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 The leading web portal for pharmacy resources, news, education and careers March 21, 2018
Pharmacy Choice - Glaucoma Disease State Management - March 21, 2018

Glaucoma Disease State Management

Glaucoma: Saving Sight with Foresight
by Alan P. Agins, BS, MS, PhD President - PRN Associates, Ltd. - Continuing Medical Education

Well, here it is January again and among other things that a New Year brings, January is National Glaucoma Awareness Month. This is a great time for those of us in daily contact with healthcare consumers to educate and spread the word about this potentially vision-robbing disease.

As for the numbers, more than 4 million Americans, and nearly 70 million people worldwide, have glaucoma. Unfortunately, according to experts more than 50% of people don’t even know they have it. Worldwide, it is the second leading cause of blindness. In the US approximately 120,000 persons are blind from glaucoma, accounting for 9% to 12% of all cases of blindness in this country. It is also the leading cause of blindness among African Americans. The most common form of glaucoma is open angle glaucoma. Open angle glaucoma accounts for nearly 20% of all blindness among African-Americans compared to 6% in Caucasians.

There are two main types of glaucoma: primary open angle glaucoma ("open angle") and angle closure glaucoma ("narrow angle"). Open angle glaucoma is about five times more common than narrow angle, but both are marked by an increase of intraocular pressure (IOP). In some cases optic nerve damage can occur despite normal IOP. This type is called normal tension glaucoma (NTG).

Open angle glaucoma tends to be insidious, progressing slowly often without overt symptoms. In most cases a person may not notice any loss of vision (initially it’s peripheral vision loss) until the disease has progressed significantly. Open angle glaucoma accounts for nearly 20% of all blindness among African-Americans compared to 6% in Caucasians.

Conversely closed angle glaucoma (which is the end-point of the narrow angle type) can occur suddenly and is considered a medical emergency. It is often painful, may cause decreased or cloudy vision, swelling and facial pain as well as nausea and vomiting. On a positive note, these symptoms often lead patients to seek medical attention before permanent damage occurs.

Essentially, glaucoma is caused by an imbalance in the amount of aqueous humor present in the eye at any given time. Aqueous fluid is constantly being produced and secreted by the ciliary body (located behind the iris) and eventually flows into the anterior chamber (through the pupil). At the same time, older fluid in the anterior chamber drains out through a channel known as the trabecular meshwork. Intraocular pressure depends upon exactly how much fluid is present at any given time. The elevated IOP in glaucoma is generally is due to a problem with the drainage side of the equation.

In open angle glaucoma, the channel for drainage is widely accessible but the flow through the trabecular meshwork is reduced (think of your sink when the drain is clogged with hair and other junk). Conversely, narrow angle glaucoma is associated with restricted access to the drain itself due to an iris that is pushed forward and pinches off access to the trabecular meshwork. In either case, as fluid levels build up, so does intraocular pressure which ultimately can damage the sensitive nerve fibers of the retina.

Since there are rarely any symptoms in the early stages of the disease, it is important that people get regular eye examinations by qualified professionals. Screening for glaucoma is usually performed as part of a standard eye examination performed by ophthalmologists and optometrists

Although intraocular pressure is only one of the major risk factors for glaucoma, lowering it via various pharmaceuticals and/or surgical techniques is currently the mainstay of glaucoma treatment. And while there is no “cure” for glaucoma, medication and surgery can help stop or slow the progression of the disease. Pharmacologically, the treatment of glaucoma is aimed at reducing intraocular pressure by either improving aqueous outflow or reducing the production of aqueous fluid, or both. Drugs that enhance aqueous outflow include the prostaglandin analogs, non-selective sympathomimetics, and cholinergic agonists. Drugs that decrease the production of aqueous humor include the topical beta-blockers and carbonic anhydrase inhibitors . Alpha2-agonists have a dual mechanism, decreasing aqueous production and increasing trabecular outflow.

Much like in the treatment of hypertension, there is often poor compliance with medications and follow-up visits for glaucoma. A 2003 study of patients in an HMO found that half failed to fill their prescription the first time and one in four failed to refill their prescriptions a second time. Unfortunately this is a major reason (yet preventable) for vision loss in many glaucoma patients.

So, this January (and throughout the year) I encourage everyone reading this raise awareness in all your patients and customers of the importance for regular eye exams and, for patients with existing glaucoma, of the importance of compliance with their medications and follow up visits to their doctors.
Links - Glaucoma
Prevent Blindness America is the nation's leading volunteer eye health and safety organization dedicated to fighting blindness and saving sight.

National Eye Institute was established by Congress in 1968 to protect and prolong the vision of the American people.

Glaucoma Research Foundation is fiercely determined to wipe out glaucoma through education and research.

The Glaucoma Foundation is the premier not-for-profit organization dedicated to vital research to find cures for glaucoma.

International Glaucoma Association offers all patients and health care professionals interested in preventing blindness from glaucoma, a forum for the exchange of ideas on glaucoma as well as the opportunity to campaign actively for greater Government recognition of the problem in this country and throughout the world.

Children's Glaucoma Foundation was formed by a group of physicians, parents of children with glaucoma, and concerned citizens.

American Glaucoma Society promotes excellence in the care of patients with glaucoma and preserve or enhance vision by supporting glaucoma specialists and scientists through the advancement of education and research.

Glaucoma Australia was incorporated in 1988 when a Council and officers were appointed. It is a non-profit registered charity.

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