Glaucoma is a potentially a blinding status, a disease which exhibits a characteristic eye neuropathy which may ensue in progressive ocular field loss. ( Kanski, 2006 ) . Glaucoma was considered a neurological disease, as the association in raising intraocular force per unit area ( IOP ) occurred over several centuries but was boosted by setup betterments in tonometer between 1880 and 1910. ( Paul N.S. et. Al, 2010 ) . Development of optic measuring setup and findings can make a new construct that may alter the nomenclature of glaucoma. Yet, IOP is known to be the major hazard factor among others which is proven in so many instances around the universe. ( Quigley et. Al, 2006 ) .
Glaucoma has been highlighted to be the 2nd largest cause of sightlessness in the universe and it acquiring increase annually. It has been expected to increase by 79.6 million by twelvemonth 2020 with 74 % of these will be Open Angle Glaucoma ( OAG ) . ( Quigley et. Al, 2006 ) . The position as the 2nd largest cause of blinding glaucoma were besides agreed by Leske M.C. , 2007 but there are assorted spread of etiology that need farther elucidation to let better comparison across surveies. Identifying through the hazard factors helps glaucoma status to be clearly understood the manner it consequence the patients and other related complications. The end of placing the hazard factors for glaucoma is to acknowledge the possibility of patient with greater hazard to hold a diagnostic ocular loss that consequence their quality of life. ( Keith E. et. Al, 2009 ) .
General hazard factor for glaucoma had been long discussed which include the age, race, household history, optic hazard factors ( IOP, Optic nervus caput characteristics ) , myopia, systemic hazard factors ( diabetes mellitus, immature age, unequal IOP control, high rate of patterned advance despite intervention ) . ( Allingham R.R. et. Al, 2005 ) . Elevation in intraocular force per unit area ( IOP ) has long been considered to be the primary cause of glaucoma. High in IOP normally defined as greater than 21mm quicksilver ( Hg ) . However, even people with normal force per unit areas can develop glaucoma excessively. Many research shows that taking oculus beads can assist to take down the IOP lift to decrease the hazard of glaucoma. Although holding 21mmHG of IOP, this does non intend that we have glaucoma but considered as a hazard factor. Upward of six million people in United States have elevated IOP without incontrovertible perimetric ocular field harm. ( Kreuger D.E. et. Al, 1980 ; Armaly M.F. et. Al, 1980 ; Quigley H.A. et. Al, 1994 ) .
In black people, unfastened angle glaucoma is the taking cause of sightlessness and is 6~8 times more common than in Caucasians. It is besides been notified that the hazard is high for people who is over 40 old ages of age. As for Asiatic and Eskimos, more likely to develop closed-angle glaucoma than other races.
A recent big clinical test discovered that patients with dilutant corneas ( the clear construction at the forepart of the oculus ) are at an increased hazard of developing glaucoma. They besides found that African-Americans have thinner corneas than Caucasians.
Patient with corneal thickness less than 555microns have three fold greater hazard of developing glaucoma as compared with those whoaa‚¬a„?s cornea are more than 588microns midst. Some specializer believe that there is a common collagen abnormalcy found in both cornea and lamina cribosa that predisposes patient to glaucoma. Although corneal thickness is portion glaucoma hazard factor, this has non yet translated to clinical pertinence as many inquiry about corneal thickness remain unreciprocated.
Age is another hazard of acquiring glaucoma after age of 50. Some other happening suggest that at age of 40 the hazard of acquiring glaucoma is true for black people. However, glaucoma can happen in anyone at any age which include inborn & A ; juvenile glaucoma. Since bulk glaucoma recorded comes from older citizen, precedence of the hazard glaucoma were classified to be 50 old ages of age.
Hereditary were besides considered as a hazard factor for glaucoma disease. In instance of inborn glaucoma that appears in the first months of life, finally at birth or in utero. Congenital glaucoma is characterized by minor deformities of the irido-corneal angle of the anterior chamber of the oculus. Other observation happening include rupturing, photophobia and expansion of the Earth looking in the first month of life. Heredity of inborn glaucoma is autosomal recessionary which involve CYP1B1, GLC3A and GLC3B. Juvenile glaucoma is considered as a primary unfastened angle glaucoma which looking during first two decennaries of life. Primary open-angle glaucoma has high IOP lift ( & gt ; 21mmHG ) , digging of the ocular nervus caput & A ; lost of ocular field. POAG is the most prevalence type of glaucoma, impacting 1 in 100 population of 40 old ages of age. Treatment affect medical and frequently surgical. Heredity is autosomal dominant, and there are two cistrons that have been identified, MYOC ( myocilin cistrons ) on chromosome 1q21-q31 and optineurin cistron in the GLC-1E interval on chromosome 10p. ( Kanski, 2007, Wiggs J.L, 1994 ) . Myocilin is still ill understood in POAG and a survey of group of unrelated POAG patients found myocilin mutants in at least 4 % of the grownup patients. The equivalent of familial procedure to hold familial myocilin mutant is up to 33 % if any of household member at age 35 who develop glaucoma to be pass on to their inheritor.
