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Prevalence of visual field defects due to capsular and simple glaucoma in H??lsingland, Sweden

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Prevalence of visual field defects due to capsular and simple glaucoma in H??lsingland, Sweden

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Abstract

In a region where both simple and capsular glaucoma are common, the observed prevalence of glaucoma with glaucomatous visual field defects based on hospital records is presented. The prevalence increased with increasing age to a maximum of 4.5% of the age group 81-85. Capsular glaucomas accounted for two thirds of the glaucomatous visual field defects. A comparison with previous population surveys indicates that the frequency of simple glaucoma is of the same magnitude as elsewhere. The high frequency of glaucomatous visual field defects can be due to the occurrence of capsular glaucoma. This supports the hypothesis that capsular glaucoma has its own epidemiology.

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... 8 Studies have also shown that glaucomatous damage progresses more rapidly in patients with PXF and glaucoma when compared with those having chronic open-angle glaucoma. [9][10][11][12][13][14] Visual field defects have also been shown to be more severe at the time of diagnosis in patients with pseudoexfoliative glaucoma (PXG) 11,15 and to deteriorate more rapidly when compared with chronic open-angle glaucoma. 16 Cataracts have been reported to be more common in PXF patients, 17,18 and PXF has also been shown to be associated with zonulysis during cataract surgery as well as postoperative lens dislocation. ...
... 8 Studies have also shown that glaucomatous damage progresses more rapidly in patients with PXF and glaucoma when compared with those having chronic open-angle glaucoma. [9][10][11][12][13][14] Visual field defects have also been shown to be more severe at the time of diagnosis in patients with pseudoexfoliative glaucoma (PXG) 11,15 and to deteriorate more rapidly when compared with chronic open-angle glaucoma. 16 Cataracts have been reported to be more common in PXF patients, 17,18 and PXF has also been shown to be associated with zonulysis during cataract surgery as well as postoperative lens dislocation. ...
Article
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Background: The purpose of this study was to investigate the demographics of pseudoexfoliation syndrome (PXF) and pseudoexfoliative glaucoma (PXG) in a Singapore hospital eye outpatient clinic. Methods: A retrospective study of 93 consecutive patients (146 eyes) with PXF was undertaken by a single ophthalmologist over a period of 37 months (July 1, 2006, to July 31, 2009). Results: Ninety-three (2.8%) of 3,297 patients seen during the study period were diagnosed with PXF. Forty-three (46.2%) of the 93 PXF patients were male. Indians were 5.04 times more likely to develop PXF than Chinese (P<0.001, 95% confidence interval 3.05-8.33), while Malays were 2.22 times more likely to develop PXF as compared with Chinese (P=0.029, 95% CI 1.08-4.55). Twenty-two (23.7%) of the 93 PXF patients had PXG at the time of diagnosis. There was no statistically significant difference in mean age between PXF and PXG patients. There was a larger proportion of males with PXG than females (P<0.001). Conclusion: PXF is not infrequent in elderly Singapore eye clinic patients, and is more likely to occur in Indians than in Chinese. In the Singapore eye clinic setting, males may be more likely to develop PXG, although larger studies will be required to confirm this.
... Yet, the effect of sex-specific risk factors in glaucoma is not often considered, likely because sex has not been unequivocally identified as a risk factor for glaucoma (Tielsch et al. 1990;Varma et al. 2004). For example, several studies have shown a higher prevalence of primary open-angle glaucoma (POAG) in males (Kim et al. 2016;Leske et al. 1994;Leibowitz et al. 1980), while others found higher rates in females (Lindblom and Thorburn 1982;Mason et al. 1989;Mitchell et al. 1996;Friedman et al. 2004). Yet other studies failed to find an association between sex and POAG (Hollows and Graham 1966;Klein et al. 1992;Tielsch et al. 1991;Wensor et al. 1998). ...
Article
Full-text available
Glaucoma is a leading cause of irreversible blindness worldwide and is characterized by progressive loss of visual function and retinal ganglion cells (RGC). Current epidemiological, clinical, and basic science evidence suggest that estrogen plays a role in the aging of the optic nerve. Menopause, a major biological life event affecting all women, coincides with a decrease in circulating sex hormones, such as estrogen. While 59% of the glaucomatous population are females, sex is not considered a risk factor for developing glaucoma. In this review, we explore whether menopause is a sex-specific risk factor for glaucoma. First, we investigate how menopause is defined as a sex-specific risk factor for other pathologies, including cardiovascular disease, osteoarthritis, and bone health. Next, we discuss clinical evidence that highlights the potential role of menopause in glaucoma. We also highlight preclinical studies that demonstrate larger vision and RGC loss following surgical menopause and how estrogen is protective in models of RGC injury. Lastly, we explore how surgical menopause and estrogen signaling are related to risk factors associated with developing glaucoma (e.g., intraocular pressure, aqueous outflow resistance, and ocular biomechanics). We hypothesize that menopause potentially sets the stage to develop glaucoma and therefore is a sex-specific risk factor for this disease. Graphical Abstract
... Also in Sweden (Lindblom & Thorburn 1982) and Iceland (Jonasson & Thordarson 1987) a falling glaucoma prevalence beyond roughly 80 years of age has been reported. Furthermore, the latter material revealed increasing prevalence for macular degeneration, though an increase including all age groups. ...
Article
In this population-based screening study, dealing with 1941 persons above 64 years of age from three different municipalities, the overall open-angle glaucoma prevalence was found to be 8.3%. The prevalence in the separate areas (7.0%, 8.6%, and 9.5%) were not statistically different. Roughly 30% of the population with pseudo-exfoliation syndrome had glaucoma, and 4.2% had ocular hypertension, whereas the corresponding figures for those without pseudo-exfoliation were 4% and 0.8%, respectively. The high glaucoma rates are partly due to the high pseudo-exfoliation prevalence in the area. The prevalence of the capsular glaucoma increased towards a maximum between 75 and 79 years of age, whereafter the curve declined. This may indicate reduced survival time of glaucomatous patients.
... In Finland, 20-40% of all open-angle glaucomas are classified as ExG (Krause 1973;Krause et al. 1988). ExG has been reported to respond more poorly to medical therapy than primary openangle glaucoma (POAG) (Aasved 1971;Aasved et al. 1979); furthermore, the progression of visual field damage has been shown to occur more rapidly and optic nerve damage to be more pronounced (Tarkkanen 1965;Aasved 1971;Lindblom & Thorburn 1982;Konstas et al. 1997). Because of the more aggressive nature of ExG, surgical interventions are often required in order to control IOP in these patients. ...
