12/2/2016 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 Malik Kahook, MD Robert Stamper, MD • Taking Combigan and • Wouldn’t YOU rather • Generics are cheaper latanoprost use brand name or and just as effective • Target IOP = ≤ 14 mmHg preservative-free • Active 63-year-old • Recent IOPs are 18-21 drops? • Appearances matter mmHg • Mother went blind • Complaining about the from glaucoma drops 1
12/2/2016 Case #2: no LPI or LPI • Referred as a PAC suspect • No symptoms of intermittent angle closure Case #2: A primary angle closure elicited, no problem with dilation 1 year ago suspect is referred and has no signs • On no anti-cholinergic, sympathomimetic drugs of intermittent angle closure OD OS VA 20/25 20/25 -1.50+2.00x175 -0.50+2.00x166 IOP 19 mmHg 20 mmHg PTM 360 o , no PAS PTM 360 o , no PAS Gonio Lenses 1+ NS 1+ NS AC Shallow temporal Shallow temporal angle angle 2
12/2/2016 Case #3: A patient presents with Shan Lin, MD Ying Han, MD, PhD newly diagnosed advanced • There’s no harm in • Let’s do an LPI right away glaucoma waiting and observing 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 3
12/2/2016 Sriranjani Padmanabhan, MD Yvonne Ou, MD • Let’s go straight to surgery • Give medications or laser a trial first 4
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