Medical Management for Glaucoma

Glaucoma ◽  
2012 ◽  
Author(s):  
Shalini Sood-Mendiratta
Keyword(s):  
Side Effects ◽  
Corneal Thickness ◽  
Diagnostic Testing ◽  
Visual Fields ◽  
Ciliary Muscle ◽  
Angle Closure ◽  
Slow Progression ◽  
Progression Of Disease ◽  
Future Potential ◽  
Direct Acting

When evaluating patients for glaucoma or ocular hypertension, the question remains whether or not the patient should be treated, and when treatment should be initiated. Treatment decisions are usually guided by risk factor assessment, and these include race, age, family history, medical history, IOP, central corneal thickness, and clinical examination, including optic nerve appearance and ancillary diagnostic testing. The information is compiled in each individual to determine the risk of significant visual loss in the patient’s lifetime. Numerous studies have demonstrated that lowering IOP slows progression of this disease. Most common current medical therapies are therefore ocular hypotensive medications. The armamentarium of medications has expanded over the past two decades in terms of number and classes. Future potential therapies may include those that provide neuroprotection, but the main focus of this chapter will be on medications most frequently used to treat glaucoma. The goal of therapy is to slow progression of disease with the fewest side effects and medications and the lowest doses and cost of therapy. Consideration of these issues maximizes compliance and effectiveness of therapy in long-term disease control. An effective medication lowers the IOP 20% to 30% from baseline. Figure 10.1 lists the most common classes of medications with mechanism of action and common side effects; sample bottles of medications are also shown. We will discuss each class of medications and offer clinical pearls. • Direct-acting: pilocarpine HCl, pilocarpine gel •Indirect-acting: echothiophate iodide, eserine sulfate ointment, demecarium bromide, isofluorophate •Affect the parasympathetic or cholinergic system through direct- or indirect-acting Agents •In addition to effects on ciliary muscle, parasympathomimetics stimulate muscarinic receptors of the iris sphincter to cause miosis. This may improve outflow facility in eyes with angle-closure glaucomas by relieving pupillary block or by changing the anatomy of the peripheral iris in the angle. •Miosis may cause dimness of vision, contraction of visual fields, and pinhole effect. •Patients may develop brow ache due to ciliary muscle spasm.

scholarly journals Pattern ERG as a predictor in ocular hypertensive

2016 ◽  
Vol 15 (2) ◽  
Author(s):  
Paaraj Dave ◽  
Jitendra Jethani
Keyword(s):  
Amplitude Ratio ◽  
Corneal Thickness ◽  
Visual Fields ◽  
Cross Sectional Study ◽  
Control Group ◽  
Study Group ◽  
Pattern Erg ◽  
Check Size ◽  
Cross Sectional ◽  
The Mean

Purpose: To report the repeatability of Pattern Electrotretinogram (PERG) and its findings in ocular hypertension (OHT) and normal eyes.Methods: A cross-sectional study where PERG responses were compared between the study group comprising of 80 eyes of 80 patients with intraocular pressure (IOP)>21 mmHg and the control group with 80 eyes of 80 normal individuals (IOP≤21mmHg). The optic disc and the visual fields were normal with a visual acuity of ≥ 0.8 in both groups. PERG was recorded twice for each individual in the control group by a single operator on 2 consecutive days to assess the repeatability.Results: The mean age in the study and control groups was 50.05±10.03 and 54.8±7.66 years(p=0.44) respectively. The mean IOP was 26.55±3.9 mmHg for the study group as opposed to 14.45±2.9 mmHg for the controls (p<0.001). The central corneal thickness and the cup-disc ratio was similar between the groups (p>.05). The P50-N95 amplitude (p=0.01) and the P50 latency (p<0.001) was statistically significantly different between both the groups. The intra-class correlation coefficient (ICC) showed poor agreement for all parameters except for N35-P50 0.8 to 16 degree check size amplitude ratio (PERG ratio).Conclusion:  Increase in P50 latency emerges as a new candidate for early glaucoma indicator in addition to reduction in P50-N95 amplitude. PERG parameters suffer from high test-retest variability. Deterioration in PERG recordings should be interpreted with caution. The variability is lesser for the PERG ratio which maybe more meaningful while monitoring for change over time.