Article
To investigate the efficacy and safety of mitomycin C (MMC)-augmented deep sclerectomy with implant (DSCI) in patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG). A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser goniopunctures and complications were compared postoperatively. Surgery was considered as a complete success when IOP was < 18 mmHg without antiglaucoma medication. Preoperatively, the mean IOPs were 23.1 +/- 5.8 and 25.4 +/- 8.3 mmHg, and 13.8 +/- 6.1 and 11.2 +/- 5.6 mmHg in the POAG and ExG groups, respectively, at 12 months. 77.4% and 75.7% of surgeries were a complete success in the POAG and ExG groups, respectively [not significant (NS)]. Five patients (16.1%) in the POAG group but none in the ExG group (0%) were receiving antiglaucoma medication at 12 months (NS). Nd:YAG laser goniopuncture was performed in 29.0% of eyes in the POAG group and in 55.6% of eyes in the ExG group (p = 0.047). Postoperatively, choroidal detachment occurred in 16.1% of eyes in the POAG group and in 10.8% of eyes in the ExG group (NS). We encountered no serious complications related to MMC use. DS with MMC augmentation appears to be equally effective in ExG and POAG patients in lowering IOP to target levels, at least in the short term, with few immediate postoperative complications.
... Medical therapy has been reported to be less effective in ExG than primary open-angle glaucoma (POAG) (Aasved 1971;Aasved et al. 1979). Furthermore, the progression of visual field damage has been shown to occur faster, and the optic nerve damage was more severe in ExG compared to POAG (Tarkkanen 1965;Aasved 1971;Lindblom & Thorburn 1982;Konstas et al. 1997;Leske et al. 2007). Because of the more aggressive nature of ExG, surgical treatments are often required for controlling the IOP in these patients. ...
Article
To investigate the efficacy and safety of mitomycin C (MMC)-augmented deep sclerectomy with implant (DSCI) in primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) patients. A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser goniopuncture treatments and complications were compared postoperatively after 36- month follow-up. Surgery was considered as a complete success when IOP was <18 mmHg without antiglaucoma medication. Preoperatively the mean IOPs were 23 ± 6 mmHg and 25 ± 8 mmHg, and 13 ± 4 mmHg and 11 ± 4 mmHg in the POAG and ExG groups, respectively, at 36 months. At 36 months, 74% and 73% of surgeries were a complete success in the POAG and ExG group, respectively [not significant (NS)]. Two patients (8%) of the POAG group and one of the ExG group (3%) were receiving antiglaucoma medication at 36 months (NS). Nd:YAG laser goniopuncture was performed more often in the ExG group (87%) than in the POAG group (61%, p = 0.024). Postoperatively choroidal detachment occurred in 16% of eyes in the POAG group and in 11% of eyes in the ExG group (NS). DSCI with MMC augmentation appears to be as effective in patients with ExG and POAG in lowering IOP to target levels at medium term with few immediate postoperative complications.
... fiable cause of open-angle glaucoma in the world. 1 Exfoliation glaucoma (XFG) generally runs a more rapidly progressive course than does primary open-angle glaucoma (POAG), with more aggressive and severe intraocular pressure (IOP) elevation, IOP fluctuation, visual field constriction, and optic nerve head cupping at the time of diagnosis. [2][3][4] Moreover, XFG appears to be more resistant to medical therapy, with a more short-lived response and higher failure rates. 2,5-9 A significant proportion of XFG patients, therefore, require surgical intervention to control glaucoma early on in the course of the disease. ...
Conference Paper
Full-text available
in the management of periocular scarring and cicatricial ectropion. The introduction of these innovative therapeutic modalities offers ophthalmologists a greater range of possible effective treatments to address peri-ocular scar tissue and the resultant cicatricial ectropion. Core tip: There is a broad range of conservative as well as more invasive treatment modalities for cicatri-cial ectropion. Ablative lasers can be used alone or in conjunction with nonablative lasers in the treatment of periocular scarring and cicatricial ectropion. Additionally , they may be used to assist the transdermal delivery of antifibrotic agents. This treatment modality, although still uncommonly used to treat periocular scarring, is a promising new technique that offers many advantages. Ophthalmologists may utilize this technique to manage cicatricial ectropion. Ko AC, Erickson BP, Ko MJ, Sayed MS, Lee WW. Ablative laser assisted topical delivery of antifibrotics in the management of cicatricial ectropion. World J Ophthalmol 2014; 4(2): 7-13 Available from:
... Exfoliation syndrome is an age-related condition, common worldwide, and a major risk factor for the development of XFG (Lindblom & Thorburn 1982, Konstas 1993, Ritch 1994. Patients with XFG have higher intraocular pressures and more severe damage at the time of detection than do patients with primary (idiopathic) open-angle glaucoma, and damage progresses more rapidly (Tarkkanen 1965, Aasved 1971, Lindblom & Thorburn 19841997b). ...
Article
To provide evidence for the hypothesis that dynamic iridolenticular contact predisposes to the development of glaucoma in exfoliation syndrome (XFS). We present four patients with bilateral XFS and unilateral exfoliation glaucoma (XFG) whose normotensive eyes had suffered traumatic loss of dynamic iridolenticular contact. All 4 patients had bilateral XFS and developed XFG only in the untraumatized eyes. One patient had loss of iridolenticular contact in the traumatized eye, two had a nonreactive pupil, and one had had intracapsular cataract extraction at age 28. Loss of dynamic iridolenticular contact may help to protect against development of glaucoma in eyes with XFS.
... Visual field damage seen in PXG patients was found to be more severe than in POAG patients and this was clinically significant (P = 0.014 in the right eye and P = 0.025 in the left eye). This is also in agreement with the other studies that show PXG patients to have a significantly higher frequency and severity of visual field dam-age than POAG patients [5] [47]. The implication for practice is that eye care providers will need to search for this subtype of glaucoma while evaluating glaucoma patients in order to institute appropriate treatment to combat the more aggressive nature of this disease. ...
Chapter
Eine ganze Reihe von Linsenerkrankungen wird durch verschiedene Glaukomformen kompliziert. Bei manchen Situationen, wie z. B. beim Exfoliationssyndrom, ist eine Ursache-Wirkungs-Beziehung zwischen der Linsenerkrankung und dem begleitenden Glaukom noch ungeklärt. Bei anderen Situationen wiederum, wie z. B. bei verschiedenen Formen der Linsendislokation oder Katarakt, ist die Glaukomerkrankung eindeutig auf die Linsenerkrankung zurückzuführen.
