Fundamentals Of Glaucoma: A Guide For Ophthalmic Nurse Practitioners, Optometrists And Orthoptists
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Группа авторов. Fundamentals Of Glaucoma: A Guide For Ophthalmic Nurse Practitioners, Optometrists And Orthoptists
CONTENTS
FOREWORD
ACKNOWLEDGEMENTS
LIST OF CONTRIBUTORS
ILLUSTRATIONS
INTRODUCTION
1. ANATOMY
THE LAYERS OF THE EYE
The Fibrous Corneoscleral Coat
The Uvea (or Uveal Tract)
The Retina (Neural Layer)
AQUEOUS HUMOUR
Aqueous Production
Aqueous Outflow
THE RETINA AND THE OPTIC NERVE HEAD
THE LENS
2. DEFINITION AND CLASSIFICATION
OCULAR HYPERTENSION
CLOSED ANGLE GLAUCOMA
Primary Angle Closure
Phacomorphic Angle Closure Glaucoma
Secondary Angle Closure
OPEN ANGLE GLAUCOMA. Primary Open Angle Glaucoma (POAG)
Normal Tension Glaucoma (NTG)
Secondary Open Angle Glaucoma
3. EXAMINATION TECHNIQUES
VISUAL ACUITY
PERMIETRY AND IMAGING
SLIT LAMP
Lids
Conjunctiva
Cornea
Anterior Chamber (Also see note on gonioscopy)
Iris
Lens
Posterior segment
INTRAOCULAR PRESSURE MEASUREMENT. Goldmann Applanation Tonometry
Tono-pen®
iCare®
PACHYMETRY (CORNEAL THICKNESS MEASUREMENT)
GONIOSCOPY
4. INVESTIGATIONS
VISUAL FIELDS
What is the Visual Field?
What are the Types of Visual Field Testing?
How can We Quantify the Visual Field?
How is Visual Field Testing Performed?
How Do I Analyse a Visual Field Test?
Visual Field Defects
Visual Fields in Context
OPTICAL COHERENCE TOMOGRAPHY (OCT)
How Does OCT Scanning Work?
How to Analyse an OCT Printout
Reliability Index
Heat Maps/Deviation Maps
Numeric Data
Nerve Fibre Layer Sectoral Map
Macular Ganglion Cell Layer Imaging
Progression of Glaucoma on OCT Scanning
ANTERIOR CHAMBER IMAGING
Anterior Chamber Angle OCT
Ultrasound Biomicroscopy (UBM)
5. EYE DROPS
APPLICATION TECHNIQUE
TOPICAL ANTI-GLAUCOMA MEDICATION
COMPLIANCE
OCULAR SURFACE DISEASE
ANTI-GLAUCOMA MEDICATION IN PREGNANCY
COMMON SIDE EFFECTS
6. LASERS
INCREASE OUTFLOW. Selective Laser Trabeculoplasty (SLT)
TO OPEN THE DRAINAGE ANGLE. YAG Laser Peripheral Iridotomy
Laser Peripheral Iridoplasty
REDUCE INFLOW. Cyclodiode
MISCELLANEOUS. Argon Suture Lysis
YAG Goniopuncture
Pan-retinal Photocoagulation for Iris/Angle Neovascularisation
7. SURGERY
INCISIONAL SURGERY
Antimetabolites and Glaucoma Surgery
Penetrating Glaucoma Filtration Surgery
Complications
Post-Operative
Baerveldt Tube
Ahmed Valve
Molteno Tube
Complications:
Post-operative
Non-penetrating Glaucoma Filtration Surgery
NON-INCISIONAL SURGERY
Trabecular Bypass
Trabecular Excision
Schlemm’s Canal Dilation
Suprachoroidal Space
Subconjunctival Space
Reducing Production of Aqueous by the Ciliary Body
ANGLE CLOSURE GLAUCOMAS. Lens Extraction
Goniosynechialysis
8. IMPROVING QUALITY OF LIFE
GENERAL ADVICE AND MANAGEMENT. Maintaining and Improving Eyesight
Visual Acuity
Accurate Refraction
Binocular Status
MANAGING LOW VISION IN A GLAUCOMA PATIENT. Common Sense Advice for Glaucoma Patients with Visual Field Loss
Low Vision Aids for Glaucoma
LEGAL IMPLICATIONS OF BEING DIAGNOSED WITH GLAUCOMA. Driving with Glaucoma
Registration (Sight Impaired, Severely Sight Impaired) with Glaucoma
9. DEVELOPING A HOLISTIC APPROACH TO GLAUCOMA MANAGEMENT
DOES THE IOP NEED TO BE LOWER?
WHAT EVIDENCE IS THERE OF GLAUCOMA PROGRESSION?
IS THE PROGRESSION LIKELY TO THREATEN FUNCTIONAL VISION?
IS THE PATIENT USING THEIR CURRENT TREATMENT?
WHAT IS THE RISK OF INCREASING TREATMENT?
HOW PRACTICAL IS AN INCREASE IN TREATMENT?
WHAT DOES THE PATIENT THINK?
ROLE OF CLINICAL GUIDELINES
ROLE OF THE GLAUCOMA PRACTITIONER
USEFUL RESOURCES
USEFUL RESOURCES
INDEX
Отрывок из книги
Foreword
Acknowledgements
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The aqueous humour is a clear fluid that fills the anterior segment of the eye. It has many vital functions. It provides nutrients and removes toxic waste products from all surrounding structures. It is clear, allowing light to pass unhindered and acts as a vehicle for important immunological cells and chemicals. It inflates the globe to maintain structural and functional integrity to all eye structures. The degree to which this is done can be measured as the intra ocular pressure (IOP). The IOP is therefore a delicate balance between the production and drainage of aqueous humour. This is normally regulated automatically by various mechanisms to produce an ideal IOP and good blood flow around the optic nerve head. In glaucoma there is an imbalance in this system. All glaucoma treatments are therefore designed to optimize and modify this pathway, specific to the patient being treated. Controlling the IOP is the only risk factor modification proven to prevent progression in glaucoma.
Aqueous fluid is actively produced by the ciliary body. Enzymes like Carbonic Anhydrase play an important role in this process. The fluid then circulates from the posterior to the anterior chamber through the pupil.
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