Types of glaucoma
There are four chief types of glaucoma, which are primary-open angle glaucoma, primary angle closing glaucoma, secondary glaucoma and developmental glaucoma. All of these glaucoma portions one thing in common, ocular field lost.
Primary unfastened angle glaucoma ( POAG ) , is the most common glaucoma. It is categorized as chronic ( slowly-developing ) status which recorded to hold high IOP lift due to failure drainage of fluid traveling out from the oculus. The lift of IOP rises easy without hurting symptom even the ocular phonograph record have been damaged so severely until a ocular field lost is notified. Generally it is bilateral but non ever symmetrical disease, which it is characterized to be big onset, IOP over 21mmHg, ocular nervus caput amendss and ocular field lost. POAG is the most prevailing type of glaucoma, impacting about 1 in 100 of general population over the age of 40 and supra. It effects both sexes every bit and is responsible for approximately 12 % of all instances of blind enrollment in the UK and USA.
Primary angle closing of glaucoma ( PACG ) occur in anatomically predisposed eyes, without other pathology, in which vision is threatened by lift of IOP due to obstructor of aqueous flow by agencies of occlusion of the trabeculate net by the peripheral flag. Again, the it may stay symptomless or manifest as ophthalmic exigency until ocular field loss occur. Primary angle closing should merely be used when there is ocular disc harm and ocular field loss. The predisposing anatomical construction affecting PACG comparatively anterior location of the iris-lens stop secondary to short axial length, shallow anterior chamber, and narrow entryway to the chamber. The undermentioned three interconnected factors are responsible for these features. Lens size is a construction that continues to turn through out our life, as it growing mature, the construction of anterior surface will acquire closer to the cornea. At the same clip, the musculus of ligament is acquiring slacken where it let the iris-lens stop to travel anteriorly. Other than that, the corneal diameter were found to be smaller on PACG patient. The axial length were besides related to the diameter of cornea as a short oculus has a little diameter and a comparatively placed lens. ( Kanski, 2007 ) .
Secondary glaucoma is a type of glaucoma that can be either unfastened angle or close angle. This may due to traumatic status secondary to blunt injury or cataract surgery.
Developmental glaucoma is a really rare status can be classified as a inborn glaucoma whereby it present in approximately 1 in 10,000 babes. This may be due to bringing during gestation upon force per unit area on infant caput.
1.3 Diagnosis of glaucoma
Glaucoma diagnosing is no longer merely relies on the presence of force per unit area within the oculus. A disrupted construction of ocular nervus harm were able to be seen with the assistance of distending drugs. It was suggested that a dilated student oculus scrutiny should be done for at least 2 old ages. The goldmann applanation tonometry ( GAT ) has been the gilded criterion in tonometry for more than 50 old ages but there are possibilities that some mistake might take to be under-estimate or over-estimate the existent IOP measuring, particularly when the cardinal corneal thickness were accounted. ( Boehm et. Al, 2008 ; Sarkisian S.R. , 2006 ; Stevens et. Al, 2007 ) .
The applanation tonometer touches the eyeaa‚¬a„?s surface after the oculus has been numbed, and measures the sum of force per unit area necessary to flatten the cornea. It is besides known to be the most sensitive tonometer as it requires a clear on a regular basis shaped cornea to obtain proper measuring. Drops are put in the eyes to blunt the oculus and so measuring is taken. This measurement step the interior force per unit area of the oculus by finding how much force per unit area is necessary to do light indenture on the outer portion of the oculus.
Other than that, ophtalmoscopy is used to analyze the interior of the oculus, including ocular disc and the peripheral fundus of the oculus. Normally bead will be put on the oculus to distend the student so assessment can be evaluate easy by utilizing ophthalmoscope that lights up and magnifies the interior of the oculus. Recent engineering like fundus camera is much more preferred to cut down uncertainty among medical practician rating.
Ocular field appraisal by utilizing Humphrey is the most acceptable trial to find ocular field lost subjectively. Reduce ocular field is a less sensitive but more specific index of glaucoma than IOP above 21mmHg. But, if a physicians rely on ocular field to observe glaucoma, they would lose about everybody with early glaucoma. Ocular field lost may non merely occur in glaucoma, but besides occur with the patient who has retinal withdrawal, multiple induration, or even ocular neuropathy. Nevertheless, a decreased ocular field is more likely to be a mark of glaucoma than an IOP force per unit area above 21mmHg.