Article
The main reason for elevated intraocular pressure (IOP) in glaucoma capsulare is secondary plugging of the intertrabecular spaces by pigment and fibrillous material. The goal of this study was to evaluate the clinical results of "trabecular aspiration," a new surgical technique designed to improve trabecular facility in pseudoexfoliative glaucoma (PEG). Trabecular aspiration was performed under the operating microscope prior to extracapsular cataract extraction (ECCE) over half of the chamber-angle circumference using a specially designed irrigation-aspiration device in 12 eyes diagnosed with PEG and cataract. Trabecular debris and pigment were cleared with a suction force of 100 to 200 mm Hg. The mean preoperative IOP (with and without antiglaucoma medications) was 33.0 +/- 6.27 mm Hg; on postoperative day 5, 16.25 +/- 4.5 mm Hg; at 1 month, 18.1 +/- 2.68 mm Hg; at 3 months, 18.33 +/- 2.69 mm Hg; and at 6 months, 19.0 +/- 6.26 mm Hg. The mean number of antiglaucoma medications per day decreased from 3.77 preoperatively to 0.67 at 6 months postoperatively. Trabecular aspiration substantially lowered the IOP in all 12 patients. Removal of intertrabecular and pretrabecular debris prior to ECCE reduced IOP 42% from baseline at 6 months postoperatively, a clinically significant decrease. Additionally, routine preoperative and postoperative gonioscopy in most cases revealed a significant reduction of pigmentation in the area of treatment. More patients and longer follow up are required to substantiate these results.
This introductory lecture to the epidemiological session in the Workshop on the Exfoliation Syndrome (ES) gathers together figures for the prevalence of ES around the world. Prevalence figures from published reports are shown in the text separately for each country. Four ways of comparing the prevalences are used. 1) Prevalences in people over 60 years of age, 2) Percentages of glaucoma in persons with ES, 3) Percentages of ES in patients with glaucoma or ocular hypertension, with separate statistics for the proportion of capsular glaucoma in patients treated with laser trabeculoplasty (LTP), 4) Prevalence of ES in patients with cataract. The major differences in prevalence can partly be explained by the different techniques used in the investigations. Very few authors have studied people in different countries, which is the best way of obtaining comparable results. The author has personally studied Finns, Lapps, Eskimos in Greenland, Canada and Alaska, Icelanders, populations in Tunis, India and Peru and four populations in the USSR by the same technique. The prevalences vary from 0% in Eskimos to 21% in Finns over 60 years of age, and are at the same high level in Lapps, Finns, Russians in Novosibirsk and Icelanders, but significantly lower in all the others. The results support the opinion that ES is not uniformly distributed in all countries, and this is confirmed by many reports from different countries in this workshop.
95 eyes of patients with bilateral exfoliation syndrome (ES) were examined with fluoroangiography. The visual field and the intraocular pressure were tested in the same eyes. The relationship between visual field defects, fluoroangiographic changes of the optic disk and intraocular hypertension is discussed. The results show that when hypertension and defects of perfusion are present in the same eye the visual field defect is always present and it is more severe.
This paper attempts to evaluate exfoliative glaucoma management. Exfoliative glaucoma is generally considered to be more severe than chronic open angle glaucoma. Pressures are generally higher and more resistant to the pressure lowering effect of various medications. Laser trabeculoplasty is generally more effective in exfoliative glaucoma in the first year but successful in only 50% of eyes at two years follow-up. Filtration surgery is far more effective in exfoliative glaucoma than it is in chronic open angle glaucoma.
Article
Occurrence of exfoliation syndrome was studied in 172 eyes enucleated for haemorrhagic and absolute glaucoma in 1962-82, using histopathological techniques. Exfoliation was found in 33% of haemorrhagic glaucoma cases and in 22% of absolute glaucoma. In patients over 70, exfoliation was found in 53% of the haemorrhagic cases and in 46% of the absolute glaucoma cases. Capsular glaucoma may provoke haemorrhagic glaucoma and may lead to blindness and enucleation of eye with or without vascular catastrophe.
Article
A compilation of all prescriptions issued for glaucoma medication in Iceland for a 6 months period, together with hospital records of all patients operated on for primary open-angle glaucoma but not on glaucoma medication, were analysed for the prevalence and distribution of glaucoma in Iceland. The glaucoma population consisted of 1916 individuals (991 males and 925 females), amounting to an overall prevalence of 8.3 per thousand population. About 80% of the patients were on glaucoma medication and the remaining had been operated on but had not used drugs. Only 2.6% of the glaucoma population was under 50 years of age. The overall prevalence among those aged 50 and older was 35.3 per 1000, all having primary open angle glaucoma (subsuming glaucoma with pseudoexfoliation of the lens capsule). The prevalence increased with age from 5.7 per 1000 at age 50-59, to 107.5 at age 80 and older. Rates for males were significantly higher than rates for females in all age groups. The rates were highest in regions where ophthalmologists visit health centers regularly. Assuming that the open-angle glaucoma patients in Iceland as a whole have a similar eye status to the patients attending the University Outpatient Glaucoma Clinic, the overall prevalence of GVFD (glaucoma visual field defects) in the population aged 50 and older is 19.1 per thousand. The age specific prevalence of GVFD in Iceland is therefore consistent with results of prevalence studies in neighbouring countries.
Article
IOP was measured in 1062 middle-aged and elderly subjects of a small Sicilian town, enrolled in a population based survey. The mean IOP was 15.1 +/- 3.7 mmHg without interocular or sex differences. A small but significant age-dependent increase of IOP was found. Circadian and seasonal influences were recorded: IOP was higher in the morning and in winter. The prevalence of chronic open-angle glaucoma was 1.2%, but it grew to 3.6 if only subjects aged 70 years or more were considered. IOP of 24 mmHg or more was found in 2.7%, while 4.3% of subjects showed IOP of 21 mmHg or more. This survey shows that mean IOP of the Mediterranean population studied is similar to the IOP found in other epidemiologic investigations; the prevalence of glaucoma, however, seems to be rather high.
Article
Pseudoexfoliation syndrome is characterized by the presence of glycoprotein fibers in ocular and extraocular tissues, and often is associated with glaucoma. Pseudoexfoliation material may be associated closely with elastic microfibrillar-associated glycoprotein as well as elastin. Four optic nerve heads of two patients with pseudoexfoliation syndrome and glaucoma were examined using electron microscopy and immunogold detection of elastin. Optic nerve heads from healthy age-matched individuals and patients with primary open-angle glaucoma were used for comparisons. In all eyes with pseudoexfoliation and glaucoma, there was marked and widespread elastosis in the connective tissue of the lamina cribrosa. Elastotic fibers appeared as large and irregular aggregates of electron-dense material labeled with anti-elastin antibody. Abundant microfibrils were interspersed in the elastotic aggregates, whereas no typical pseudoexfoliation fibers were observed. In contrast, there were less elastotic fibers in the lamina cribrosa from patients with primary open-angle glaucoma compared with pseudoexfoliation glaucoma. Other changes of extracellular matrix were similar to those observed in primary open-angle glaucoma: decreases in collagen fiber density, presence of basement membranes not associated with cell surfaces, and abundant bundles of microfibrils not labeled with elastin antibody. The elastic fibers appeared normal in other locations within the optic nerves of patients with pseudoexfoliation glaucoma, including in the pial septa and blood vessels of the retrolaminar myelinated optic nerve. The authors' findings demonstrate marked and site-specific elastosis in the lamina cribrosa of patients with pseudoexfoliation syndrome with glaucoma, suggesting an abnormal regulation of elastin synthesis and/or degradation in the optic nerve of patients with this disease.
