Welcome to the Glaucoma Debates Case #1: Your patient doesnt want - - PowerPoint PPT Presentation

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Welcome to the Glaucoma Debates

Case #1: Your patient doesn’t want laser or surgery for increasing IOP, but also complains about her drops

Case #1: Doesn’t like drops, doesn’t want surgery

• Moderate glaucoma by VF
• Adamantly against surgery
• Taking Combigan and

latanoprost

• Target IOP = ≤ 14 mmHg
• Recent IOPs are 18-21

mmHg

• Complaining about the

drops

• Active 63-year-old
• Appearances matter
• Mother went blind

from glaucoma Malik Kahook, MD

• Wouldn’t YOU rather

use brand name or preservative-free drops? Robert Stamper, MD

• Generics are cheaper

and just as effective

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Case #2: A primary angle closure suspect is referred and has no signs

• f intermittent angle closure

Case #2: no LPI or LPI

• Referred as a PAC suspect
• No symptoms of intermittent angle closure

elicited, no problem with dilation 1 year ago

• On no anti-cholinergic, sympathomimetic

drugs

OD OS VA 20/25 20/25

• 1.50+2.00x175
• 0.50+2.00x166

IOP 19 mmHg 20 mmHg Gonio PTM 360o, no PAS PTM 360o, no PAS Lenses 1+ NS 1+ NS AC Shallow temporal angle Shallow temporal angle

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Shan Lin, MD

• There’s no harm in

waiting and observing Ying Han, MD, PhD

• Let’s do an LPI right away

Case #3: A patient presents with newly diagnosed advanced glaucoma

Case #3: Initial Meds/Laser vs. Surgery

• Referred by optometrist
• IOP = 38 and 36 mmHg
• Nerves = 0.95 and 0.9

73-year-old retired lawyer

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Yvonne Ou, MD

• Give medications or

laser a trial first Sriranjani Padmanabhan, MD

• Let’s go straight to surgery