Clinical Ophthalmology - 2019 by Weber MD C. G

Author:Weber MD, C. G.
Language: eng
Format: epub
Publisher: Pacific Primary Care Software PC
Published: 2014-08-05T00:00:00+00:00

Glaucoma:

Links: Risks, Info, ICD | Etiology | IOP | Exam & Dx | Congenital Glaucoma | Open Angle Glaucoma | Closed Angle Glaucoma | Tx Acute Angle Closure | Meds use to Tx and Meds to avoid | Tonometry |

Glaucoma is classified as closed- or open-angle. Closed-angle glaucoma often presents with acute symptoms (eye pain and blurred vision) and is an emergency. Primary open-angle glaucoma (POAG), the more prevalent form of glaucoma, is a leading cause of impaired vision. An insidious disease in which incr IOP reduces the blood flow and damages the optic nerve. It is the leading cause of irreversible blindness in the world. Causes optic neuropathy, in which axons of optic nerve die. Seen in ~2% pop >40yo and 10% >70yo.

• Silent cerebral infarcts (found most often in the basal ganglia) may promote progressive visual-field loss in patients with normotensive glaucoma, a prospective cohort study suggests (Ophthalmology 2009;DOI:10.1016/j.ophtha.2009.02.003)....Twice as many patients with field progression had silent cerebral infarcts, compared with patients who had stable-field, normotensive glaucoma.....Multivariable regression analysis revealed four independent predictors of field progression: Disc hemorrhage (HR 2.28), Silent cerebral infarct (HR 1.61), Systemic hypertension (HR 1.48), Central corneal thickness (per 30 µm of thinning) (HR 1.35).

• The U.S. Preventive Services Task Force found insufficient evidence showing that screening for glaucoma is beneficial (Ann Intern Med 2013:Jul 9:e-pub ahead of print)....Most primary care settings are not equipped to measure IOP, and most primary care clinicians are not sufficiently skilled to reliably detect “cupping” of the optic disc (a characteristic finding in POAG). More-accurate detection of POAG requires more-sophisticated techniques including automated visual-field testing.

Risks: Older age, increased IOP, FHx, being African American.

ICD10 Codes:

H40.00 Preglaucoma, unspecified.

H40.009 unspecified eye.

H40.019 Open angle with borderline findings, low risk, unspecified eye

H40.029 High risk, unspecified eye

H40.039 Anatomical narrow angle, unspecified eye

H40.053 Ocular hypertension, bilateral

H40.10X4 open-angle glaucoma indeterminate stage

H40.11X4 Primary open-angle glaucoma, indeterminate stage

H40.1392 Pigmentary glaucoma, unspecified eye, moderate stage

H40.219 Acute angle-closure glaucoma, unspecified eye

H40.2292 Chronic angle-closure glaucoma, unspecified eye, moderate stage

H40.30X2 Glaucoma secondary to eye trauma, unspecified eye, moderate stage

H40.50X2 Glaucoma secondary to other eye disorders, unspecified eye, moderate stage

• Patients with glaucoma consume the greatest share of resources in the first 6 months after their diagnosis, according to the findings of a longitudinal cohort study (Am J Ophthalmol. 2012;154:452-459).....Remarkably, 5% of patients account for just less than one quarter of glaucoma-related expenditures.

• In a study from South Korea, people with worsening glaucoma on just one side were also more likely to sleep with the affected eye facing downward (Am J Opthalmol. 2013;online December 15).....The researchers say that position raises the eye's internal pressure and probably hastens deterioration of the eye. The results don't prove that sleeping position accounts for worsening glaucoma on one side. But they at least verify a link "between the preferred sleeping position and asymmetric visual field loss between eyes," the authors write. "Certainly, if one has severe damage in one eye it would seem to make sense to attempt to avoid sleeping on your side with that eye down," he said.

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