Glaucoma Short Paper 1: Medical Literature Review for a Case Study

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1 Glaucoma Short Paper 1: Medical Literature Review for a Case Study BBH 411W Devon Stobbe * The purpose of the writing is to fulfill course requirements for BBH 411W and to stand as a personal writing sample, but the findings should not be treated as generalizable research

2 Abstract The following literature review includes the etiology, symptomology, and treatment of glaucoma. The corresponding case study surrounds the story of a middle-aged woman with many predispositions to a glaucoma diagnosis. A family history of diabetes and glaucoma, diabetes herself, smoking cigarettes, and extra stress compose her risk factors. Recommended treatment for a positive prognosis is discussed. Introduction Glaucoma is a common ocular disease that affects both the structure and function of the eyes. This disease can ultimately result in blindness and stems from an increase in pressure inside the eye, termed intraocular pressure (WebMD, 2014). As the pressure of the liquid inside the eye builds, the optic nerve - which sits posterior to the eye and is responsible for sending the images an individual view s to the brain for processing can become damaged and lose its ability to transmit these image signals to the brain (NEI). This loss of function results in some degree of vision loss, if not complete blindness. Two types of glaucoma exist: Open-angle glaucoma and Angle-closure glaucoma. These types differ in both their prominence and their prognosis. The most common form, Open-angle glaucoma, arises slowly due to improper drainage of the ocular fluid; while Angle-closure is less common, arises much more rapidly, and is due to a decreased angle between the iris and the cornea (WebMD, 2014). Diagnosis for either of these forms can be concluded through various tests. These tests include measuring the intraocular pressure of an individual s eye (tonometry), checking the optic nerve for damage, as well as performing various visual field tests to check vision proficiency (NEI).

3 There are many etiological theories present concerning the onset of glaucoma. A recent study outlined a positive association between the presence of Chronic Kidney Disease (CKD) and glaucoma. The mechanism for this association is believed to arise from an imbalance of urea in the blood that is often present in individuals with CKD, which travels down its concentration gradient to the aqueous humor of the eye, causing an increased level of fluid and pressure (Wong et al., 2014). Another risk factor associated with developing glaucoma is the presence of Diabetes Mellitus. Individuals who have Diabetes Mellitus have decreased retinal blood flow as well as increased blood-glucose levels, which are both believed to contribute to intraocular pressure sensitivity, leading to a heightened risk of developing glaucoma (Doucette, 2015). Certain environmental and personal factors are also hypothesized to contribute to glaucoma. These factors include previous eye injury, aging (40+), overuse of corticosteroids, smoking, as well as the presence of certain genes (WebMD, 2014). Susan Jones is a 46-year-old woman who lives in Philadelphia. Her father had Diabetes Mellitus, which resulted in glaucoma, causing him to go blind in his left eye. Susan has always made sure to visit her Optometrist regularly for this reason, especially because she has diabetes herself. But after recently losing her job, Susan lost her health insurance, and therefore has not been to the eye doctor in a few years. She smokes cigarettes daily, and has not been taking care of her health in respect to her diabetes. Although symptomatically she feels fine and has not experienced any pain, she has been noticing some instances where she cannot see peripherally, but this occurs fairly infrequently so she isn t worried. Expected prognosis for common cases of glaucoma depend on how early the disease has been caught. Because the symptoms are irreversible, early diagnosis is key to a desirable

4 prognosis. If diagnosed early enough, an individual has several options. Various medications in the form of eye drops are often prescribed in order to either decrease the production of intraocular fluid, or increase the rate at which the fluid is able to flow out of the eye. These medications include Prostaglandins, Beta blockers, and Alpha-adrenergic agonists (Mayo Clinic, 2015). Another option for treatment includes a surgery in which a small incision is created in the eye to extract a portion of the improperly functioning meshwork of the eye using a tool called a trabectome (Augenheilkunde, 2014). These treatment options have proven success for most patients when the disease is caught early enough, but if vision loss has occurred already, nothing can be done to reverse it. Because Susan has genetic susceptibility to both diabetes and glaucoma, it is important for her to see an Optometrist regularly, especially because she is experiencing questionable peripheral vision. Getting regular vision field tests as well as a tonometry test annually are important for individuals with a predisposition like Susan. Choosing to stop smoking cigarettes is another lifestyle change Susan could enact in order to improve her prognosis of glaucoma, as well as choosing to eat a healthy diet and avoiding caffeinated beverages which often increases intraocular pressure (WebMD, 2014).

5 References Augenheilkunde, Klinik. "Minimally Invasive Glaucoma Surgery Using the Trabectome." (2015): PubMed. Web. 26 Jan < Doucette, Lance P. "The Interactions of Genes, Age, and Environment in Glaucoma Pathogenesis." Survey of Ophthalmology 60.4 (2015): PubMed. Web. 26 Jan < =Entrez:PubMed&id=pmid: >. Mayo Clinic. "Glaucoma." Mayoclinic.org. The Mayo Clinic, 15 Sept Web. 26 Jan < >. NEI. "Facts About Glaucoma." The National Eye Institute. Web. 26 Jan < WebMD. "Glaucoma and Your Eyes." WebMD. 28 Sept Web. 26 Jan < Wong, Chee Wai, et al. "Kidney And Eye Diseases: Common Risk Factors, Etiological Mechanisms, And Pathways." Kidney International 85.6 (2014): Academic Search Alumni Edition. Web. 26 Jan

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