A 16-year-old female was scheduled for her periodic ophthalmic evaluation to update her spectacle lens prescription. At the visit, she reported a history of migraines, but the remainder of her personal and family medical history was non-contributory. She took no medications and had a history of low hyperopic refractive correction.
Exfoliative glaucoma can prove to be a particularly difficult disease for opthalmologists to manage. In this article, aspects of IOP-lowering therapy specific to this type of glaucoma are considered, as well as the range of treatments available and the potential advantages and challenges associated with each therapy.
Glaucoma is a term that describes a family of progressive optic neuropathies. All of the glaucomas share characteristic and progressive cupping of the optic nerve head, and this cupping is most easily viewed by means of direct stereoscopic evaluation through a dilated pupil.
The next time I see a patient with diabetic retinopathy who seems to be nonchalant or blasé regarding his condition, I’m going to say something along the lines of this: “Mr._______, this leaking of your blood vessels is going on elsewhere in your body, but your eyes just happen to be the only place we can see it without being invasive.”
Cup-to-disc ratio is certainly important in evaluating a patient for glaucoma. However, it’s not the only clinical measurement to consider. Evaluate the overall size of optic discs. Optic disc hemorrhages may have corresponding retinal nerve fiber defects. Subtle areas of parapapillary atrophy are another indicator for the possible presence of glaucoma. Look beyond the optic disc cupping to gather additional information.