Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1998 Dec;74(878):709–715. doi: 10.1136/pgmj.74.878.709

Glaucoma: diagnosis and management.

D A Infeld 1, J G O'Shea 1
PMCID: PMC2431621  PMID: 10320884

Abstract

Glaucoma is the third most prevalent cause of global blindness, accounting for over 5 million blind. It is common in Western Countries; the estimated prevalence of primary open angle glaucoma rises from a total prevalence of 1.1% to approximately 3% of our population as it ages. Ethnicity affects both the risk of developing glaucoma and the outcome. It is an expensive disease both to detect and to treat. Recent scientific advances include elucidation of the genetic mechanism behind the disease and the study of haemodynamic and biochemical co-factors in the development of glaucomatous optic neuropathy, particularly in relation to the pathogenesis of normal tension glaucoma. Several new types of topical medication have recently been developed for use in glaucoma; both the impact of these therapies and their cost effectiveness remain to be evaluated. There are widely differing regimes which effectively treat glaucoma; some ophthalmologists prefer early surgical intervention whilst others reserve surgery for relatively advanced disease. All methods of current treatment rely on the reduction of intra-ocular pressure; as yet there is no medication which has been definitively proven to be either neuroprotective or to influence favourably optic nerve perfusion. Despite this, most sufferers of glaucoma are able to lead lives of quality. Increased community awareness of glaucoma, and earlier detection of the condition, will doubtless result in decreased morbidity due to glaucoma.

Full text

PDF
711

Images in this article

710Figure 1
on p.710
710Figure 2
on p.710
711Figure 3
on p.711
711Figure 4
on p.711
711Figure 5
on p.711
713Figure 6
on p.713
714Figure 7
on p.714