Article
The main reason for elevation of intraocular pressure in pseudoexfoliation glaucoma is due to secondary plugging of the intertrabecular spaces by pigment and fibrillous material. The aim of the present study was to introduce a new surgical concept to clean trabecular meshwork in pseudoexfoliative glaucoma. 'Trabecular aspiration' was performed under the operating microscope prior to extracapsular cataract extraction in half of the chamber angle circumference using a specially designed irrigation-aspiration device. The hand-held instrument has three outlets, one for aspiration (400 microns wide and 45 degrees horizontally angulated to meet the slope of the meshwork) and two openings (650 microns) for irrigation to maintain a deep anterior chamber and to keep the iris away from suction. Trabecular debris and pigment was cleared with a suction force of 100-200 mmHg. The effect of trabecular aspiration was cross-checked by analysing the aspirate. Pigment granules, fibrillous protein and other forms of trabecular debris were identified in the aspirate using light- and scanning electron microscopy. The morphological analysis of the trabecular aspirate clearly indicates the efficacy of 'trabecular aspiration' for removing pre- and intratrabecular debris. The clinical relevance of this new procedure looks promising, a clinical trial, recently initiated, is warranted.
The records of all patients with simple and capsular glaucoma who visited our clinic in the period from 1.1.1972 to 31.12.1982, and who were alive at the 31.12.82, have been evaluated. In the population older than 49 years 0.54% had simple and 0.74% had capsular glaucoma, equally distributed on men and women. In average near 60% had capsular glaucoma, with great variation in different municipalities. Highest figures were found in a belt reaching from the coast into the inland. Both simple and capsular glaucoma showed increasing occurrence till 75-80 years, thereafter the curves decline.
Article
The horizontal diameter of the pupil was measured on 20 eyes with exfoliation syndrome and 20 control eyes before and after the instillation of 10% phenylephrine and 4% pilocarpine eye drops. Pupil dilation induced by topical application of the alpha 1 adrenoceptor agonist phenylephrine was significantly smaller in eyes with exfoliation syndrome compared to controls. The cholinergic agonist pilocarpine decreased pupil diameter and this effect was significantly less in cases with exfoliation syndrome. We conclude from these data that the pharmacological response to both adrenergic and cholinergic stimulation is weaker in eyes with exfoliation syndrome compared to controls.
Article
The "true" prevalence and clinical attributes of exfoliation glaucoma remain controversial. The authors studied these characteristics in glaucoma patients requiring trabeculectomy. One hundred consecutive patients undergoing trabeculectomy for open-angle glaucoma were investigated by clinical examination (biomicroscopy and gonioscopy) and classified into three categories: exfoliation glaucoma, possible exfoliation glaucoma, and primary open-angle glaucoma (POAG). A definitive diagnosis of exfoliation glaucoma was provided by pathologic examination of iris tissue. All 22 patients with clinical evidence of exfoliation glaucoma and 4 of 18 patients with possible exfoliation glaucoma on clinical examination had ultrastructural evidence of exfoliation material. The prevalence of exfoliation glaucoma, therefore, was 26%. The clinical examination for the diagnosis of exfoliation glaucoma had an 85% sensitivity rate and a 100% specificity rate. In comparison with POAG, patients with exfoliation glaucoma had higher untreated intraocular pressure (IOP), higher IOP with medical therapy, and shorter duration of medical therapy. They were more often operated on for unacceptably high IOP. Exfoliation glaucoma patients exhibited significantly lower IOP after surgery. Exfoliation glaucoma is common in patients requiring trabeculectomy for open-angle glaucoma. This condition differs from POAG by a poorer response to medical therapy and a better response to trabeculectomy.
Article
To estimate the prevalence of glaucoma among people worldwide. Available published data on glaucoma prevalence were reviewed to determine the relation of open angle and angle closure glaucoma with age in people of European, African, and Asian origin. A comparison was made with estimated world population data for the year 2000. The number of people with primary glaucoma in the world by the year 2000 is estimated at nearly 66.8 million, with 6.7 million suffering from bilateral blindness. In developed countries, fewer than 50% of those with glaucoma are aware of their disease. In the developing world, the rate of known disease is even lower. Glaucoma is the second leading cause of vision loss in the world. Improved methods of screening and therapy for glaucoma are urgently needed.
Article
A population-based survey of 760 people 65-74 years of age was conducted in the municipality of Tierp, central Sweden. The methods used to identify glaucoma suspects were applanation tonometry, automatic perimetry (Competer 350), and binocular assessment of the optic disc. For a diagnosis of definite open-angle glaucoma, a visual field defect was required. Open-angle glaucoma was found at a prevalence of 5.70% (95% confidence interval: 4.12-7.27), which is higher than those figures reported for comparable surveys carried out on white populations. The occurrence of capsular glaucoma may in part explain this finding. Twenty of the 45 open-angle glaucomas were diagnosed before the survey. In this category, capsular glaucoma accounted for 60%, whereas 84% of cases detected during the survey were chronic simple glaucomas. Eight cases (18%) were classified as normal tension glaucoma, all of whom were diagnosed during the survey. Chronic simple glaucoma was significantly more prevalent in males than in females.
Article
To estimate the prevalence and incidence of open-angle glaucoma among black and white persons in the United States and to characterize quantitatively their life experience with glaucoma using a life table approach to estimate disease duration. Review of published data on glaucoma combined with statistical models to estimate prevalence and incidence. The association of open-angle glaucoma with age was examined separately for white and black persons. By the year 2000, the number of persons in the United States with primary open-angle glaucoma is estimated to be 2.47 million (1.84 million white and 619,000 black Americans). A model using derived incidence rates for open-angle glaucoma (OAG) and United States mortality data indicated that the average black American has OAG 27% longer than the average white American (16.3 years compared to 12.8 years). Meta-analysis to obtain pooled prevalence estimates for glaucoma provides useful information on length of disease and age distribution of those affected. It may assist in estimating treatment effects and associated costs to derive data that effect health care decisions.
