the correlation between glaucoma and aging

7/28/2019 The Correlation Between Glaucoma and Aging

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THE CORRELATION BETWEEN

GLAUCOMA AND AGING

Purnamandala


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Introduction

Glaucoma comes from Greek word glaucos meaning

aquamarine, giving the sensation of colour at pupil

glaucoma patient.

Glaucoma is eye disease which is marked by theincreasing of intraocular pressure which is

accompanied with minimizing of visual field.

Almost 80.000 blind United States resident as result

of glaucoma


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Anatomy and Physiology of Aqueous

humor drainage


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Intraocular Pressure

Normal 15-18 mmhg

IOP can be increased due to due to the flow

resistance of Aquous Humor

Open angle gloucoma

It is due to decreased of trabekula meshwork

permeability

Close angle gloucoma

It is due to the narrow of anterior chamber


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Glaucoma

Glaucoma is a name given to a group diseases in whichthe intraocular pressure (IOP) is sufficiently elevated todamage vision.

Glaucoma is currently defined as a disturbance of the

structural or functional integrity of the optic nerve thatcauses characteristic atrophic changes in the opticnerve, which may also lead to specific visual fielddefects over time.

The generic term glaucoma should only be used inreference to the entire group of glaucomatousdisorders as a whole, because multiple subsets ofglaucomatous disease exist.


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There are two type of glaucoma :

1.Primary angle closure glaucoma

2. Primary angle open glaucoma


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Predisposing factors

1. Anatomical

Eyes with PACG characterized by:

A relatively anterior location of the iris-lens diaphragm

A shallow anterior chamber depth & narrow entrance tothe chamber angle

The proximity of peripheral iris to cornea enables angleclosure to occur more easily than in normal eye

Positive family history for angle closure

Age over 40-50 years

Woman

History of angle closure symptoms

Hypermetropia

PseudoexfoliationRacial group (eskimo > asian > caucasian = african


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Dilator muscles contraction exerts aposterior vector increases amount ofapposition between iris & the anteriorlylocated lens & enhances degree ofphysiological pupillary block

Simultaneous dilatation pupil rendersperipheral iris more flaccid

Relative puppilary block causes

pressure in posterior chamber &peripheral iris bow anteriorly (iris bombe)

The angle becomes obstructed byperipheral iris & IOP

Dilator muscle theory

Pupils spinhter prime culprit inprecipitating angle closure. Pupillaryblocking force the spinchter greatest whenpupils diameter 4 mm

Spinchter muscle theory

not understoodEmotional

2. Physiological


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Lens induced PACG lens size (phacomorphic) & lens position (phacotopic) lens

passes against the posterior surface of the iris and ciliary body or indirectly when the

increased lens-iris contact hastens the pupillary block component.

Shorter eye of a hypertropic person in middle to old age continually growing lens

may be sufficiently anterior to impede the flow of aqueous through the pupil andproduce a pupillary block results in the development of a pressure gradient across

the iris that causes the iris to bow forward (iris bombe) mechanically cover the

trabecular meshwork IOP


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Pupillary block a pressure gradient exists between the anterior & posterior

iris surfaces the pressure in the posterior chamber greater than anterior

chamber. Absolute pupillary block there is no aqueous flow through the pupil as

in occlusion pupillae as a result of posterior synechiae (iris to lens).

Relative pupillary block some degree of resistance to forward aqueous

flow exists between the surfaces of the anterior capsule & the posterior iris.


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Iris induced PACG plateau iris mechanism results from iridotrabecular

contact when the pupil is dilated. Also referred to as angle crowding occur

when any or all of the following occur:

oTissue of the peripheral iris is thick (peripheral iris roll)

oIris base inserts anteriorly and leaves only a very narrow ciliary band,

or inserts into the scleral spur

oCiliary processes are displaced anteriorly in the posterior chamber

and push the iris base forward into the angle recess


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Primary angle open glaucoma

Primary open-angle glaucoma (POAG) isdescribed distinctly as a multifactor opticneuropathy that is chronic and progressive

with a characteristic acquired loss of opticnerve fibers

POAG is a major worldwide health concern,because of its usually silent, progressivenature, and because it is one of the leadingpreventable causes of blindness in the world


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Intraocular pressure also can be elevated through obstruction of aqueous humor

drainage. This occurs through a structure called the trabecular meshworkand appears to

be the main mechanism by which intraocular pressure becomes elevated

In Elderly people,the trabecula meshwork will degenerate


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Mechanism of Open Angle Glaucoma


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Major Risk Factors: These tend to be related to

the mechanical theory of damage to the opticnerve.

Age: 40 years and older

History of elevated intraocular pressureFamily history of glaucoma

Ethnicity: African American and Hispanic

Myopia (nearsightedness)


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Discussion

Age affects the occurrence of glaucoma, where

increasing age affects the anatomy of the eye

The lens in elderly people will be thicker, and then it

makes higher degree of hypermetropia. High degrees of hypermetropia are strongly related

to angle closure glaucoma.

Aging also can cause drainage channels in thetrabecular meshwork to shrink or narrow, which

slows the outflow of fluid from the eye.


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CONCLUSION

Glaucoma is a name given to a group diseases in whichthe intraocular pressure (IOP) is sufficiently elevated todamage vision.In primary angle closure glaucoma, The lens inelderly people will be thicker, and then it makes higher degreeof hypermetropia. Lens induced angle closure glaucoma

results directly when a lens passes against the posteriorsurface of the iris and ciliary body or indirectly when theincreased lens-iris contact hastens the pupillary blockcomponent. In the angle closure glaucoma the obstruction toaqueous outflow is caused by closure of the chamber angle by

the peripheral iris.In primary open-angle glaucoma, Aging alsocan cause drainage channels in the trabecular meshwork toshrink or narrow, which slows the outflow of fluid from theeye.


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REFERENCES

Yanoff M, Duker JS. Ophthalmology. 2nd ed. 2004. Philadelphia:Elsevier. p.1416,1423,1491-93.

Mansjoor A, Triyanti K, Savitri R, Wardhani WI, Setiowulan W. KapitaSelekta Kedokteran. Edisi 3. 2000. Media Aesculapius. FakultasKedokteran Universitas Indonesia. p.59.

Valdilvia.primary open angle glaucoma .Accessed at July 111st 2011.Available at: http://www.glaucoma-eye-info.com/Open-Angle-Glaucoma.html

.Bell JA. Primary Open-Angle Glaucoma .Accessed at July 13rd2011Available at:http://emedicine.medscape.com/article/1206147-overview#a0101

Dorland N. Kamus Kedokteran Dorland. Edisi 31. 2010. Jakarta:Penerbit Buku Kedokteran EGC. p.915
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the correlation between glaucoma and aging

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