Making sense of ‘side effects’: Counterpublic health in the era of direct-acting antivirals

2019 ◽  
Vol 72 ◽  
pp. 77-83 ◽  
Author(s):  
Joanne Bryant ◽  
Jake Rance ◽  
Peter Hull ◽  
Limin Mao ◽  
Carla Treloar
Keyword(s):  
Side Effects ◽  
Direct Acting Antivirals ◽  
Making Sense ◽  
Direct Acting

Role of Central Corneal Thickness on Baseline Parameters and Progression of Visual Fields in Open Angle Glaucoma

2007 ◽  
Vol 17 (4) ◽  
pp. 545-549 ◽  
Author(s):  
H. Shah ◽  
C. Kniestedt ◽  
A. Bostrom ◽  
R. Stamper ◽  
S. Lin
Keyword(s):  
Visual Field ◽  
Central Corneal Thickness ◽  
Open Angle Glaucoma ◽  
Corneal Thickness ◽  
Visual Fields ◽  
Negative Relationship ◽  
Significant Risk ◽  
Mean Deviation ◽  
Open Angle ◽  
Visual Field Progression

Purpose To evaluate the relationship of central corneal thickness (CCT) to baseline visual field parameters and visual field progression in patients with primary open-angle glaucoma (POAG). Methods Charts of consecutive patients with POAG were reviewed to obtain visual field data. Visual field was measured by standard threshold static perimetry. Variables analyzed included mean deviation (MD) and pattern standard deviation (PSD). Results A total of 121 eyes examined over 4 years were evaluated. A significant negative relationship between CCT and PSD (correlation coefficient: −0.02, p<0.05) was found. Analyses comparing CCT to change in PSD and MD (visual field progression) were statistically not significant. Conclusions Patients with thinner corneas initially present with a greater visual field defect, indicating that thin corneas may contribute to advanced glaucomatous damage at the time of diagnosis. However, CCT does not seem to be a significant risk factor for progression of the disease.

scholarly journals An Investigation of the Side Effects, Patient Feedback, and Physiological Changes Associated with Direct-Acting Antiviral Therapy for Hepatitis C

2019 ◽  
Vol 16 (24) ◽  
pp. 4981
Author(s):  
Pin-Sheng Wu ◽  
Te-Sheng Chang ◽  
Sheng-Nan Lu ◽  
Hsiang-Jou Su ◽  
Shu-Zhi Chang ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Side Effects ◽  
Rural Areas ◽  
Virologic Response ◽  
Hcv Infection ◽  
Physiological Changes ◽  
High Cure ◽  
Patient Feedback ◽  
Direct Acting ◽  
Physiological Markers

Background: Hepatitis C virus (HCV) infection is one of the major causes of liver cirrhosis and hepatocellular carcinoma globally. The advent of direct-acting antivirals (DAAs) with high cure rates provides an opportunity to reduce the rising HCV disease burden. However, few studies have explored the side effects and physiological benefits of DAA therapy in rural areas. The aim of this study was to investigate the subjective reports of discomfort, patient feedback about the course of treatment, and physiological changes after DAA treatment in HCV patients. Methods: A descriptive, prospective, comparative cohort study was conducted from January to August 2019 in western coastal Yunlin County, Taiwan. Data regarding demographic characteristics, subjective discomfort levels, and physiological responses were collected through face to face interviews and from medical records by a cooperating hospital. Results: Six-hundred-and-twenty-three participants with an active HCV infection were identified; 555 (89.1%) had completed treatment, and sustained virologic response was achieved in 99.6% (n = 553). The mean age was 64.9 (standard deviation = 13.1) years, and 35% of patients experienced discomfort during DAA treatment, including fatigue, itching, and dizziness. After three months of treatment, physiological markers, including body weight (p < 0.001), waist circumference (p < 0.05), blood pressure (p < 0.001), alanine aminotransferase (p < 0.001), and aspartate aminotransferase (p < 0.001), had significantly improved. Almost all participants provided positive feedback about the treatment experience and reported manageable side effects. Conclusions: The findings showed that, in an endemic rural area, DAA treatment had a high cure rate and improved physiological markers with few discomforts. These results can be used to reduce the barriers HCV patients face in adopting new medications.

