By George A. Cioffi, MD
This part underwent significant revision for the 2008-2009 edition.Topics mentioned contain the epidemiologic facets of glaucoma; hereditary and genetic components; intraocular strain and aqueous humor dynamics; medical evaluate; clinical administration of and surgical treatment for glaucoma. This variation comprises up to date tables and revised photos, in addition to a number of new photographs illustrating either ailment entities and surgical recommendations.
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Additional resources for 2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009)
Reprinted with permission from Wright KW, ed. Textbook of Ophthalmology. ) 40 . Glaucoma Koeppe-type lenses are also quite useful for performing funduscopy. When used with a direct ophthalmoscope and a high-plus-power lens, they can provide a good view of the fundus, even through a very small pupil. These lenses are especially helpful in individuals with nystagmus or irregular corneas. Inconvenience is the major disadvantage of the direct gonioscopy systems. Indirect gonioscopy is more frequently used in the clinician's office.
In addition, the biomechanical properties of an individual cornea may vary, resulting in changes of the relative stiffness or rigidity of the cornea and altering the measurement. The Goldmann tonometer, Perkins tonometer, pneumatonometer, noncontact tonometer, and Tono- Pen are all affected by CCT. Currently, there is no validated correction factor for the effect of CCT on applanation tonometers; therefore, clinical application of any of the proposed correction methods should be avoided. The Ocular Hypertension Treatment Study (OHTS) found that a thinner central cornea was a strong predictive factor for the development of glaucoma in subjects with ocular hypertension.
The Goldmann-type goniolens requires a viscous fluid such as methylcellulose for optical coupling with the cornea. In lenses with only 1 mirror, the lens must be rotated to view the entire angle. Posterior pressure on the lens, especially if it is tilted, indents the sclera and may falsely narrow the angle. The combination of the lens manipulation and the use of viscous fluid often temporarily reduces the clarity of the cornea and may make subsequent fundus examination, visual field testing, and photography more difficult.
2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009) by George A. Cioffi, MD