 - 142]

Keywords: Conjunctival erosion, Patch graft, Tube shunt

PDF  |  DOI: 10.5005/jp-journals-10008-1121  |  Open Access |  How to cite  | 

Abstract

All across the world, glaucomatologists are adopting broader use of glaucoma drainage implants even as a primary surgical modality. To avoid tube exposure, which may predispose the eye to endophthalmitis, the implanted tube must be covered by a patch graft. However, these patch grafts also carry a high rate of progressive thinning and erosion, which is believed to result from the lack of cellular infiltration from the surrounding host conjunctival stroma and poor integration of these patch grafts to the host tissue. An ideal patch graft should offer good tensile strength, be suitable for tectonic support, and have biological activities to promote cellular infiltration by the surrounding host conjunctival stroma, thus reducing progressive allogeneic patch graft thinning/erosion. This review talks about various materials and modalities used for an exposed tube repair.

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