Autoimmunity associated with immunotherapy of cancer

Blood ◽  
2011 ◽  
Vol 118 (3) ◽  
pp. 499-509 ◽  
Author(s):  
Sally M. Amos ◽  
Connie P. M. Duong ◽  
Jennifer A. Westwood ◽  
David S. Ritchie ◽  
Richard P. Junghans ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Monoclonal Antibodies ◽  
Side Effects ◽  
Cell Transfer ◽  
Serious Adverse Events ◽  
Normal Tissues ◽  
Immune Mediated ◽  
Organ Systems ◽  
Immunotherapy Of Cancer ◽  
Future Potential

Abstract In this age of promise of new therapies for cancer, immunotherapy is emerging as an exciting treatment option for patients. Vaccines and cytokines are being tested extensively in clinical trials, and strategies using monoclonal antibodies and cell transfer are mediating dramatic regression of tumors in patients with certain malignancies. However, although initially advocated as being more specific for cancer and having fewer side effects than conventional therapies, it is becoming increasingly clear that many immunotherapies can lead to immune reactions against normal tissues. Immunotoxicities resulting from treatment can range from relatively minor conditions, such as skin depigmentation, to severe toxicities against crucial organ systems, such as liver, bowel, and lung. Treatment-related toxicity has correlated with better responses in some cases, and it is probable that serious adverse events from immune-mediated reactions will increase in frequency and severity as immunotherapeutic approaches become more effective. This review introduces immunotherapeutic approaches to cancer treatment, provides details of toxicities arising from therapy, and discusses future potential ways to avoid or circumvent these side effects.

scholarly journals Biometric indicators of Eyes with Occult Lens Subluxation inducing Secondary Acute Angle Closure

2019 ◽  
Author(s):  
Xiaoli Xing ◽  
Liangyu Huang ◽  
Fang Tian ◽  
Yan Zhang ◽  
Yingjuan Lv ◽  
...  
Keyword(s):  
Axial Length ◽  
Corneal Thickness ◽  
Anterior Chamber Depth ◽  
Acute Angle ◽  
Angle Closure ◽  
Lens Subluxation ◽  
Lens Thickness ◽  
Primary Angle Closure ◽  
Lens Position ◽  
Acute Angle Closure

Abstract Background: To compare the anterior biometry of eyes with secondary acute angle closure induced by occult lens subluxation (LS), misdiagnosed as acute primary angle closure (APAC) at the first visit, APAC, chronic primary angle closure glaucoma (CPACG), cataract. Methods: This retrospective case study included 17 eyes with PAC due to occult LS, who were misdiagnosed as APAC on their first visit, 56 eyes diagnosed as APAC, 54 eyes diagnosed as CPACG, and 56 eyes diagnosed as cataract. Axial length (AL), Central corneal thickness (CCT), anterior chamber depth (ACD) and lens thickness (LT) were recorded. Lens position (LP), relative lens position (RLP), corrected lens position (CLP) were calculated. Quantitative data were subject to one-way analysis of variance and correlation analysis. Categorical data were analyzed using the chi-squared test. Results: The patients in the LS group had a longer ocular axial length than those with acute angle closure and CPACG. Corneal thickness in the LS group was not significantly different from that in the APAC group, but was significantly different from those of the CPACG and cataract group. The APAC group had the smallest ACD, while the LS group had the smallest AD. The LS group exhibited significantly shallower ACD (P<0.01). The LS group had the largest lens thickness. Conclusions: This study revealed that LS secondary PAC patients had a shallower ACD, thicker CCT and lens thickness comparing to those of APAC, CPACG and cataract patients. A short depth (< 1.25 mm) and a thick lens thickness (> 5.13 mm) are crisis of lens subluxation in our data. LP and CLP can be helpful for differential diagnosis. Trial registration: NCT03752710, retrospectively registered.

scholarly journals Ocular Adverse Effects of Antidepressants – Need for an Ophthalmic Screening and Follow up Protocol

2019 ◽  
pp. 1-6
Author(s):  
Varsha Narayanan
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Selective Serotonin Reuptake Inhibitors ◽  
The Elderly ◽  
Visual Disturbance ◽  
Significant Rise ◽  
Angle Closure ◽  
Ocular Side ◽  
Screening Protocol

Depression is emerging to be one of the commonest mental health disorders worldwide affecting a wide age group. The prescription of antidepressants has risen considerably in last decade with a preference for using newer antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs). There have been many published reports of Ocular side effects with Antidepressants related to Dry eye, Visual disturbance, Angle closure glaucoma and Retinal effects. There has also been a significant rise in antidepressant usage by the elderly, which is a population at risk for ocular adverse effects. Therefore, it is pertinent to understand the antidepressants from the perspective of their mechanisms of action and all possible Ocular adverse effects, and develop an Ophthalmic screening protocol and follow up for patients being put on Antidepressants. Patients should also be counselled for reporting alert signs of ocular side effects immediately. These steps may help to avert and decrease visual complications with Antidepressants.

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