Glaucoma: Identification & Co-Management

Article Outline

• Copyright

• 
  • View Large Image
  • Download to PowerPoint

• 
  • View Large Image
  • Download to PowerPoint

• G. Timothy Petito, O.D.

Glaucoma: Identification and Co-Management is a very handy reference that should be accessible to any clinician dealing with glaucoma, especially for those out of optometry school for some time but wishing to increase their knowledge of the disease process and care of patients with glaucoma. It is a composite of lecture notes from certificate courses run in the United Kingdom much like those run in the United States before practicing ODs become certified to deliver therapeutic care of the glaucoma patient.

The first chapter provides a rather exhaustive review of the epidemiology and statistics associated with the various forms of glaucoma. Both authors are hospital-based epidemiologists, and their overview of the topic is well-presented and understandable, even to a clinician who has been out of school for some time, and well worth reading. Although not intended to be a complete course in statistics or epidemiology, the chapter does give a rational basis for an understanding of the risk factors for glaucoma and which populations warrant a higher level of vigilance. Although most of the studies and statistics are well known, it is a very good single source review of the available statistics.

The second chapter is a nice review of aqueous production that is well-covered in 9 pages. The diagrams and micrographs are helpful in refreshing a practitioner's mind or to help a novice learn the mechanisms of the production of aqueous.

The third chapter does an admirable job of covering normal anatomy as well as the changes in histology and pathology in the glaucomatous eye. The various theories of the pathogenesis of glaucomatous optic neuropathy are presented insightfully and clearly. However, it would have been nice to have a few more, or clearer, mechanical drawings demonstrating the 2 main theories presented of optic nerve damage.

The fourth chapter is organized to transition through the subject of the anterior chamber angle anatomy to its gonioscopic examination. The treatment of the topic is a bit elementary and would serve as a nice introduction for a student learning gonioscopy. The tables and drawings of the applicable anatomy make it easy to understand and visualize the anterior chamber angle. The color plates are well labeled and add to the text. Here it would have been nice to see a few more examples of abnormal gonioscopic findings.

The chapter on visual field testing is very basic and may be useful for a student of optometry or even for a technician who wishes to learn the basics of visual field testing. The discussion of the Henson range of instruments, which are used in Europe, is extensive and precedes a discussion of the principles of the Humphrey Field Analyzer. A discussion of the principles of automated perimetry deals quite nicely with the principles of the description of visual fields, using decibels of light to describe how sensitive the retina is. One of the nice things about this discussion is the inclusion of multiple field printouts from 5 patients with glaucoma. Each of the cases presented has an extensive interpretation of the tests, which outlines how one should analyze a visual field test result.

After the discussion of visual fields is a description of the normal and abnormal optic nerve heads and leads logically into a presentation of the methods of evaluating the optic nerve ranging from direct ophthalmoscopy to high-tech instrumentation such as the HRT, GDx, and OCT. The basics of this instrumentation are good for practitioners just getting into the field of glaucoma co-management.

Once the fundamentals of diagnosis are covered, and an elementary but extensive description of therapeutic options available is covered, there are some tables that make the treatment decision reasonably straightforward. A discussion of the autonomic nervous system, which helps with an understanding of the mechanism of treatment, is presented, is quite complete, and serves as a nice review for practitioners who have been out of the classroom for some time. This discussion alone is a good reason to have this text available. A fairly complete description of the drugs available for the treatment of glaucoma is included. (It is interesting that a few of the medications discussed are not available to those of us in the United States.)

The next chapter very ably discusses the surgical options available in glaucoma. The photographs accompanying the text are very good and make it easier for a clinician new to the co-management of glaucoma to visualize the expected appearance of a postsurgical eye.

Glaucoma: Identification & Co-Management belongs on the shelf of any optometrist desiring to begin glaucoma management or co-management. Sections are good as a quick reference, making the text valuable for that alone. The flow and logic of the layout reads like what it is—a compilation of the notes from a series of courses given in England to prepare the optometrists of that country for the added responsibility of glaucoma co-management.