GLAUCOMA: A SHORT REVIEW

Supervisor
Dr. MITAL PATEL
Assistant Professor
Department of Pharmacy Practice
Parul Institute of Pharmacy
Parul University
Presented by:
MD. IQUBAL AHMAD
MUSTAK ALI KHAN
SUKANYA BHOWMICK
 INTRODUCTION
• It is a group of disorders characterized by an abnormally
high intra-ocular pressure (IOP), optic nerve weakness
and peripheral visual field loss (tunnel vision).
• It is a symptomatic condition of the eye where the intra-
ocular pressure (IOP) is more than normal (above 10-21
mm Hg).
• Untreated of glaucoma leads to permanent damage of
the optic nerve and resultant visual field loss, which can
progress to blindness.
 Causes of Glaucoma
• Glaucoma is the result of damage to the optic nerve. As
this nerve gradually deteriorates, blind spots develop in
your visual field. For reasons that doctors don't fully
understand, this nerve damage is usually related to
increased pressure in the eye.
 Risk Factors
Advanced age
Elevated Intra-ocular Pressure
High Myopia
Have a family history of Glaucoma
Take certain steroid medications such as prednisolone
Have had an injury to eye
Have corneas that are thinner than usual
 Types of Glaucoma
1. Open-Angle (Chronic) Glaucoma
2. Angle-Closure (Acute) Glaucoma
3. Congenital Glaucoma
4. Normal Tension Glaucoma
5. Secondary Glaucoma
 Open-Angle Glaucoma
• This is the most common type of glaucoma.
• Doctor may also call it wide-angle glaucoma.
• The drain structure in the eye (called the trabecular
meshwork) looks fine, but fluid doesn’t flow out like it
should.
 Angle-Closure Glaucoma
• This is more common in Asia.
• This is also called as Acute or Chronic Angle-Closure
Glaucoma.
• Eye doesn’t drain like it should because the drain space
between iris and cornea becomes too narrow.
• This can cause a sudden buildup of pressure in the eye.
 Congenital Glaucoma
• It is a birth defect that damages the optic nerve.
• This is also called as Childhood Glaucoma or Pediatric
Glaucoma.
• It can lead to an irreversible visual loss of the child.
 Normal Tension Glaucoma
• In normal-tension glaucoma, the optic nerve becomes
damaged even though your eye pressure is within the
normal range.
• The exact reason for this is still unknown.
 Secondary Glaucoma
• It is the name used to describe glaucomas that occur as a
side effect of injury or another eye condition.
• Medicines such as corticosteroids, may also cause this
type of glaucoma.
• Rarely eye surgery can cause secondary glaucoma.
 Common Symptoms of Glaucoma
• Severe pain in the eye
• Redness in the eye
• Photosensitivity
• Excess lacrimal production
• Sudden vision disturbance
• Seeing colored rings around lights
• Slow loss of side vision (also called tunnel vision) {mainly Open-
angle Glaucoma}
• Decreased or cloudy vision, often called “steamy vision”. {mainly
Angle-closure Glaucoma}
 Review of Literature
1. Paul C, Sengupta S, Choudhury S, Banerjee S, Sleath BL conducted
a study between June 2011 to January 2014 regarding the prevalence of
glaucoma in a larger rural and urban east indian population to make the
result comparable to other international landmark glaucoma prevalence
studies.
2. Senthil S, Badakere S, Ganesh J, Krishnamurthy R, Dikdhit S,
Choudhari N, Garudadri C, Mandal AK, conducted the study between
March 2013 to May 2014 to describe the prevalence of various types of
childhood glaucomas, their clinical features and treatment methods.
3. Palinkar A, Khandekar R, Venkataraman V conducted the study in
2001 in Rajnandangaon district of Chhattisgarh State of central India to
assess the prevalence of glaucoma in the age group of ≥ 35 years.
• Ramakrishnan R, Nirmalan PK, Krishnadas R, Thulasiraj RD,
James MT, Joanne K, David SF, Alan LR conducted the study in a
total of 5150 subjects aged 40 years to determine the prevalence of
glaucoma and risk factors for primary open-angle glaucoma in a rural
population of southern India.
AIM
• To study short report on Glaucoma Disease which includes
introduction, causes, risk factors, diagnosis and its treatment.