Article
Objective: The primary cause of intraocular pressure (IOP) elevation in pseudoexfoliation glaucoma is obstruction of the intertrabecular spaces by exfoliation material. Previously, the authors reported on a new concept of nonfiltering glaucoma surgery-trabecular aspiration-designed to increase trabecular outflow in pseudoexfoliation glaucoma. In the current study, a description of the modified instrument, its refined surgical technique, and long-term clinical results will be given to substantiate the efficacy of trabecular aspiration in the surgical management of pseudoexfoliation glaucoma. Study design: The study design was a prospective and nonrandomized study. Participants: A total of 68 eyes of 54 patients suffering from medically uncontrolled pseudoexfoliation glaucoma were treated by bimanual trabecular aspiration. Thirty-four eyes of 28 pseudoexfoliative patients treated by standard trabeculectomy constituted the control group. Intervention: Trabecular debris and pigment were cleared with a suction force of 100 to 200 mmHg under light tissue-instrument contact using a modified intraocular aspiration probe. The aspiration cannula is 400 microm in diameter and horizontally angulated at 45 degrees. Irrigation of the anterior chamber was performed via a separate irrigation cannula. Main outcome measures: The IOP and number of medications before and after surgery were measured. Results: In 42 eyes of 36 patients, trabecular aspiration was performed in combination with cataract extraction and lens implantation. The IOP dropped from 32.4 +/- 7.2 mmHg (range, 23-52 mmHg) under maximal tolerated medical therapy before surgery to 18.7 +/- 1.7 mmHg (range, 16-23 mmHg) at 2 years after surgery, with 54% of patients being controlled without medication. In 22 eyes of 19 patients, trabecular aspiration was performed as primary surgical intervention. The IOP dropped from 31.3 +/- 7.1 mmHg (range, 23-42 mmHg) before surgery to 16.8 +/- 3.4 mmHg (range, 12-23 mmHg) at 18 months after surgery, with 45% of patients not taking medication. Conclusions: Bimanual trabecular aspiration is safe and efficacious in decreasing IOP both with and without cataract extraction in pseudoexfoliation glaucoma. However, there seems to be a slight regression in effect over time attributed to undisturbed liberation of exfoliative debris. Argon-laser trabeculoplasty before trabecular aspiration reduces the IOP-lowering effect of this procedure. A prospective, randomized, multicenter study is warranted to finally assess the potential of trabecular aspiration in pseudoexfoliation glaucoma.
Article
To analyze the relationship between intraocular pressure (IOP) and visual field loss in patients with primary open-angle glaucoma (POAG) and in those with pseudoexfoliative glaucoma (PEXG). A cross-sectional, observational study. Thirty-one patients with PEXG and 31 patients with POAG that was newly diagnosed were included in this study. The authors recorded the untreated IOP and the amount of the visual field loss, at presentation, in both study groups. The authors found a significant relationship between IOP and visual field mean deviation (MD) index (P = 0.0001, r = 0.68) in PEXG but not in POAG eyes (P = 0.7). The authors found that untreated IOP levels can explain the amount of visual field loss, as measured by the MD index, much better in patients with PEXG than in comparable patients with POAG. Thus, vulnerability of the optic nerve head to increased IOP appears to be different in these two diagnostic categories.
A prospective study was performed to determine the prevalence of exfoliation syndrome in a glaucoma population of South Louisiana. Five hundred consecutive open angle glaucoma patients over 50 years of age (median age 70.6 years) from both indigent clinic and private referral sources were examined for the presence of exfoliation material on the lens capsule. The prevalence in caucasian patients was 2.7%, blacks 0.4%, combined 1.4%. This compares with a reported prevalence of exfoliation syndrome among patients with open angle glaucoma in the United States of 3% to 28%, Denmark of 26%, Ireland of 66%, and Sweden of 75%. This low prevalence may be a reflection of the ethnic origin of the population, but other explanations are considered.
Article
A prospective study of pseudoexfoliative (PSX) glaucoma was carried out in the Northwest of Spain. In 546 examined eyes with open-angle glaucoma, PSX glaucoma was found in 243 (44.5%). The mean age in eyes with PSX glaucoma was 72.4 years as opposed to 68.2 of the glaucomas without PSX. Intraocular pressure (IOP) and visual field defects were higher in the PSX glaucomas than in the non-PSX (P less than 0.0001), and within PSX glaucomas was higher in males than in females (P less than 0.001). We found no relation between the IOP of one eye and the contralateral in the bilateral PSX glaucomas, while there was a certain relation to the rest of bilateral glaucomas. In 83.9% of the unilateral glaucomas there was PSX. In 68.4% of the eyes with alteration of the field defect degree 3-4, PSX-glaucomas were observed. Finally, 59.6% of the eyes with glaucoma and cataract showed PSX.
Article
Glaucoma prevalences in the 5 Nordic countries are estimated on basis of a) wholesale of glaucoma medicaments (Denmark, Iceland, Norway, and Sweden) and b) registered glaucoma patients receiving free medication (Finland). Prevalences are compared nationally and internationally. The estimated glaucoma prevalence is highest in Norway (2.19% related to the population greater than 40 years), lowest in Denmark (0.76% in the same age group). The prevalence in Iceland, Finland, and Sweden are 2.0, 1.94, and 1.55%, respectively. We suggest that the relatively large differences in glaucoma prevalence between the countries may be explained by geographical differences in occurrence of capsular glaucoma. The sources of error concerning prevalence estimates based on glaucoma drug consumption are discussed. Pre-supposing a balance numerically between undetected glaucoma cases and patients receiving glaucoma medication without really having glaucoma, the glaucoma drug sales statistics may be taken as fair indicators of glaucoma prevalence.
Article
This investigation determined eye care utilisation patterns in a rural county in Ireland. Population based estimates of visual impairment and glaucoma were available, so the two studies will optimise planning for eye care services for the county. Roscommon has a population of 55,000 served by one ophthalmologist and two optometrists. Data were collected on all outpatient visits for all providers for a 3 month period. Information was abstracted on demographics, presenting and final diagnoses. Expected number of visits for glaucoma were calculated using the population structure and rates of glaucoma, and assuming one visit per year per glaucoma patient. 1398 patients had a total of 1442 visits in 3 months. A third of the visits were to optometrists, and all but 21 visits were for normal eye examinations or glasses. The majority of children aged less than 16 years, and people older than 60 years were seen by the ophthalmologist. Among children, 81% of all visits were to the ophthalmologist and 92% were classified as a normal examination. Only an estimated 188 visits per year for glaucoma were observed, compared with 1100 expected. In this rural county, many of the visits to the ophthalmologist were for normal eye examination, particularly among children. Screening algorithms which would free the ophthalmologist to see more complicated problems could be considered. There is an underutilisation of services by glaucoma patients. Reasons for this are described.
Article
The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.
