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But in any case, anything that gets the glaucoma doc talking to the cornea doc is a big plus in my book. Treating the whole eye, rather than compartmentalizing the front and the back... what a concept! Good going.
Ocular Surface Disease Exacerbated Glaucoma: Optimizing theOcular Surface Improves Intraocular Pressure Control.
PURPOSE:
To describe a series of 4 patients with inadequately controlled primary open angle glaucoma and ocular surface disease (OSD) in whom a combination approach was used to manage the OSD resulting in improved intraocular pressure (IOP) control.
PATIENTS AND METHODS:
A retrospective review of the clinical notes of 4 patients referred to a tertiary surgical glaucoma service was performed. At the initial visit, measures to control the OSD were employed in all patients; twice-daily lid hygiene measures, a 3-month course of 50 mg daily oral doxycycline, topical carmellose sodium (celluvisc) 0.5% 4 to 6 times daily, and preservative-free equivalents of topical antiglaucoma medications as deemed appropriate, depending on the perceived severity of the OSD.
RESULTS:
Patients were reviewed for a maximum of 24 months after intervention. In all patients treatment resulted in a marked symptomatic and clinical improvement in the ocular surface with a reduction in hyperemia, meibomian gland dysfunction and superficial keratopathy. A reduction in the IOP also occurred in all patients, obviating the need for glaucoma drainage surgery during the study period.
CONCLUSIONS:
Patients with severe OSD often have glaucoma that is refractive to medical therapy. Furthermore, the surgical success of glaucoma filtering surgery is compromised in patients with scarring and inflammation of the conjunctiva. The term we postulate is "OSD exacerbated glaucoma." This is the first study to suggest that the use of a combination approach comprising medical treatment to manage the OSD in patients with primary open angle glaucoma may lead to an improvement in the IOP control and the management of glaucoma.
To describe a series of 4 patients with inadequately controlled primary open angle glaucoma and ocular surface disease (OSD) in whom a combination approach was used to manage the OSD resulting in improved intraocular pressure (IOP) control.
PATIENTS AND METHODS:
A retrospective review of the clinical notes of 4 patients referred to a tertiary surgical glaucoma service was performed. At the initial visit, measures to control the OSD were employed in all patients; twice-daily lid hygiene measures, a 3-month course of 50 mg daily oral doxycycline, topical carmellose sodium (celluvisc) 0.5% 4 to 6 times daily, and preservative-free equivalents of topical antiglaucoma medications as deemed appropriate, depending on the perceived severity of the OSD.
RESULTS:
Patients were reviewed for a maximum of 24 months after intervention. In all patients treatment resulted in a marked symptomatic and clinical improvement in the ocular surface with a reduction in hyperemia, meibomian gland dysfunction and superficial keratopathy. A reduction in the IOP also occurred in all patients, obviating the need for glaucoma drainage surgery during the study period.
CONCLUSIONS:
Patients with severe OSD often have glaucoma that is refractive to medical therapy. Furthermore, the surgical success of glaucoma filtering surgery is compromised in patients with scarring and inflammation of the conjunctiva. The term we postulate is "OSD exacerbated glaucoma." This is the first study to suggest that the use of a combination approach comprising medical treatment to manage the OSD in patients with primary open angle glaucoma may lead to an improvement in the IOP control and the management of glaucoma.
Batra R, Tailor R, Mohamed S.
University Hospitals Birmingham, Birmingham, UK.
`Consider offering people with COAG who are intolerant to a prescribed medication: alternative pharmacological treatment (a prostaglandin analogue, beta-blocker, carbonic anhydrase inhibitor or sympathomimetic) or a preservative-free preparation if there is evidence that the person is allergic to the preservative.'
NB ocular hypertenson is extended here to include chronic inflammation, and that anyone with a risk of raised eye pressure through chronic inflammation or use of steroid eyedrops is entitled to frequent eye pressure checks, NHS. When the eye pressure is raised, an optometrist must refer to an ophthalmologist and the ophthalmologist must provide a management plan. The optometrist must be qualified to identify clinical changes and must refer them (College of Optometrist guidelines). Clinical changes for which they must refer include intraocular pressure above 21mmHg, signs on optic nerve heads and fundus.
A list of qualified optometrists providing co-care services in the 'community' is provided by the Primary Care Trust or Clinical Commissioning Group.