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Summary of selected papers on Selective Laser Trabeculoplasty Selective laser trabeculoplasty study: eye drops versus laser - largest...
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article thumbnailWhat is glaucoma?

All about glaucoma; symptoms, types and diagnosis of glaucoma Glaucoma is a condition that leads to slow, but progressive...
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Glaucoma FAQ section
MIgraine and glaucoma PDF Print E-mail
Written by Administrator   
Monday, 21 September 2015 20:28

Migraine and glaucoma can sometimes be associated. Typically, most people who have experienced migraine are at a low risk of developing glaucoma. However, patients with normal pressure glaucoma, for example, quite commonly have a history of migraine. It is believed that in those cases that it is not just the eye pressure that can be associated with some of the changes in visual fields, but also somehow the circulation in the optic nerve can affect the onset and progression of glaucoma.

Migraine has many trigger factors, but can particularly be triggered by red wine, and specific stronger rich cheeses.

migraine

Image of some visual symptoms experienced by someone experiencing a migraine.

 
Primary angle closure glaucoma PDF Print E-mail
Written by Administrator   
Monday, 21 September 2015 20:15

CAUSE & SYMPTOMS

Primary angle closure glaucoma (‘’narrow or closed angle glaucoma’’) is the less common of the two major types of glaucoma where in the iris tends to be blocking the filtration channels (trabecular meshwork) of the eye resulting in obstruction of the drainage of fluid out of the eye. This can lead to a sudden sharp rise of eye pressure resulting in ‘an attack of angle closure’ which may give rise to the following symptoms :

  • red eye
  • severe eye pain (or headache)
  • seeing haloes around lights
  • cloudy vision
  • sickness

Sometimes patients might experience intermittent ‘sub-acute attacks’ classically in the evening giving rise to misty vision, coloured rings around white lights  and some discomfort around eyes. The rise of pressure can also happen over a longer period of time when these acute symptoms are lacking (‘chronic angle closure’).

 

Field loss in patient with advanced glaucoma

RISK FACTORS

  • Patients above 40 years of age
  • Long-sightedness (high plus power in spectacles)
  • Ethnic origin – commoner in Asians (rarer in Caucasians)
  • Females

Many drugs can cause angle closure, including drugs with "anti-cholinergic" side effects. For such medications, there is usually a caution on the enclosed medication leaflet that advises "do not take this medication if you have glaucoma". Other drugs that can cause angle closure include sulpha based drugs (eg topiramate), dilating drops (eg cyclopentolate) and some anti-depressant medications (eg amitriptylline).


DIAGNOSIS

If patients experience any of the above symptoms they should contact their GP or optician immediately so that they can be referred to the hospital eye clinic for urgent treatment to avoid permanent loss of sight.


TREATMENT

Patients usually require admission for treatment of acute angle closure glaucoma. The treatment is with tablets or intravenous injections to reduce the eye pressure rapidly along with lots of eye drops. It may take from a couple up to few hours before the eye feels comfortable and the pressure is adequately lowered. Once the pressure in controlled, patients often require a further laser treatment (YAG laser iridotomy) in the affected eye to prevent a future recurrence and often a preventative laser treatment in the other good eye which carries the risk of a similar attack. Often many of these patients will go on to have a cataract extraction operation in near future which is best decided by the glaucoma specialist.

narrow angles

Narrow angles demonstrated on OCT

Last Updated on Monday, 21 September 2015 20:34
 
Mr PH Galloway, MBBS, FRCOphth PDF Print E-mail
Written by Administrator   
Monday, 21 September 2015 00:00

Mr Galloway is a Consultant Ophthalmic Surgeon at St James University Hospital, Leeds. His major interests are glaucoma management, and cataract surgery; Mr Galloway reviews over 2000 patients with glaucoma each year. He performs hundreds of specialist intraocular procedures per year, in addition to laser treatment for glaucoma. He trained in general ophthalmology at Bristol Eye Hospital undertaking a subspecialty training fellowship in glaucoma at Vancouver Eye Care Center, University of British Columbia, Canada. He is the author of 'MCQ Companion to the Eye: Basic Sciences in Practice' (published by W.B. Saunders, 2000) and is a member of the Royal College of Ophthalmologists, and the European Society of Cataract and Refractive Surgeons.

His areas of expertise are:

  • Glaucoma surgery (such as trabeculectomy, combined cataract and glaucoma surgery, tube impant surgery, endoscopic laser for glaucoma)

  • Small incision cataract surgery (routine and complex cases, especially patients with glaucoma)

  • Medical management of glaucoma

  • Glaucoma laser procedures (such as peripheral iridotomy, selective laser trabeculoplasty, ECP-endoscopic laser)

  • Laser treatment/surgery(eg selective laser trabeculoplasty)

  • Advanced/refractory glaucoma management

He is a member of the following professional organisations:

• Fellow of the Royal College of Ophthalmologists
• American Academy of Ophthalmology
• British Medical Association
• UK & Ireland Cataract and Refraction Surgeons
• European Society of Cataract and Refractive Surgeons
• International Glaucoma Association

Mr Galloway has 2 children, enjoys skiing from time to time, and in his spare time is a member of the Leeds and Bradford Triathlon club. In 2016, he is planning to raise money for St Gemma's Hospice and here is his JustGiving link for sponsorship:
JustGiving - Sponsor me now!