Article
Exfoliation syndrome (XFS) is an age-related disease in which abnormal fibrillar extracellular material is produced and accumulates in many ocular tissues. Its ocular manifestations involve all of the structures of the anterior segment, as well as conjunctiva and orbital structures. Glaucoma occurs more commonly in eyes with XFS than in those without it; in fact, XFS has recently been recognized as the most common identifiable cause of glaucoma. Patients with XFS are also predisposed to develop angle-closure glaucoma, and glaucoma in XFS has a more serious clinical course and worse prognosis than primary open-angle glaucoma.
Article
With the introduction of nonpenetrating deep sclerectomy (NPDS), the safety profile of filtering surgery has dramatically improved owing to the extraocular nature of the procedure that addresses abnormally increased aqueous outflow resistance in Schlemm’s canal and the juxtacanalicular trabecular meshwork without entering the anterior chamber. The use of space-maintaining devices, antimetabolites and neodymium:YAG laser goniopuncture as adjuvant tools in NPDS has improved the long-term results, so that they are comparable with those of trabeculectomy. Therefore, NPDS has become the procedure of choice in the last few years for primary open-angle glaucoma, as well as some other forms of secondary open-angle glaucoma with surgeons who have mastered the procedure. NPDS involves removal of 4 × 4-mm deep scleral flap to deroof Schlemm’s canal and expose Descemet’s membrane, forming a decompression space or scleral lake. Aqueous humor reaches the scleral lake via the newly created trabeculo-Descemet’s membrane to be drained through different routes. The relatively long surgical learning curve remains the main disadvantage of NPDS. In this article, surgical technique, mechanism and routes of filtration, indications, contraindications, complications and results of NPDS will be discussed.
Article
Abstract The aim was to elucidate whether goniodysgenesis is more frequently observed in elderly patients with glaucoma, and furthermore, which signs of goniodysgenesis are of importance and most unanimously detected. Thus, 3 examiners evaluated 21 glaucoma patients and 19 non-glaucoma patients in a masked fashion. None of the patients had a First-degree heredity. Gonioscopy, slit-lamp examination and measurements of the corneal and pupillary diameter were performed, in all 26 variables. Significantly (P < 0.05) more frequent in glaucoma were an increased corneal diameter, scleral overriding, hypoplasia of the pupillary seam, abnormal Schwalbe's line and an opaque pretrabecular membrane (one examiner). Less frequent were a peripupillary yellow pigment ring and pigment stars on the lens. Inter-observer variation was small regarding e.g. corneal diameter but rather large regarding e.g. the pretrabecular membrane.
Article
The observed total prevalences of simple and capsular glaucoma, based on hospital records in a district with a population of about 190 000 are presented. All open-angle glaucoma patients receiving glaucoma medication are included. The total combined prevalence of simple and capsular glaucoma in the population was 0.60. The prevalences of both simple and capsular glaucoma were almost the same, 0.32 and 0.28, respectively. 47% of the open-angle glaucoma patients had exfoliation syndrome. The prevalences are age-dependent with a maximum of 4.5% combined (2.1% simple, 2.4% capsular) in the age group of 75 to 84 years. The mean annual increase in the prevalence of open-angle glaucoma was nearly linear in the age groups 65 to 84 years (0.19%), being higher in the exfoliation syndrome group (0.11%) than in the simple glaucoma group (0.08%). The results are compared to some previous population surveys.
Article
Background: To investigate the growth factor activity in the aqueous humour of patients with exfoliation syndrome (XFS). Methods: We collected 154 aqueous humour samples (69 from patients with XFS and 85 from age-matched controls) prior to routine extracapsular cataract surgery. Growth factor activity was investigated using a [3H]thymidine incorporation assay on McCoy cells that assesses DNA synthesis. Albumin concentration was measured by a radio-immunoassay as an index of blood aqueous barrier integrity. N-Acetylglucosaminidase (NAG) activity, a marker of cellular breakdown, was ascertained by a fluorometric method. Results: XFS aqueous samples exhibited significantly higher growth factor activity than to the control samples (P<0.001). Albumin concentration was also higher in the XFS group. NAG activity was similar in the two groups. No relationship between growth factor activity and the other parameters investigated was found. Conclusions: Increased growth factor activity was detected in the aqueous humour of patients with XFS. This finding may be re-lated to the pathogenesis of XFS.
Article
In a well defined population, the observed incidence of different types of glaucoma during the years 1980-82 is presented. The great majority of glaucoma patients was found to have primary open angle glaucoma, and of these approximately 3/4 had capsular glaucoma. The observed annual incidence of all types of glaucoma increases with increasing age to a maximum of 0.7% in the age group 81-85 years. In the same age group, the annual incidence of primary open angle glaucoma with visual field defects was 0.44%.
Article
Glaucoma prevalences in the 5 Nordic countries are estimated on basis of a) wholesale of glaucoma medicaments (Denmark, Iceland, Norway, and Sweden) and b) registered glaucoma patients receiving free medication (Finland). Prevalences are compared nationally and internationally. The estimated glaucoma prevalence is highest in Norway (2.19% related to the population > 40 years), lowest in Denmark (0.76% in the same age group). The prevalences in Iceland, Finland, and Sweden are 2.0, 1.94, and 1.55%, respectively. We suggest that the relatively large differences in glaucoma prevalence between the countries may be explained by geographical differences in occurrence of capsular glaucoma. The sources of error concerning prevalence estimates based on glaucoma drug consumption are discussed. Pre-supposing a balance numerically between undetected glaucoma cases and patients receiving glaucoma medication without really having glaucoma, the glaucoma drug sales statistics may be taken as fair indicators of glaucoma prevalence.
Article
To investigate the conjunctival inflammatory alterations of patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) and correlate the findings with the success of deep sclerectomy (DS) surgery and with the patients' medical history. Altogether 25 POAG and ExG patients of the prospective DS study were divided, based on the diagnosis and success of the operation, into 4 groups, POAG S (success), POAG F (failure), ExG S, and ExG F. Controls were obtained from other ophthalmologic surgery patients who did not have glaucoma, and their conjunctiva was examined to be normal. Inflammatory cell subtypes in the conjunctiva were identified and quantified by using immunohistochemistry and monoclonal antibodies: CD3 (T-lymphocyte marker), CD4 (T-helper lymphocyte marker), CD8 (T-cytotoxic lymphocyte marker), CD20 (pan-B cell marker), CD38 (plasma cell marker), CD45RA (naïve T-cell marker), and CD68 (macrophage marker). Higher numbers of inflammatory cells were found in the conjunctiva of the glaucoma patients on medical treatment compared with the normal conjunctiva of the controls. Moreover, T-lymphocytes, T-helper lymphocytes, T-cytotoxic lymphocytes, B cells, plasma cells, and macrophages were found in significantly higher numbers in patients in whom DS failed during the follow-up period of 2.5 years than those with surgical success. High numbers of cytotoxic and helper T-lymphocytes, plasma cells, and macrophages indicate a chronic inflammatory reaction in the conjunctiva of glaucoma patients. The chronic inflammation is most probably owing to the chronic topical treatment of the patients and seems to be a significant risk factor for DS surgery failure.
