ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Two major prevalence surveys for chronic open-angle glaucoma have been published in the last year. These are discussed in relation to the comprehensive Baltimore Eye Survey of 2 years ago, which also studied the blindness arising from the disease and comparative figures for white and black individuals. The newer tests for identification of loss of visual function prior to visual field loss as demonstrated by conventional automated perimetry are considered. The three main screening tests for chronic open-angle glaucoma—ophthalmoscopy, tonometry, and perimetry—are evaluated in the light of case finding experience in the United Kingdom. The maximum detection of asymptomatic early chronic open-angle glaucoma in the community is likely to be best achieved by a combination of public awareness of glaucoma aided by patient-based associations and the promotion of improved glaucoma testing and case finding by the army of professionals who are already in place in most developed countries and who carry out primary eye examinations.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Glaucoma is the second leading cause of blindness in the United States. The cost of this disease in suffering and dollars is great for patients and society. The disease and its treatment may have an enormous impact on the patient's quality of life. The label of glaucoma alone may induce anxiety and depression. Topical medications, oral medications, and surgical treatment may produce adverse effects that have significant consequences for the patient. This article reviews the adverse effects of p-blockers, miotics, carbonic anhydrase inhibitors, and surgical treatment and the relationship of these adverse effects to the patient's quality of life. It is sometimes difficult to determine whether these treatments are more detrimental than the disease itself. The true goal of any treatment is to minimize the “dis” “ease” of patients and attempt to make them whole.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Intraocular pressure follows a circadian rhythm in humans and animals. This rhythm depends on the alternation of day and night for animals and waking and sleeping for humans. Like the pineal gland and retina, the ciliary body produces indoleamines according to a circadian rhythm. In humans, serotonin is produced in the morning and stimulates the Na+K+-ATPase of the ciliary epithelium to increase aqueous humor secretion. During the night or the sleeping period for humans, the serotonin is transformed into melatonin, N-acetyl-N-formyl-5-methoxy kynurenamine (AFMK), and N-acetyl-5-methoxy kynureanamine (AMK). Melatonin and its two metabolites are potent prostaglandin inhibitors. Endogenous prostaglandins of the trabecular meshwork increase the uveoscleral outflow during the day and are blocked by melatonin, AFMK, and AMK during the night or sleep. This blockage explains the maintenance of intraocular pressure during the night or sleep despite a decrease in aqueous humor production of 50%. Thus, the circadian rhythm of indoleamines drives the diurnal variations of intraocular pressure. It remains to be investigated whether the rhythm of indoleamine production in the ciliary body is driven in the same way as in the pineal gland where an inductible cyclic adenosine monophosphate early repressor with a circadian rhythm, being high at night and low during the day, acts as a circadian clock.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Carbonic anhydrase inhibitors have been investigated for topical administration in glaucoma therapy during the past few years. A group of substances termedthienothiopyran-2-sulfonamidesseems to be the most promising. Additivity has been shown with β-blockers and is likely to occur with most other topical glaucoma medications. Topical carbonic anhydrase inhibitors lower intraocular pressure by reducing aqueous humor formation. Side effects include local irritation and allergies. Systemic side effects such as electrolyte imbalances could not be detected. Blood dyscrasias have not been reported. Dose-dependent blood dyscrasias are likely to be reduced because of the decreased amount of substance. Non-dose-dependent idiosyncratic blood dyscrasias may be expected in a small fraction of patients.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Cumulative evidence strongly indicates that glaucomatous optic neuropathy is a multifactorial disease with many systemic and ocular factors acting in different combinations to interfere with optic nerve head circulation—the final common pathway in the production of glaucomatous optic neuropathy. The vital prerequisite for an understanding of the vascular etiology of glaucomatous optic neuropathy is an adequate basic knowledge of the factors that control optic nerve head blood flow. This review summarizes current knowledge of that, and discusses briefly many conditions and factors that can influence the optic nerve head blood flow and development of glaucomatous optic neuropathy along with recent advances made in those areas.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The appearance of the optic disc of patients with glaucoma can revert toward normal after intraocular pressures have been lowered. This phenomenon occurs more frequently in patients with early glaucoma and in younger patients, but is not limited to such patients. The frequency of reversible change has not been well established but is probably approximately 30% in patients in whom the intraocular pressure is lowered more than 30%. The continuing clinical course of patients in whom improvement in disc appearance is noted is better than the course of patients without such a change. Similar improvements in visual fields also occur. The mechanism involved in the reversible changes in the disc and field are discussed. Before such changes are able to be routinely used in management, better methods of detecting real change in the optic disc and visual field are required. For now, ophthalmologists should be aware of the reality of reversible changes and should search for them, because they may be indicators that intraocular pressure has been adequately lowered.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This article gives a brief overview of methods for the investigation of circulatory changes in ocu\ar blood flow. Methods for detection of systemic factors and blood flow in the ophthalmic artery, ciliary vessels, choroid, retinal locations, optic nerve head, and in the anterior uvea are described. In addition results concerning glaucoma obtained with these methods are presented.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The magnicellular system seems to be affected early and specifically by glaucomatous damage. It shows high temporal resolution and good motion perception. Psychophysical tests investigating the temporal transfer characteristics of the afferent visual system thus are of special interest for the detection of early glaucomatous damage. Flicker perimetry is largely independent from disturbances of the ocular media and provides a means to identify eyes with pressure-produced functional loss. Defects in temporal modulation perimetry may precede the onset or progression of defects in conventional light-sense perimetry. Motion sensitivity seems to be affected early by glaucomatous damage. The problem of noisefield campimetry is the lack of quantification and reliability control of the patients' responses. Large-field or Ganzfeld stimulators can separate glaucomatous from normal eyes with high sensitivity and specificity; their value for the identification of eyes at risk to develop progression of functional loss still must be demonstrated.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The diagnosis of normal-tension glaucoma includes optic nerve head and retinal nerve-fiber layer assessment, standard static computerized visual field testing, gonioscopy, and a diurnal (24-hour) intraocular pressure curve. In addition to a careful history to exclude previous phases of increased intraocular pressure, an internal medicine checkup including 24-hour ambulatory blood pressure measurements and neurological assessment are required. Additionally, carotid artery Doppler sonography, nailfold capillary microscopy, and a computed tomography scan of the brain may be performed.

ISSN:1040-8738    

出版商:OVID    

年代:1994

数据来源: OVID