Eye book

Last Updated on Monday, 21 September 2015 21:10
 
Research on SLT PDF Print E-mail
Written by Administrator   
Sunday, 20 September 2015 00:00

Summary of selected papers on Selective Laser Trabeculoplasty


Selective laser trabeculoplasty study: eye drops versus laser - largest combined trials

BMC Ophthalmol. 2015 Aug 19;15:107.

Both SLT and topical medication demonstrate similar success rates and effectiveness in lowering intraocular pressure in patients with open-angle glaucoma.

Selective laser trabeculoplasty study: SLT and ALT and retreatment options

Russo V et al. Eur J Ophthalmol. 2009 May-Jun;19(3):429-34. Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with uncontrolled open-angle glaucoma.

SLT is effective as treatment for patients with OAG and appears to be equivalent to ALT in IOP lowering at 12 months only in patients without a prior treatment. In case of retreatment SLT appears to be better than ALT in IOP lowering.

Selective laser trabeculoplasty study: whether to have 180 degree or 360 degree treatments

Prasad N, Murthy S, Dagianis JJ, Latina MA. J Glaucoma. 2009 Feb;18(2):157-60. A comparison of the intervisit intraocular pressure fluctuation after 180 and 360 degrees of selective laser trabeculoplasty (SLT) as a primary therapy in primary open angle glaucoma and ocular hypertension.

This study suggests that 360-degree SLT is more efficacious in achieving smaller IOP fluctuations than treatment with 180-degree SLT.

Selective laser trabeculoplasty study: IOP fluctuation and SLT

Nagar M, Luhishi E, Shah N. J Glaucoma. Br J Ophthalmol. 2009 Apr;93(4):497-501. Intraocular pressure control and fluctuation: the effect of treatment with selective laser trabeculoplasty.

Both SLT and latanoprost had a significant impact on IOP control and fluctuation / ... / SLT has the benefit of being a one-time intervention not requiring ongoing patient compliance..



SLT laser SLT laser machine

Images of the SLT laser machine

Last Updated on Sunday, 20 September 2015 10:17
 
What is glaucoma? PDF Print E-mail
Written by Administrator   
Sunday, 20 September 2015 00:00

All about glaucoma; symptoms, types and diagnosis of glaucoma

Glaucoma is a condition that leads to slow, but progressive loss of nerve fibres in the optic nerve. Many factors may increase the risk of this condition. If left untreated, this can lead to loss of peripheral vision (i.e. what can be seen at the sides of the visual field, rather than in the centre). In older people, glaucoma is one of the commonest causes of preventable blindness. If glaucoma progresses, it can affect all peripheral vision, then impair central vision, and -- very rarely -- may lead to very significant visual impairment. Treatments for glaucoma are aimed at bringing down the pressure in the eye to a level that is low enough to prevent harm to the optic nerve. Once the optic nerve is affected by glaucoma, lowering the pressure in the eye prevents further damage to the nerve. Damage already done to the optic nerve cannot be reversed. Screening for glaucoma is important from around age 40, every two years at least, unless you are in a higher risk group (eg Afro-caribbean race, or very strong family history of glaucoma).

Signs and symptoms of glaucoma

Symptoms of glaucoma are often absent in the early stages of the disease. Unfortunately, impaired vision is sometimes the first sign of glaucoma. Classically in angle closure glaucoma, symptoms and signs of glaucoma may include eye pain, cloudy vision, red eyes, headaches, and nausea.

How Is Glaucoma Diagnosed?

Frequent eye examinations are the best way to detect glaucoma. Your ophthalmologist will test the eye’s drainage angle, evaluate the optic nerve (ophthalmoscopy), measure eye pressure, and test the visual field of each eye (perimetry). The information from these examinations is compared at regular intervals to determine if glaucoma damage has progressed over time. Regular examinations play a critical role in the early detection of glaucoma.

Glaucoma Progression

Glaucoma typically initially affects side (peripheral) vision first. If left untreated, vision loss will continue, eventually resulting in total blindness. If glaucoma is identified early and treated appropriately, good eyesight can most likely be maintained.

Types of glaucoma.

There are several types of glaucoma, all of which affect the optic nerve. Open-angle glaucoma, the commonest form of the disease, develops when the angle between the cornea and the iris where fluid is supposed to drain from the eye is open, but the fluid drains out too slowly. Closed or narrow angle glaucoma occurs when the drainage angle is blocked by part of the iris and fluid cannot drain from the eye. Normal-tension glaucoma occurs in patients with normal intraocular pressure and is treated in the same way as open-angle glaucoma. Congenital glaucoma occurs when a child is born with a poor drainage outflow facility.

Treatment for glaucoma.

There are two main types of treatment for glaucoma: medication and surgery. Both of these treatments for glaucoma manage the disease by lowering the intraocular pressure. Medications and eye drops are common treatments, but there is the possibility of side effects, and they may eventually become ineffective over time. If the IOP cannot be managed by medications or eye drops alone, surgery or laser may be recommended. Your ophthalmologist will decide on your "target IOP" to help plan your treatment.

Recovery after Glaucoma Treatment

Glaucoma surgery is usually painless, although some patients may experience a slight stinging sensation following the procedure. Local anaesthetics are used to minimise any patient discomfort. After surgical treatments for glaucoma, it is possible to experience blurred vision or irritation. Typically, however, these effects are short-lived and normal activities, such as going to work or running errands, can be resumed after 2-3 days. This time period can be variable, it depends on the exact procedure performed.

optic disc

Last Updated on Sunday, 20 September 2015 10:11
 
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