Article
Chronic open angle glaucoma is an etiologically heterogeneous group of diseases characterized by damage to the optic nerve, resulting in peripheral visual loss that can progress to involve the fovea and central vision. Open angle glaucoma can be divided into primary conditions and conditions which are secondary to another ocular or systemic disease. Causes of secondary glaucoma include uveitis, cataract, trauma, and disorders affecting the development structure of the angle. This review focuses on primary open angle glaucoma (POAG), since it accounts for the vast majority of the disease burden in the US population and its etiology remains unknown.
Article
Full-text available
Aim: Glaucoma is defined as chronic, progressive optic neuropathy caused by a group of ocular conditions, which leads to damage of the optic nerve with loss of visual function. This study was conducted to find out the changes in corneal curvature, axial length and intraocular pressure. Materials and Methods: The present study was conducted in the Department of Ophthalmology, S P Medical College and Associated Group of Hospitals, Bikaner. A total of fifty cases of either age- and sex-matched controls were selected for this study. These cases were divided into two groups: Group A (sutureless trabeculectomy with mitomycin-C [MMC]) and Group B (sutureless trabeculectomy without MMC). Results: The mean post-operative intraocular pressure (IOP) was lowered in MMC-treated eyes when compared to control at 1½ months. The IOP reduction was greater in the MMC-treated eyes (13.25 mmHg at 1½ months) as compared to control Group B (16.9 mmHg at 1½ months). Comparing results with the present study, it was found that success rate in MMC-treated eyes was noted in 23 (92%) individuals, in which complete success was in 22 (88%) while qualified success in 1 (4%) and qualified failure in 2 (8%) with mean IOP of 13.2 mmHg at 1½ months, whereas in control group, success rate was noted in 19 (76%) individuals, in which complete success was in 18 (72%) and qualified success in 1 (4%), while qualified failure in 6 (24%) with mean IOP of 16.9 mmHg at 1½ months after operation. Conclusion: Results of this study are in favour of intraoperative application of MMC during filtration surgery, especially in cases with high-risk failure.
Article
This paper is based on a prospective survey covering 275,600 sight tests by optometrists in England and Wales. It analyses the age and sex distribution of 1402 referrals for suspected glaucoma and 456 confirmed cases of the disease. The proportion of sight tests which led to a confirmed case increased with age, for both sexes, to a maximum at approximately 70 years, and then tended to decline. Cases of glaucoma in people aged 36-51 years accounted for about a tenth of the total, which is more than is generally recognized. Wider adoption of routine tonometry for middle aged people would help to ensure that these cases are detected at an early stage. Confirmed cases of glaucoma in which raised intraocular pressure had not been given as a reason for referral, i.e. probable low tension glaucomas, increased from 5% of patients < 51 years old to 13% of patients > 75 years old. Glaucoma was found to be much more common in men.
Article
Of all patients attended to in a clinic during 1986, 441 had open angle glaucoma diagnosed during 1974-1986 on the basis of either a verified visual field defect, a glaucomatous disc, or a repeated intraocular pressure value of at least 35 mm Hg. At first presentation of recent cases 1984-1986 (N = 128) 65 per cent were more than 70 years old. Capsular glaucomas were twice as common as simple glaucomas (low tension cases included). 62 per cent of capsular but only 26 per cent of simple glaucomas had an initial pressure of 35 mm Hg or more (p < 0.001). One third of both capsular and simple glaucomas had an advanced visual field defect with breakthrough to the periphery in the worse eye already at first presentation. This was more common if the initial pressure was 35 mm Hg or more (p < 0.05). Almost half remained unilateral cases, and the rate of severely impaired visual function in the better eye did not exceed 15 per cent. While generally 30-50 per cent of glaucomatous field defects had progressed in five years, the progression in early detected cases was only three per cent (p < 0.05). Visual field defects with breakthrough to the periphery already at first presentation progressed more often than circumscribed scotomas (p < 0.02).
Article
Full-text available
Purpose: To evaluate the efficacy and safety of primary glaucoma drainage implant (GDI) surgery for exfoliation glaucoma (XFG). Methods: This study was a retrospective, consecutive case series study including 36 eyes of 36 patients with XFG who underwent primary GDI surgery. Intraocular pressure (IOP), the mean deviation (MD) from the visual field exam, corneal endothelial cell density (ECD), and the number of topical antiglaucoma agents used during the preoperative and postoperative periods were retrospectively analyzed. Surgical success was defined by the following criteria: (1) IOP ≤ 18 mmHg and an IOP reduction of 20% with 1 or no medication; (2) IOP ≤ 15 mmHg and an IOP reduction of 25% with 1 or no medication; and (3) IOP ≤ 12 mmHg and an IOP reduction of 30% with 1 or no medication. The probability of success of GDI surgery was determined via Kaplan-Meier survival analysis. Results: The preoperative IOP was 25.9 ± 4.7 mmHg, and the postoperative IOP at 24 months was decreased to 14.2 ± 3.6 mmHg (p value < 0.001). The postoperative MD and ECD were similar to baseline (MD p value = 0.155; ECD p value = 0.055). However, a significant reduction in the number of antiglaucoma agents was observed (p value < 0.001). The surgical success rates were 77.8%, 63.9%, and 55.6% at 24 months for criteria 1, 2, and 3, respectively. Early hypotony (4 patients, 11.1%) and persistent corneal edema (5 patients, 13.9%) were the most common early and late postoperative complications, respectively. Conclusions: In XFG, primary GDI surgery reduced IOP by 45.2% and had a 77.8% success rate according to criteria 1 at 24 months postoperatively. However, considering that ECD reduction continues to decline over time, primary GDI surgery should be carefully considered in XFG.
Article
In a case-finding study in a municipality in central Sweden, 128 cases of chronic open-angle glaucoma with visual field defects (VFD) were found. The prevalence amounted to 1.4% in those greater than or equal to 45 years of age. Sixty-three percent had capsular glaucoma. Advanced visual field defects (AVFD), i.e. a restriction of the visual field to a diameter of less than or equal to 20 degrees, were seen in 49 patients. Four patients had AVFD in both eyes. Patients with AVFD were older, had had the disease longer, had higher mean initial intraocular pressure (IOP), and had more extensive VFD at the time of diagnosis. When age and duration were taken into consideration, the risk of developing AVFD was 14 times greater in those with VFD stage III at the time of diagnosis, i.e. a Bjerrum scotoma with nasal breakthrough or more widespread VFD. An IOP of greater than or equal to 35 mmHg signified that the risk of having VFD stage III at the time of diagnosis, when age and type of glaucoma were taken into consideration, was 8.6 times greater than if the IOP was less than 35 mmHg.