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abecia E., Martínez-Jarreta B., Casalod Y., Bell B., Pinilla I., Honrubia F. M. Genetic markers in primary open-angle glaucoma. Int Ophthalmol. 1996;20(1-3):79–82. doi: 10.1007/BF00212950. [DOI] [PubMed] [Google Scholar]
  2. Andreanos D., Georgopoulos G. T., Vergados J., Papaconstantinou D., Liokis N., Theodossiadis P. Clinical evaluation of the effect of mitomycin-C in re-operation for primary open angle glaucoma. Eur J Ophthalmol. 1997 Jan-Mar;7(1):49–54. doi: 10.1177/112067219700700109. [DOI] [PubMed] [Google Scholar]
  3. Broadway D. C., Grierson I., O'Brien C., Hitchings R. A. Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile. Arch Ophthalmol. 1994 Nov;112(11):1437–1445. doi: 10.1001/archopht.1994.01090230051020. [DOI] [PubMed] [Google Scholar]
  4. Butt Z., O'Brien C., McKillop G., Aspinall P., Allan P. Color Doppler imaging in untreated high- and normal-pressure open-angle glaucoma. Invest Ophthalmol Vis Sci. 1997 Mar;38(3):690–696. [PubMed] [Google Scholar]
  5. Chen Y. F., Wang T. H., Hung P. T. Automated perimetry in primary open-angle glaucoma. J Formos Med Assoc. 1997 Jun;96(6):441–445. [PubMed] [Google Scholar]
  6. Coffey M., Reidy A., Wormald R., Xian W. X., Wright L., Courtney P. Prevalence of glaucoma in the west of Ireland. Br J Ophthalmol. 1993 Jan;77(1):17–21. doi: 10.1136/bjo.77.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dielemans I., Vingerling J. R., Wolfs R. C., Hofman A., Grobbee D. E., de Jong P. T. The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study. Ophthalmology. 1994 Nov;101(11):1851–1855. doi: 10.1016/s0161-6420(94)31090-6. [DOI] [PubMed] [Google Scholar]
  8. Diggory P., Cassels-Brown A., Fernandez C. Topical beta-blockade with intrinsic sympathomimetic activity offers no advantage for the respiratory and cardiovascular function of elderly people. Age Ageing. 1996 Nov;25(6):424–428. doi: 10.1093/ageing/25.6.424. [DOI] [PubMed] [Google Scholar]
  9. Greve E. L., Rulo A. H., Drance S. M., Crichton A. C., Mills R. P., Hoyng P. F. Reduced intraocular pressure and increased ocular perfusion pressure in normal tension glaucoma: a review of short-term studies with three dose regimens of latanoprost treatment. Surv Ophthalmol. 1997 Feb;41 (Suppl 2):S89–S92. doi: 10.1016/s0039-6257(97)80013-6. [DOI] [PubMed] [Google Scholar]
  10. Hitchings R. A. Intraocular pressure and circulation at the disc in glaucoma. Acta Ophthalmol Scand Suppl. 1997;(220):15–22. doi: 10.1111/j.1600-0420.1997.tb00165.x. [DOI] [PubMed] [Google Scholar]
  11. Holló G., van den Berg T. J., Greve E. L. Scanning laser Doppler flowmetry in glaucoma. Int Ophthalmol. 1996;20(1-3):63–70. doi: 10.1007/BF00212948. [DOI] [PubMed] [Google Scholar]
  12. Hume J., Abbott F. Setting up a shared care glaucoma clinic. Nurs Stand. 1995 Dec 6;10(11):34–36. doi: 10.7748/ns.10.11.34.s38. [DOI] [PubMed] [Google Scholar]
  13. Johnson A. T., Drack A. V., Kwitek A. E., Cannon R. L., Stone E. M., Alward W. L. Clinical features and linkage analysis of a family with autosomal dominant juvenile glaucoma. Ophthalmology. 1993 Apr;100(4):524–529. doi: 10.1016/s0161-6420(13)31615-7. [DOI] [PubMed] [Google Scholar]
  14. Kahn H. A., Leibowitz H. M., Ganley J. P., Kini M. M., Colton T., Nickerson R. S., Dawber T. R. The Framingham Eye Study. I. Outline and major prevalence findings. Am J Epidemiol. 1977 Jul;106(1):17–32. doi: 10.1093/oxfordjournals.aje.a112428. [DOI] [PubMed] [Google Scholar]
  15. Kaiser H. J., Schoetzau A., Stümpfig D., Flammer J. Blood-flow velocities of the extraocular vessels in patients with high-tension and normal-tension primary open-angle glaucoma. Am J Ophthalmol. 1997 Mar;123(3):320–327. doi: 10.1016/s0002-9394(14)70127-8. [DOI] [PubMed] [Google Scholar]
  16. Kaiser H. J., Schoetzau A., Stümpfig D., Flammer J. Blood-flow velocities of the extraocular vessels in patients with high-tension and normal-tension primary open-angle glaucoma. Am J Ophthalmol. 1997 Mar;123(3):320–327. doi: 10.1016/s0002-9394(14)70127-8. [DOI] [PubMed] [Google Scholar]
  17. Kosoko O., Gaasterland D. E., Pollack I. P., Enger C. L. Long-term outcome of initial ciliary ablation with contact diode laser transscleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group. Ophthalmology. 1996 Aug;103(8):1294–1302. doi: 10.1016/s0161-6420(96)30508-3. [DOI] [PubMed] [Google Scholar]
  18. Larsson L. I., Rettig E. S., Brubaker R. F. Aqueous flow in open-angle glaucoma. Arch Ophthalmol. 1995 Mar;113(3):283–286. doi: 10.1001/archopht.1995.01100030037018. [DOI] [PubMed] [Google Scholar]
  19. Leske M. C., Connell A. M., Schachat A. P., Hyman L. The Barbados Eye Study. Prevalence of open angle glaucoma. Arch Ophthalmol. 1994 Jun;112(6):821–829. doi: 10.1001/archopht.1994.01090180121046. [DOI] [PubMed] [Google Scholar]
