Glaucoma Progression - Risk Factors, Diagnostic and Treatment Strategies

Glaucoma is a progressive optic nerve neuropathy that leads to considerable visual disturbances over time. In order to keep the rate of progression as low as possible, we need to consider many different aspects that directly and indirectly affect progression of glaucoma. Over 16 chapters, distinguished authors shed light on the multifaceted scope of glaucoma progression and make many valuable recommendations on the difficult task of dealing with this.

1.Intraocular pressure as a risk factor for glaucoma progression 121.1.Intraocular pressure as a risk factor121.2.Fluctuations in IOP as a risk factor141.3.Measurement errors as risk factors for misjudging progression162.Glaucoma type as a risk factor for progression examplified bypseudoexfoliation (PEX) syndrome192.1.Clinical characteristics202.2.PEX as a risk factor for the development of glaucoma202.3.PEX as a risk factor for glaucoma progression222.4.Histopathological basis of ocular hypertension222.5.Histopathological basis of reduced pressure tolerance233.Ophthalmological markers of progression263.1.Corneal thickness263.2.Corneal hysteresis283.3.Ocular pulse amplitude303.4.Myopia313.5.Transpapillary pressure difference343.6.Lamina cribrosa364.Systemic diseases as risk factors for glaucoma and their significance forglaucoma progression394.1.Risk factors394.1.1.Lipid disorders404.1.2.Diabetes mellitus424.1.3.Hypertension445.Biochemical features as risk factors for glaucoma and their significancefor progression of glaucoma 575.1.Vascular dysregulation and glaucoma575.2.Biochemical markers of glaucoma progression585.2.1.Endothelin 1585.2.2.Homocysteine635.2.3.Antiphospholipid antibodies696.The importance of biomarkers for glaucoma progression826.1.Genetic biomarkers in glaucoma826.2.Proteomic biomarkers in glaucoma837.Structural diagnosis of glaucoma progression887.1.Loss of neuroretinal rim (NRR)887.2.Loss of retinal nerve fibre layer thickness897.3.Disc margin bleeding as a biomarker of structural progression917.4.Changes in retinal vessels during the course of the disease947.5.Changes in the parapapillary retinal pigment epithelium948.Perimetric diagnosis of glaucoma progression978.1.Why perimetry?988.2.What is a visual field? The basics of the visual field998.3.What does a typical glaucomatous visual field look like?998.4.Conducting a visual field examination998.5.Evaluation of a visual field defect1008.6.Determining whether progression has occurred1018.7.Outlook1038.8.References1039.Electrophysiological diagnosis of glaucoma progression1079.1.Electroretinograms (ERGs)1079.1.1.Pattern-reversal ERG1079.1.2.Flash ERG1089.1.3.On and off ERGs1099.2.Visual evoked potentials (VEPs)1119.2.1.Blue-on-yellow VEPs1129.2.2.Multifocal VEP11310.The relationship between changes in function and structure in theprogression of glaucoma11710.1.Metabolic processes in primary open angle glaucoma11710.2.Clinical consequences12010.3.Factors influencing the examination conditions12011.Drop use as a risk factor for glaucoma progression 12411.1.Evidence-based medicine in drug vs surgical treatment of glaucoma12411.2.Specific aspects of drop use in the glaucoma patient12511.2.1.Pharmacological factors influencing drop use12511.2.1.1.Local bioavailability of the active substance12511.2.1.2.Primary containers for antiglaucoma agents12511.2.1.3.Drop techniques12811.2.1.4.The use of drop aids13111.2.2.Patient adherence in relation to drop use13311.2.3.Monitoring of glaucoma with drop use13512.Preservatives in ophthalmic drugs as a risk factor in the progression ofglaucoma13812.1.Toxicity of preservatives13812.2.Inflammation and fibrosis after long-term therapy with preservative-containing drops13912.3.Clinical aspects13912.4.New developments in the preservation of ophthalmic drugs14013.Communication as a risk factor for glaucoma progression 14213.1.Communication is an effect – not an intention14213.2.We cannot not communicate: importance of gestures 14313.3.The relationship level determines the factual level14413.4.Benefit-oriented speech14513.5.The question14613.6.Active listening14613.7.I-messages14714.Psychological changes during the course of glaucoma 14814.1.Psychosomatic change caused by crises as part of chronic illness14814.2.Mechanisms to resolve conflict14814.3.Adaptation and defence processes14814.4.Anxieties about blindness15014.5.Sociocultural environment15114.6.The patient’s anxiety and conflict situations15214.7.Sensitive doctor and patient communication15315.Surgical strategies in glaucoma progression 15515.1.Value of pressure lowering through surgery in the treatment of glaucoma15515.2.Surgical procedures15715.2.1.Trabeculectomy/epibulbar drainage devices15715.2.2.Non-fistulating surgical methods15915.2.3.Stents16115.2.4.Laser surgery16216.Practical recommendations for everyday life of glaucoma patients takinginto account progression16716.1.Dietary recommendations (general, antioxidants)16716.2.Glaucoma and acupuncture/relaxation methods16916.3.Homeopathy and anthroposophic medicine16916.4.Glaucoma and body posture16916.5.Intraocular pressure and playing musical instruments16916.6.Glaucoma and exercise16916.7.Glaucoma and sauna17116.8.Glaucoma and driving17117.Abbreviations174Index175