Article
Surgical and laser procedures traditionally used in the management of exfoliation glaucoma (XFG) include laser trabeculoplasty, trabeculectomy, and glaucoma drainage implant surgery. Having demonstrated similar safety and efficacy in XFG compared with primary open-angle glaucoma, trabeculectomy remains the most commonly performed surgery in XFG. Recent trends in practice patterns in developed nations demonstrate a shift towards glaucoma drainage implant surgery, which is currently the procedure of choice in XFG for many, particularly in developed nations. In addition, cataract surgery alone may significantly decrease intraocular pressure in patients with XFG, may prevent glaucoma development in patients with exfoliation syndrome, and is recommended to be performed early in the course of the disease. With the relatively recent introduction of nonpenetrating glaucoma surgery and the ongoing evolution of minimally invasive glaucoma surgery, several other surgical procedures have now become part of the glaucoma surgeon's armamentarium when treating XFG, including the Ex-PRESS shunt, deep sclerectomy, viscocanalostomy, Trabectome, as well as angle procedures. These techniques have demonstrated promising results in various types of glaucoma. More research is, however, needed to establish the safety and efficacy of these procedures in XFG.
Article
A group of 100 institutionalized geriatric patients aged 69-94 years (mean 81.2 years) was studied at Koskela Helsinki Municipal Hospital. The selection of the patients was randomized by taking 100 patients having a birth-date divisible by five. Glaucoma occurred in 15% of the patients (14 women and one man). Six patients had bilateral primary open-angle glaucoma. One patient had capsular glaucoma in one eye and secondary glaucoma in the other eye. Eight patients had glaucoma only in one eye; three narrow-angle glaucoma, three primary open-angle glaucoma and two secondary glaucoma. Exfoliation occurred in 21 patients (26%, 21/80). Ten patients had bilateral exfoliation and 11 exfoliation only in one eye. IOP was measured in 75 patients, 150 eyes, with applanation tonometry, averaging 12.5 mmHg (SD 5.0), and in 22 patients, 44 eyes, with Schiötz tonometry, averaging 16.3 mmHg (SD 5.6). Visual acuity for long distance and also the reading acuity were greater than 0.3 in 66% (54/82).
Article
In general, an association exists between the ocular pressure level and the future development of glaucomatous visual function loss. Using the ocular pressure reading, the task of searching for individuals who are likely to develop glaucomatous visual function loss can be limited. Identification of the individual who is destined to develop glaucomatous field defect cannot be made on the basis of tonometric and tonographic values with any practical degree or precision as to warrant the diagnosis or the therapeutic intervention for glaucoma prior to the onset of visual field defect, nor can the definite diagnosis of glaucoma be made in the individual subject prior to the demonstration of a characteristic involvement of visual function. Skillful thorough examination of the central visual field must be the cornerstone of any attempt at early detection of glaucoma.
Article
To study the prognosis of capsular glaucoma (102 eyes) as compared to simplex glaucoma (58) eyes), a retrospective comparison of the functional status of these diseases when first diagnosed and five years afterwards was made. At the first examination the capsular glaucoma eyes were on average more seriously damaged. After five years this tendency was more marked with several amaurotic eyes, 17% as compared to 10% of the simplex glaucoma group. Severe visual field loss in the eyes with advanced glaucoma after five years was present in 48% of the capsular glaucoma group but only 19% of the simplex glaucoma group.
Article
In a hospital series of 222 consecutive glaucoma cases in Central Finland, senile open angle glaucoma was observed in 137 patients (61.7 %>. Simple glaucoma was present in 79 (35.6 %>) of these, capsular glaucoma in 58 (26.1 %). The simple glaucomas constituted 57.7% and the capsular glaucomas 42.3 % of the senile open angle glaucomas. The proportion of capsular glaucoma clearly grew with increasing age and constituted 61.5% in the oldest age group (80–89 years). Capsular glaucoma was diagnosed at a mean age of 67.9 years, simple glaucoma 7.3 years earlier. Despite the fact that pseudoexfoliation of the lens is more frequent in Finland than in Norway, the capsular glaucomas constitute about 40 % of the hospitalized senile open angle glaucomas in both countries.
Article
The occurrence of glaucoma was studied in a population comprising 1963 persons born during 1907 to 1921 and living in a small Swedish suburban and rural district. The records of 24 patients treated for glaucoma were examined. An estimate of the prevalence of glaucoma in untreated persons was based on an examination of 1511 subjects by standardised methods (including automatic perimetry) and strict diagnostic criteria. About 20% of all cases of glaucoma with visual field defects in the whole population were already known. Only 7 out of 15 cases of previously unknown but manifest glaucoma had intraocular pressures above 20-5 mmHg. The reduction in visual capacity caused by glaucoma in the present population was limited.
100 cases of the exfoliation syndrome are reviewed with comments on detection, signs, prognosis and nomenclature. Comparison of the involved eye in unilateral cases with the uninvolved fellow eye reveals abnormalities of the seemingly normal eye in the majority of cases. It is postulated that the exfoliation syndrome may exist in three different states: in a normal eye without glaucoma, causing a secondary glaucoma when the exfoliative process itself causes the block to aqueous outflow, in which exfoliation aggravates an existing open angle glaucoma. Histological study confirms impressions of earlier workers that the material can be found outside of the eye near vessels and basement membranes. Further work needs to be done in an attempt to detect exfoliative material in the basement membranes of tissues elsewhere in the body. The term 'exfoliation syndrome' is strongly suggested to replace all previous nomenclature. 'Exfoliation syndrome with and without glaucoma' may be appropriate modifications.
The Framingham eye study monograph
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Hollows F C & Graham P A (1966): Intra-ocular pressure, glaucoma, and glaucoma suspects Krause U (1973): Frequency of capsular glaucoma in central Finland. Acta Ophthalmol Layden W E & Shaffer R N (1974): Exfoliation syndrome. Am J Ophthalmol78: 835-841.
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Aasved H (1971a): The frequency of optic nerve damage and surgical treatment in chronic Aasved H (1971b): Intraocular pressure in eyes with and without fibrillopathia epithelio-Armaly M (1969): Ocular pressure and visual fields. Arch Ophthalmol81: 25-40. Bankes J L K, Perkins E S, Tsolakis S & Wright J E (1968): Bedford glaucoma survey. Br Med Bengtsson B (198 1 ) : The prevalence of glaucoma. Br J Ophthalmol65: 46-49.