  20. Lichter P. R., Richards J. E., Boehnke M., Othman M., Cameron B. D., Stringham H. M., Downs C. A., Lewis S. B., Boyd B. F. Juvenile glaucoma linked to the GLC1A gene on chromosome 1q in a Panamanian family. Am J Ophthalmol. 1997 Mar;123(3):413–416. doi: 10.1016/s0002-9394(14)70147-3. [DOI] [PubMed] [Google Scholar]
  21. Migdal C., Gregory W., Hitchings R. Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology. 1994 Oct;101(10):1651–1657. doi: 10.1016/s0161-6420(94)31120-1. [DOI] [PubMed] [Google Scholar]
  22. Mitchell P., Smith W., Attebo K., Healey P. R. Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study. Ophthalmology. 1996 Oct;103(10):1661–1669. doi: 10.1016/s0161-6420(96)30449-1. [DOI] [PubMed] [Google Scholar]
  23. Odberg T. Visual field prognosis in early glaucoma. A long-term clinical follow-up. Acta Ophthalmol (Copenh) 1993 Dec;71(6):721–726. doi: 10.1111/j.1755-3768.1993.tb08590.x. [DOI] [PubMed] [Google Scholar]
  24. Patel K. H., Javitt J. C., Tielsch J. M., Street D. A., Katz J., Quigley H. A., Sommer A. Incidence of acute angle-closure glaucoma after pharmacologic mydriasis. Am J Ophthalmol. 1995 Dec;120(6):709–717. doi: 10.1016/s0002-9394(14)72724-2. [DOI] [PubMed] [Google Scholar]
  25. Richards J. E., Lichter P. R., Herman S., Hauser E. R., Hou Y. C., Johnson A. T., Boehnke M. Probable exclusion of GLC1A as a candidate glaucoma gene in a family with middle-age-onset primary open-angle glaucoma. Ophthalmology. 1996 Jul;103(7):1035–1040. doi: 10.1016/s0161-6420(96)30570-8. [DOI] [PubMed] [Google Scholar]
  26. Robin A. L. Ocular hypotensive efficacy and safety of a combined formulation of betaxolol and pilocarpine. Trans Am Ophthalmol Soc. 1996;94:89–103. [PMC free article] [PubMed] [Google Scholar]
  27. Robin A. L., Ramakrishnan R., Krishnadas R., Smith S. D., Katz J. D., Selvaraj S., Skuta G. L., Bhatnagar R. A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol. 1997 Aug;115(8):969–974. doi: 10.1001/archopht.1997.01100160139001. [DOI] [PubMed] [Google Scholar]
  28. Sack J., Healey D. L., de Graaf A. P., Wilkinson R. M., Wilkinson C. H., Barbour J. M., Coote M. A., McCartney P. J., Rait J. L., Cooper R. L. The problem of overlapping glaucoma families in the Glaucoma Inheritance Study in Tasmania (GIST). Ophthalmic Genet. 1996 Dec;17(4):209–214. doi: 10.3109/13816819609057895. [DOI] [PubMed] [Google Scholar]
  29. Schuman J. S., Horwitz B., Choplin N. T., David R., Albracht D., Chen K. A 1-year study of brimonidine twice daily in glaucoma and ocular hypertension. A controlled, randomized, multicenter clinical trial. Chronic Brimonidine Study Group. Arch Ophthalmol. 1997 Jul;115(7):847–852. doi: 10.1001/archopht.1997.01100160017002. [DOI] [PubMed] [Google Scholar]
  30. Stewart W. C., Chauhan B. C. Newer visual function tests in the evaluation of glaucoma. Surv Ophthalmol. 1995 Sep-Oct;40(2):119–135. doi: 10.1016/s0039-6257(95)80002-6. [DOI] [PubMed] [Google Scholar]
  31. Stewart W. C., Sine C. S., LoPresto C. Surgical vs medical management of chronic open-angle glaucoma. Am J Ophthalmol. 1996 Dec;122(6):767–774. doi: 10.1016/s0002-9394(14)70372-1. [DOI] [PubMed] [Google Scholar]
  32. Strahlman E., Tipping R., Vogel R. A double-masked, randomized 1-year study comparing dorzolamide (Trusopt), timolol, and betaxolol. International Dorzolamide Study Group. Arch Ophthalmol. 1995 Aug;113(8):1009–1016. doi: 10.1001/archopht.1995.01100080061030. [DOI] [PubMed] [Google Scholar]
  33. Tuck M. W., Crick R. P. The cost-effectiveness of various modes of screening for primary open angle glaucoma. Ophthalmic Epidemiol. 1997 Mar;4(1):3–17. doi: 10.3109/09286589709058056. [DOI] [PubMed] [Google Scholar]
  34. Ulrich A., Ulrich C., Barth T., Ulrich W. D. Detection of disturbed autoregulation of the peripapillary choroid in primary open angle glaucoma. Ophthalmic Surg Lasers. 1996 Sep;27(9):746–757. [PubMed] [Google Scholar]
  35. Ustundag C., Diestelhorst M. Efficacy of argon laser trabeculoplasty: 3-year preliminary results of a prospective placebo-controlled study. Graefes Arch Clin Exp Ophthalmol. 1997 Jun;235(6):354–358. doi: 10.1007/BF00937283. [DOI] [PubMed] [Google Scholar]
  36. Vernon S. A., Spencer A. F. Intraocular pressure control following microtrabeculectomy. Eye (Lond) 1995;9(Pt 3):299–303. doi: 10.1038/eye.1995.58. [DOI] [PubMed] [Google Scholar]
  37. Vesti E., Raitta C. A review of the outcome of trabeculectomy in open-angle glaucoma. Ophthalmic Surg Lasers. 1997 Feb;28(2):128–132. [PubMed] [Google Scholar]
  38. Wishart P. Therapeutic options in primary open-angle glaucoma. Acta Ophthalmol Scand Suppl. 1997;(220):23–29. doi: 10.1111/j.1600-0420.1997.tb00167.x. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES