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Glaucoma

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The healthy eye
• Light rays enter the eye
through the cornea, pupil and
lens.
• These light rays are focused
directly onto the retina, the
light-sensitive tissue lining the
back of the eye.
• The retina converts light rays
into impulses; sent through the
optic nerve to your brain, where
they are recognized as images.

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What is glaucoma?
• Disease of the optic nerve.
• When damage to the optic nerve fibers
occurs, blind spots develop; blind spots
usually go undetected until optic nerve is
significantly damaged.
• Leading cause of blindness in the United
States, especially for older people.
• Early detection and treatment are keys to
preventing vision loss from glaucoma.
Normal vision
Vision as it might be
affected by glaucoma

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Anatomy of glaucoma
• Clear liquid called aqueous humor circulates inside the front
portion of the eye.
• To maintain a healthy level of pressure within the eye, a small
amount of aqueous humor is produced constantly, while an equal
amount flows out of the eye through a microscopic drainage
system—the trabecular meshwork.

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Anatomy of glaucoma
• With glaucoma, aqueous humor does not
flow through the trabecular meshwork
properly.
• Over time, eye pressure IOP increases,
damaging the optic nerve fibers.

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Types of glaucoma
Two main categories of glaucoma:
• Open-angle glaucoma: the most common form of glaucoma - (the most
common form that affects approximately 95% of individuals)
• Closed-angle glaucoma: a less common and more urgent form of
glaucoma.
Other Types of glaucoma:
Normal-Tension Glaucoma
Congenital glaucoma
Juvenile glaucoma
Secondary glaucoma

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Types of glaucoma – Open-angle
Open-angle glaucoma
• Trabecular meshwork becomes less
efficient at draining aqueous humor.
• Intraocular pressure (IOP) builds up,
which leads to damage of the optic
nerve.
• Damage to the optic nerve occurs at
different eye pressures among
different patients.
• Typically, glaucoma has no
symptoms in its early stages.
Open-angle glaucoma

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Types of glaucoma – Open-angle
Open-angle glaucoma is the most common form of the disease, is
progressive and characterized by optic nerve damage. The most significant
risk factor for the development and advancement of this form is high eye
pressure. Initially, there are usually no symptoms, but as eye pressure
gradually builds, at some point the optic nerve is impaired, and peripheral
vision is lost. Without treatment, an individual can become totally blind.

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Glaucoma risk factors – Open-angle
Strong risk factors for open-angle glaucoma include:
 High eye pressure (IOP)
 Family history of glaucoma
 Age 40 and older for African Americans
 Age 60 and older for the general population, especially Mexican Americans
 Thin cornea
 Suspicious optic nerve appearance with increased cupping (size of cup,
the space at the center of optic nerve, is larger than normal)
Continued

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Glaucoma risk factors – Open-angle (cont)
Additional risk factors for open-angle glaucoma include:
 High myopia (severe nearsightedness)
 Diabetes
 Eye surgery or injury
 High blood pressure
 Use of corticosteroids (for example, eye drops, pills*, inhalers and creams)

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Types of glaucoma – Closed-angle
Closed-angle (or narrow-angle) glaucoma:
• The drainage angle of trabecular
meshwork becomes blocked by the iris.
• IOP builds up very fast.
• Symptoms include severe eye or
brow pain, redness of the eye,
decreased or blurred vision.
• Must be treated as a medical
emergency—must visit
ophthalmologist immediately.
Closed-angle glaucoma

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Types of glaucoma – Closed-angle
Closed-angle glaucoma may be acute or chronic. In acute closed-angle glaucoma
the normal flow of eye fluid (aqueous humor) between the iris and the lens is
suddenly blocked. Symptoms may include severe pain, nausea, vomiting, blurred
vision and seeing a rainbow halo around lights. Acute closed-angle glaucoma is a
medical emergency and must be treated immediately or blindness could result in one
or two days. Chronic closed-angle glaucoma progresses more slowly and can
damage the eye without symptoms, similar to open-angle glaucoma.

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Glaucoma risk factors – Closed-angle
Closed-Angle Glaucoma
 Age
 Family history
 Poor short-distance vision (farsightedness)
 Eye injury or eye surgery
 East Asian and Inuit ethnicity

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Types of glaucoma
Normal-Tension Glaucoma
 Cardiovascular disease
 Family history of glaucoma
 Japanese ethnicity
 Low eye pressure IOP
Normal-tension glaucoma occurs when eye pressure is normal, yet the optic nerve is
damaged and peripheral vision is lost. Lowering eye pressure through medication
sometimes slows the progress of the disease, but this type of glaucoma may worsen
despite low pressure. Treatment is generally the same as for open-angle glaucoma with
high eye pressure.

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Types of Glaucoma
Congenital glaucoma affects infants born with defects that prevent
the normal drainage of fluid from the eye.
Juvenile glaucoma is open-angle glaucoma that affects children,
adolescents and young adults.
Secondary glaucoma can be open-angle or closed-angle, and is the
result of some other medical condition in the eye or the body.
Examples of secondary glaucoma include:
Pigmentary glaucoma, a rare form, in which pigment granules from the iris flake off into the eye fluid
(aqueous humor) and clog the eye’s drainage system (trabecular meshwork).
Pseudoexfoliation Syndrome occurs when white material appears to flake off the lens of the eye and
block normal flow of the aqueous humor.
Neovascular glaucoma occurs when abnormal blood vessel growth blocks the eye’s fluid drainage
channels and leads to increased eye pressure. This abnormal growth can be caused by low blood
supply to the eye due to diabetes, insufficient blood flow to the head because of blocked neck arteries,
or blood vessel blockage in the back of the eye.
Iridocorneal Endothelial Syndrome (ICE) has a number of features, including the breaking off of cells
from the cornea, which blocks the drainage channels in the eye and leads to increased eye pressure.
Scars may also connect the iris to the cornea.

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Detecting Glaucoma
Regular glaucoma check-ups include two routine eye tests:
1. Tonometry – eye pressure test IOP
2. Ophthalmoscopy is a test that allows a health professional to see inside the
back of the eye (called the fundus) and other structures using a magnifying instrument
(ophthalmoscope) and a light source.
Additional tests:
Perimetry (the perimetry test is also called a visual field test)
Gonioscopy is a painless eye test that checks if the angle where the iris
meets the cornea is open or closed, showing if either open angle or closed
angle glaucoma is present.

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Detecting Glaucoma
Tonometry:
The tonometry eye test measures the inner pressure of the eye also known as
Intraocular Pressure or IOP.
Tonometry is carried out by an instrument called a TONOMETER.

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Types of Tonometry:
Applanation tonometry measures intraocular pressure either by the force required
to flatten a constant area of the cornea (e.g. Goldmann tonometry) or by the area
flattened by a constant force.
Goldmann tonometer: Stationary device requires anesthesia drops, requires
contact with cornea and is attached to a slit lamp – usually is used by an
Ophthalmologist.

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Types of tonometry
non-contact tonometry or air-puff tonometry:
This type of tonometer uses a rapid air pulse to applanate the cornea. Intraocular pressure is estimated
by detecting the force of the air jet at the instance of applanation.
In most cases a stationary unit,
Does not require anesthetic drops

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Types of tonometry
Tono-pen - is a portable electronic, digital pen-like instrument that determines IOP
by making contact with the cornea, after use of topical anesthetic eye drops – tip
covers are used between the patients.

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Types of tonometry
The newest Advancement in tonometry is DIATON TONOMETER –
It measures intraocular pressure (IOP) through the Eyelid.
Diaton Tonometer is intended for use by Inpatient & Outpatient Clinics such as
Hospitals, Emergency Rooms, Nursing & Elderly Homes,
General & Specialty Practitioners as well as Ophthalmologists and Optometrists.
DIATON Requires No Contact with Cornea No Anesthetic Drops, No Risk of Infecting

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Diaton Tonometry
•Safe
•Quick
•Efficient
•Painless
•Noninvasive
Can be used on
Children and Adults

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Four Key Facts About Glaucoma
Glaucoma is a leading cause of blindness
Glaucoma can cause blindness if it is left untreated. And unfortunately approximately 10% of people
with glaucoma who receive proper treatment still experience loss of vision.
There is no cure (yet) for glaucoma
Glaucoma is not curable, and vision lost cannot be regained. With medication and/or surgery, it is
possible to halt further loss of vision. Since glaucoma is a chronic condition, it must be monitored for
life.
Screening, detection and prevention is the first step to preserving your vision.
Everyone is at risk for glaucoma
Everyone is at risk for glaucoma from babies to senior citizens. Yes, older people are at a higher risk for
glaucoma but babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in the
United States).
Young adults can get glaucoma, too. African-Americans in particular are susceptible at a younger age.
There may be no symptoms to warn you
With open angle glaucoma, the most common form, there are virtually no symptoms. Usually, no pain is
associated with increased eye pressure.
Vision loss begins with peripheral or side vision. You may compensate for this unconsciously by
turning your head to the side, and may not notice anything until significant vision is lost. The best way
to protect your sight from glaucoma is to get tested. If you have glaucoma, treatment can begin
immediately.

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Statistics About Glaucoma
It is estimated that over 4 million Americans have glaucoma but only half of those know they have it. (1)
Approximately 120,000 are blind from glaucoma, accounting for 9% to 12% of all cases of blindness in
the U.S. (2)
About 2% of the population ages 40-50 and 8% over 70 have elevated IOP.
Glaucoma is the second leading cause of blindness in the world, according to the World Health
Organization.
Glaucoma is the leading cause of blindness among African-Americans. (2)
Glaucoma is 6 to 8 times more common in African-Americans than Caucasians. (3)
African-Americans ages 45-65 are 14 to 17 times more likely to go blind from glaucoma than Caucasians
with glaucoma in the same age group.
The most common form, Open Angle Glaucoma, accounts for 19% of all blindness among African-
Americans compared to 6% in Caucasians. (4)
Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics,
and people who are severely nearsighted.
Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide. (5)

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Statistics About Glaucoma cont
Prevent Blindness America Survey found that:
Blindness ranked third (after cancer and heart disease) as people’s major
fear.
20% of people knew that glaucoma was related to elevated pressure
within the eye. Most of them mistakenly thought people could tell if they
had glaucoma due to symptoms, or that it was easily cured, or that it did
not lead to blindness.
50% had heard of glaucoma, but weren’t sure what it was.
30% had never heard of glaucoma.

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Statistics About Glaucoma
Economic Impact:
Glaucoma accounts for over 7 million visits to physicians each year. (1)
In terms of Social Security benefits, lost income tax revenues, and health
care expenditures, the cost to the U.S. government is estimated to be over
$2.5 billion annually. (6)
Sources: (1) Prevent Blindness America; (2) National Eye Health Program/National Institutes of Health; (3)
American Academy of Ophthalmology; (4) Racial differences in the cause-specific prevalence of blindness
in east Baltimore. N Engl J Med. 1991 Nov 14;325(20):1412-7; (5) Quigley, “Number of people with glaucoma
worldwide,” 1996; (6) NEI, Report of the Glaucoma Panel, Fall 1998

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Statistics About Glaucoma
as per University of Washington Department of Ophthalmology.
In U.S. - there are ONLY:
17,000 Ophthalmologists & 30,000 Optometrists
There is a great NEED for ADDITIONAL screening locations…
60 million Americans are at RISK for developing Glaucoma,

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FLORIDA AGE DEMOGRAPHICS:
Florida National % National
Households
All 6337929 1054801016%
Age 65+ 1943478 24672708 7.9%
Alone 710025 9722857 7.3%
Not Alone 1233453 14949851 8.3%
45 to 54 years 2069479 37677952 5.5%
55 to 59 years 821517 13469237 6.1%
60 to 64 years 737496 10805447 6.8%
65 to 74 years 1452176 18390986 7.9%
75 to 84 years 1024134 12361180 8.3%
85 years and over 331287 4239587 7.8%
TOTAL AT RISK (45 years and older) 6,436,089
As population ages the impact of the disease will increase…

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Glaucoma Prevention Initiative
Thank you for your attention
and your openness to challenge the ―silent thief of sight‖!