Measurement through gonioscopy lens is another appraisal to measure the iridocorneal angle or the anatomical angle formed between the eyes cornea and flag. This is really of import to associate the association of glaucomatous status. Angle between the posterior corneal surface and the anterior surface of the flag constitutes the angle of anterior chamber. The gonioscopy technique allow 2 chief groups of glaucoma to be evaluate, closed-angle glaucoma and open-angle glaucoma. By making it this manner, proper therapy will be conducted specifically to be effectual.
Treatment of glaucoma
1.5.1 Laser
Laser iridotomy and trabeculoplasty are the types of optical maser therapy for glaucoma status. Laser iridotomy attack involve the hole devising on flag in primary angle closing glaucoma while optical maser trabeculoplasty perform on unfastened angle glaucoma and claimed to be painless with the AIDSs of anaesthetic drugs. These therapy were carefully perform to forestall damaging the lens of the oculus.
Selective optical maser trabeculoplasty ( SLT ) were applied to trabeculate net with Nd: YAG optical maser normally used to handle high blood pressure. Argon optical maser trabeculoplasty ( ALT ) besides help to cut down the IOP lift for the first twelvemonth. Somehow, SLT reported to be more comfy with the patient and may be repeated for twosome times compared to ALT. Treatment with optical maser somehow wear off over old ages. SLT entirely were found to be a considerable manner for cataract surgery excessively.
Cyclophotocoagulation or optical maser cilioablation claimed to be reserved for patient with vision of 20/400 and lower in ocular sharp-sightedness. Application of optical maser Burnss is to destruct the cell that produce fluid helps to cut down the IOP lift. This attack comparatively suites for patient who are non-neovascular eyes and who had failed with antecedently surgery base. ( Paul N.S. and John R.S. , 2010 ) .
1.5.2 Glaucoma surgery
Trabeculectomy were found to cut down IOP up to 30 % for 43 % of people with NTG. ( Schulzer M. , 1992 ) . Partial remotion of the eyeaa‚¬a„?s drainage system were involve in trabeculectomy whereby a little bubble formed in between cornea and the sclerotic coat organizing a tunnel to let fluid escape. This sort of surgery will be conducted if optical maser surgery and oculus medicine is non sufficient in commanding glaucomatous status.
Viscocanalostomy was foremost described by Stegmann, a nonpenetrating process wherein two cut terminals of the canal were inflated with viscoelastic. ( Stegmann R. Et. Al, 1999 ) . In other words, it involves taking a part of sclerotic coat to let drainage of inordinate fluid. Canaloplasty beginning from catheterisation of Schlemmaa‚¬a„?s canal via an abexterno attack to reconstruct the escape of the aqueous through conventional tract. A non-invasive can be a successful manner to cut down the opportunities of acquiring infection or redness but it may non works efficaciously like invasive ways. ( Paul N.S. and John R.S. , 2010 ) .
1.5.3 Clinical remedy
Beta-blockers by and large cut down the production of aqueous tempers so that the continuance IOP lift is reduced. There are few celebrated Beta blockers available which are, timolol, levobunolol, metipranolol and carteolol.
Prostaglandin such bimatoprost, latanoprost and travoprost were classified to cut down the IOP by bettering the escape of aqueous temper. Study by Parrish et. Al, 2003, shows that there is no difference between bimatoprost, latanoprost, and travoprost in footings of take downing IOP lift. This group of drug were associated with stain of flag and blackening of the eyelid tegument.
Adrenergic agonist plants by diminishing the aqueous temper and increasing the uveoscleral escape. The side consequence involve oral cavity waterlessness, weariness, hyperemia and concern. Both brimonidine and apraclonidine are illustration of sympathomimetic agonist that works cut downing the lift of IOP. There were hazard reported with this categorization of drug and because of that, the use have been seldom applied ( Virginia P.A. and Andrew M.P. , 2006 ) .
Carbonaceous anhydrase inhibitor ( CAI ) acts as a inhibitor to bicarbonate formation whereby eventually cut down the IOP degree. CAI were found to be less side effects compared to beta-blockers or prostaglandin. Few illustration like dorzolamide and brinzolamide falls under CAI categorization which may be found in signifier of topical application or beads. CAI were used two or three times daily is considered to be the best prescription given. The side consequence may affect GI perturbations, cardinal nervous perturbations, kidney rocks, numbness or prickling esthesiss in the weaponries and legs, weariness, and sickness. ( Virginia P.A. and Andrew M.P. , 2006 ) .
Combination of drugs were presently being applied to handle glaucomatous status. For illustration, the combination of dorzolamide 2 % and timolol 0.5 % show a positive consequence better than a individual drugs use. ( Harris A. et. Al, 2001 ) . The consequence shows an betterment to cut down the lift of IOP. By utilizing this attack, medical therapeutically have move in front in happening the best manner to extinguish IOP lift constructively.
1.6 General Objective
To analyze the relationship between blood flow at the neuroretinal rim alterations in glaucomatous eyes.
1.7 Hypothesis
Decrease in blood flow in faulty neuroretinal rim in glaucomatous eyes.
