Glaucoma is the second main reason for blindness within the U.S.
A main screening instrument for glaucoma is measurement of IOP. The imply IOP of a U.S. affected person is 15 mm Hg, and the usual deviation rounded up is 3 mm Hg. Classical educating is {that a} affected person with a 3rd customary deviation IOP, which is 22 mm Hg or increased, has ocular hypertension and is a glaucoma suspect deserving additional analysis. If each one of many 350 million People had their IOP checked, 2.5%, or about 8.75 million, would have an IOP of twenty-two mm Hg or extra. Fortuitously, research recommend that just one in 10 with ocular hypertension will develop glaucoma harm. So, an elevated IOP, whereas a major threat issue for glaucoma, just isn’t glaucoma in itself.
So, who deserves therapy? If we take a look at the affected person with OCT of the optic nerve and a visible subject and there may be proof of glaucoma harm, therapy is, in fact, indicated. Nevertheless, when first seen, most sufferers with an elevated IOP could have a standard optic nerve OCT and visible subject. For me, the subsequent step is to have a look at the important thing threat elements that make a affected person extra prone to develop glaucoma. The extent of IOP is helpful. Solely 0.1% of sufferers could have an IOP increased than 24 mm Hg, and in scientific trials when potential sufferers with identified glaucoma have their medicines discontinued, the washout IOP is often within the 25 mm Hg to 27 mm Hg vary. For my sufferers with an IOP on this vary, particularly when measured on repeat examinations, I discover myself providing therapy or, at a minimal, frequent follow-up.
Sadly, most ocular hypertension sufferers could have an IOP within the 22 mm Hg to 24 mm Hg vary and on some visits measure lower than 21 mm Hg. In normal-tension glaucoma, an IOP increased than 21 mm Hg isn’t measured within the workplace, but these sufferers reveal progressive glaucoma harm. In these instances, I search for different threat elements in making the choice to deal with or not. There are lots of, together with age, intercourse, race, a constructive household historical past (particularly on the maternal aspect), a skinny cornea, myopia, some systemic ailments together with hypertension and diabetes, an elevated cup-to-disc ratio (particularly the vertical cup), a disc hemorrhage, and retinal nerve fiber thinning on OCT with an irregular visible subject with elevated imply deviation or sample customary deviation. A mixture of those core threat elements can be utilized to create a helpful threat evaluation, and there are a number of printed algorithms accessible. I see AI turning into useful sooner or later in projecting a prognosis for a person affected person and serving to personalize their technique of therapy and acceptable goal IOP.
As soon as the attention care skilled (ECP) and their affected person determine collectively that therapy is indicated, we now have each medical and procedural therapies accessible. As famous within the accompanying Healio | OSN cowl story, so-called interventional glaucoma remedy is gaining traction as an early and even main therapeutic choice. With the approval of the Belkin Imaginative and prescient Eagle laser, now the Alcon Voyager DSLT, which is less complicated on the affected person and ECP than customary selective laser trabeculoplasty, I count on vital development on this therapy. Nonetheless, we now have glorious eye drops accessible, which in generic type price lower than $15 per 30 days with sturdy IOP-lowering efficacy and security. Whereas compliance is a problem and there are various unwanted effects, particularly for benzalkonium chloride-preserved merchandise, I discover most sufferers when first recognized select to start out on a single eye drop as soon as a day in a therapeutic trial. After a couple of visits with rising rapport and belief among the many affected person, household and ECP, it’s simpler to transition to a process, often beginning with SLT or DSLT. Particularly necessary for the aged phakic affected person is the truth that cataract surgical procedure with an IOL is a strong glaucoma process and permits decrease IOP, refractive error correction, and improved corrected and uncorrected visible acuity, a triple win for many glaucoma sufferers. Together with a microinvasive glaucoma process, this may present the affected person with glaucoma with a modern-day miracle.
Interventional glaucoma remedy with laser and/or incisional procedures together with implants, a few of which additionally present long-term remedy supply, will play an rising position in treating our sufferers with glaucoma. Together with AI, which can assist determine which sufferers deserve main or next-step remedy to attain an IOP that may forestall progressive glaucoma harm, we will count on to constantly scale back the chance of blindness from glaucoma.
For extra data:
Richard L. Lindstrom, MD, could be reached at rllindstrom@mneye.com.
Sources/Disclosures
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Disclosures:
Lindstrom studies having monetary disclosures for Acquea, Alcon, Belkin Imaginative and prescient, Glaukos, Minnesota Eye Consultants, Unifeye Imaginative and prescient Companions and Visionary Ventures.