OBJECTIVES:
• To study the diagnostic means of Glaucoma disease.
• To determine special symptoms of Glaucoma.
• To study the co-relation of Glaucoma with family history.
• To study use of Medication for treatment and prevention of Glaucoma.
 Methodology
• Data of this study were drawn from the online open-access database of
PubMed and other databases such as ResearchGate, Europe PMC,
Springer, Google Scholar, and other publications. The articles were
selected as per the study requirement. Articles containing keywords such
as Frequency doubling perimetry, gonioscopy, intra-ocular pressure,
Primary angle-closure glaucoma, primary open angle glaucoma,
Childhood Glaucoma, congenital glaucoma, Blindness, low vision, etc.
were searched during the study of the particular review of the disease.
Results are calculated by studying and analyzing causes, symptoms and
various complications occurring during the infection and treatment of the
disease. Then the data is analyzed which includes treat to target
management.
 Discussion
• Various anti-glaucoma drugs are routinely prescribed in clinical
practice. The pharmacological strategies for the glaucoma treatment
fall into two classes: reduction of aqueous humor secretion and
enhancement of aqueous outflow. Five general groups of drugs, para-
sympathomimetics, carbonic anhydrase inhibitors (CAI’s), α-agonists,
β- blockers and Prostaglandin analogs have been found to be useful in
the reduction of IOP. [17] In present study, 69 % patients were male and
31% were female patients. Maximum patient was in the age group of
40-60 years (55%).
 Complications
• Untreated Glaucoma can lead to faster development of permanent
vision loss or blindness.
• Choroidal detachment
• Retinal detachment
• Chronic hypotony
• Anterior Segment necrosis.
 Diagnosis
The doctor will review the medical history and conduct a
comprehensive eye examination. He/She may perform several tests,
including:
• Measuring intra-ocular pressure (tonometry).
• Testing of optic nerve damage with a dilated eye examination and
imaging tests.
• Checking for areas of vision loss (visual field test).
• Measuring corneal thickness (pachymetry).
• Inspecting the drainage angle (gonioscopy).
Treatment
• The damage caused by glaucoma
can’t be reversed but treatment
and regular checkups can help
slow or prevent vision loss,
especially if the disease is in its
early stages.
• Glaucoma is treated by lowering
intra-ocular pressure (IOP).
Depending on the situation, treatment may includes:
Eye-drops
Oral medications
Laser treatment
Sugery
 Eye-drops
Glaucoma treatment starts with prescription eye-drops. Prescription eye-drop
medications include:

1. Prostaglandins: These increase the outflow of the aqueous humor in the eye,
thereby reducing the eye pressure. Eg: Latanoprost, Travoprost, Tafluprost, etc.
 Possible side effects include: darkening of the iris, eyelid skin, blurred vision,
etc.

2. Beta Blockers: These reduce the production of aqueous humor in the eye,
thereby lowering the intra-ocular pressure. Eg: Timolol, Betaxolol, etc.
 Possible side effects include: difficulty in breathing, slow heart rate, low BP,
etc.
3. Alpha-adrenergic Agonists: These reduce the production of
aqueous humor and increase outflow of the fluid. Eg: Apraclonidine,
Brimonidine, etc.
Possible side effects include: an irregular heart rate, high BP, red,
itchy or swollen eyes, dry mouth, etc.

4. Carbonic Anhydrase Inhibitor: These reduce the production of

fluid in the eye. Eg: Dorzolamide, Brinzolamide, etc
Possible side effects include: metallic taste, frequent urination,
tingling in the fingers and toes, etc.
 Oral Medications
If eye-drops alone don’t bring the eye pressure down to the desired
level, the doctor may also prescribe an oral medications, usually a
carbonic anhydrase inhibitors (Dorzolamide, Brinzolamide, etc).
Possible side effects include: metallic taste, frequent urination,
tingling in the fingers and toes, etc.
 Surgery and other therapies
Laser Therapy: Laser trabeculoplasty is an option if the patient have
open-angle glaucoma. The doctor uses a small laser beam to open
clogged channels in the trabecular meshwork.

Filtering Surgery: With a surgical procedure called a trabeculectomy,

the surgeon create an opening in the white (sclera) of the eye and
removes part of the trabecular meshwork.

Drainage Tubes: In this procedure, the eye surgeon inserts a small tube
shunt in the eye to drain away excess fluid to lower the eye pressure.
 Result
• The prevalence of glaucoma was 1.92% in women and 2.62%
in men. Glaucoma prevalence was 0.9% in the 40–44 years’
age group, and significantly increased to 3.55% in the 60–64
years’ age group. [15] The most commonly prescribed topical
drug was Timolol (41%), followed by Brimonidine 16.26%,
whereas the least prescribed drug was found to be
Latanaprost (5.69%). [17] Fixed dose combination
(Latanoprost+Timolol) was encountered in 14% of the
glaucoma patient’s prescription, who had high intraocular
pressure.
 Conclusion
• To conclude, β-blockers were first line drugs as monotherapy
for POAG, timolol being the first choice as it is cost-
effective.
• Early diagnosis and treatment can prevent vision loss from
the disease.
• Treatment options for patients with glaucoma include
medications such as eye-drops, topical ointment, cream, oral
medicines, laser therapy, and incisional surgery
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THANK YOU