Inheritance and Family HistoryGlaucoma is a polygenic disease with an estimated heritability of 70%. 6First-degree relatives of glaucoma patients have a 22% lifetime risk of glaucoma as compared to 2.3% among those with no family history.About 10% of siblings of glaucoma patients have glaucoma compared to 0.7% of siblings of those without glaucoma. 7The novel loci for adult-onset glaucoma include the following: POAG, [ABCA1, AFAP1, GMDS, PMM2, TGFBR3, FNDC3B, ARHGEF12, growth arrest-specific protein 7 (GAS7), FOXC1, ATXN2, TXNRD2]; PACG, (EPDR1, CHAT, GLIS3, FERMT2, DPM2-FAM102); and exfoliation syndrome (XFS) glaucoma (calcium voltage-gated channel subunit α1 A). 8 Sixteen genomic regions have been associated with POAG, eight with PACG and two with XFS.Molecular and cellular events caused by mutations in myocilin, organ procurement and transplantation network, and TANK-binding kinase 1 have been suggested to have a role in early onset glaucoma. 8Transmembrane and coiled-coil domains 1 and GAS7 mutations can effect neuron regeneration along with IOP elevation.p38 mitogen-activated protein kinases are common pathways involved in neurodegenerative IntroductIonThough IOP remains to be the best established and most modifiable risk factor, glaucoma is best considered a progressive optic neuropathy representing the final outcome of a number of disorders.As per the current knowledge, the etiopathogenesis of glaucoma may involve either one or a combination of the following major mechanisms:• Mechanical damage/barotrauma (IOP-related).• Vascular (decreased blood supply to optic nerve head).• Biochemical (decreased levels of neurotrophic factors/increase in levels of neurotoxins/mitochondrial dysfunction).There is increasing evidence that factors not limited and related to the IOP have a significant role in the etiopathogenesis as well as the progression of glaucoma. 1We need to approach glaucoma as a systemic disease and look at each system of the human body and its impact on glaucoma.This article aims to agglomerate all the risk modifiers/stressors associated with primary open and angle closure glaucoma, which together constitute a cumulative biological risk of causation/progression of glaucomatous damage. EpIdEmIologIcal Factors AgeAge is a significant modifier of the relationship between IOP and retinal nerve fiber layer (RNFL) loss over time and older patients are more likely to have glaucoma progression than younger patients at similar IOP. 2 This may be related to mitochondrial dysfunction, inability to handle oxidative damage, vascular alterations, and changes in the biomechanics of the optic nerve head with advancing age. 3 RaceHigher prevalence, earlier presentation, and faster progression of primary open-angle glaucoma (POAG) in African and Hispanic populations can be due to thinner corneas, larger optic nerve heads, and a higher prevalence of vascular diseases such as diabetes and hypertension. 4Asians are more susceptible to primary angle closure glaucoma (PACG) due to the risk of having narrow angles.
The advent of minimally invasive glaucoma surgery (MIGS) fractioned the world of glaucoma practice into two distinct groups: those who believed, and those who did not.Minimally invasive glaucoma surgery, a term at best poorly defined, was touted as a panacea for all the evils that plagued the glaucoma surgeon, be it poor compliance to medication, the ephemeral nature of SLT, or the dreaded complications of conventional glaucoma surgeries.The naysayers were quick to coin the moniker, "minimally effective glaucoma surgery (MEGS)" pointing out its potentially lesser efficacy as compared to conventional surgeries.Those on the MIGS bandwagon credited it to observer envy, and indeed, as the focus of innovations in glaucoma surgery, glaucoma surgery shifted from efficacy and cost effectiveness, to safety and efficacy, MIGS seemed here to stay. 1,2egardless of what your position is on the MIGS debate, the recent news of Alcon's voluntary and abrupt global market withdrawal of its CyPass Micro-Stent has brought into sharp focus what has always remained in the periphery of the glaucoma surgeons' field of vision: the noxious effect of glaucoma surgery on corneal endothelium. 3 ENDOTHELIAL CELLS, OR WHAT WE CHOOSE TO IGNOREGlaucoma, per se as well as its management, may have deleterious effects on the corneal endothelium.The possible mediators of this damage may include increased IOP,
Complementary and alternative medicine deserves scientific scrutiny as patients with glaucoma often lose vision despite adequate medical or surgical treatment.Most glaucomatologists abstain from recommending alternative medicine as there is little evidence to support most of the recommendations for complementary and alternate management (CAM) use in glaucoma.Megavitamin supplementation has not been shown to have a long-term beneficial effect on glaucoma.In a glaucomatous eye, a very modest benefit of IOP-lowering may be offset by the temporary elevation in IOP that accompanies exercise.There is little evidence to support the use of special diets, acupuncture, relaxation techniques, or therapeutic touch for the treatment of glaucoma.Marijuana can have a profound lowering of IOP, but the low response rate, short half-life, and significant toxicity are strong indicators that it is not an appropriate therapeutic agent.Future research must be carried out to document the effect of CAM not only on IOP, but also on perimetric tests or other objective parameters, such as ocular blood flow and nerve fiber layer thickness.
Although the healing effect of music has been recognized since time immemorial, there has been a renewed interest in its use in modern medicine. This can be attributed to the increasing focus on holistic healing and on the subjective and objective aspects of well-being. In ophthalmology, this has ranged from using music for patients undergoing diagnostic procedures and surgery, as well as for doctors and the operation theatre staff during surgical procedures. Music has proven to be a potent nonpharmacological sedative and anxiolytic, allaying both the pain and stress of surgery. This review aims to explore the available evidence about the role of music as an adjunct for diagnostic and surgical procedures in current ophthalmic practices.
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)