Thursday, 28 November 2013

Glaucoma – The Complications

Glaucoma is a medical condition of an eye disease as result of the damage of the nerve of eye’s optic over time. If left untreated, it can lead to permanently vision impair and blindness.
A. Complications
1. Psychosomatic symptoms
Studies on open-angle glaucoma have shown that many patients suffering from this disease are anxious, hypochondric, perfectionist and emotional instable, according to the Praxis an der Lichtwiese(24).
2. Scotomas
In the study to characterize the progression pattern of initial parafoveal scotomas (IPFSs) in Glaucoma using cross-sectional and longitudinal 10-2 visual field (VF) data, showed that superior and inferior IPFS have a similar characteristic pattern of progression, although the latter tend to be farther from fixation. Understanding these patterns should help in the management of such patients and in improving VF testing algorithms(25).
3. Abnormal central visual function
Glaucoma has traditionally been thought to affect peripheral visual function in its early stages and to spare central visual function until late in the disease process. According to the study by Dr. Stamper RL., histologic studies of the nerve fiber layer in eyes with glaucoma suggest that the number of ganglion cells subserving macular function is decreased even in early stages of the disease. In addition, afferent pupillary defects (a gross measurement of macular nerve fiber function) may also be present in eyes with early glaucoma. Several studies have demonstrated that color perception (largely mediated by the fovea) is defective in glaucoma. Furthermore, defects in color perception may even precede the development of visual field abnormalities. Seventy-eight percent of patients with early glaucomatous visual field defects were found to have a defect in color perception when tested with a desaturated D-15 color panel that tests only the central 1.5 degrees. In addition, both chromatic and achromatic foveal perception channels are defective in eyes with glaucoma and even in some eyes of those with suspected glaucoma. Contrast sensitivity has become recognized as an important component of visual function(26).
3. Retinal ganglion cell loss (RGC)
Late stage of Glaucoma may result in progressive death of the retinal ganglion cells (RGCs) of that can leads to optic nerve degeneration and vision loss. According to the study by the University Eye Diseases Clinic, bearing in mind the fact that the exact pathogenic mechanism is still not completely established, glaucoma treatment strategies so far are based upon the identification of glaucoma risk factors. Among them, only elevated intraocular pressure (IOP) could undergo therapeutic treatment. However, in spite of the adequate therapy and IOP lowering, very often the disease is still progressing, leading to definite visual loss and permanent blindness. This especially refers to “normal tension glaucoma”. Over the last decade, there has been significant scientific research on new strategies for the delay or prevention of retinal ganglion cell loss (RGC), which is the basic pathophysiological event that initiates the cascade of processes leading to optic atrophy(27).
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