青光眼英语课件

GlaucomaGOALS确定视神经结构、功能评估发展成POAG的风险确定处理方案减少副作用健康教育Documentthestatusofopticnervestructure,byclinicalevaluationandimaging,andfunction,byvisualfieldtesting,onpresentation。GOALS确定视神经结构、功能评估发展成POAG的风险确定处理方案减少副作用健康教育Considertreatmentofhigh-riskindividualstopreventordelaythedevelopmentofPOAGGOALS确定视神经结构、功能评估发展成POAG的风险确定处理方案减少副作用健康教育Minimizethesideeffectsoftreatmentandtheimpactoftreatmentonthepatient’svision,generalhealth,andqualityoflifeGOALS确定视神经结构、功能评估发展成POAG的风险确定处理方案减少副作用健康教育Educateandinvolvepatientsandappropriatefamilymembers/caregiversinthemanagementoftheirconditionPURPOSETodetectandmanagepatientsatriskfordevelopingglaucoma,preventdamagetotheopticnerve,andpreservepatients’qualityoflife.避免视神经损害避免发展成POAG维持患者生活质量clinicalfindingsThethatdefineaglaucomasuspectpatientarecharacterizedbyoneofthefollowinginatleastoneeyeinanindividualwithopenanteriorchamberanglesbygonioscopy:AvisualfieldsuspiciousforglaucomatousdamageintheabsenceofclinicalsignsofotheropticneuropathiesArcuatebundledefectNasalstepParacentralscotomaAltitudinaldefectLargermeanpatternstandarddeviationConsistentlyelevatedintraocularpressure(IOP)associatedwithnormalappearanceoftheopticdiscandretinalnervefiberlayerandwithnormalvisualfieldtestresultsThisdefinitionexcludesknownsecondarycausesforopen-angleglaucoma,suchaspseudoexfoliation(exfoliationsyndrome),pigmentdispersion,andtraumaticanglerecession.clinicalfindings小结oneofthefollowinginatleastoneeyeinanindividualwithopenanteriorchamberanglesAppearanceoftheopticdiscorRNFLthatissuspiciousforglaucomatousdamageAvisualfieldsuspiciousforglaucomatousdamageintheabsenceofclinicalsignsofotheropticneuropathiesConsistentlyelevatedintraocularpressure(IOP)associatedwithnormalappearanceoftheopticdiscandretinalnervefiberlayerandwithnormalvisualfieldtestresultsaconstellationofriskfactorsHigherIOPThepublichealthimportanceofearlydetectionandmanagementofthesepatientsliesinthefactthatindividualswithocularhypertensionareatincreasedriskofdevelopingglaucomatousopticneuropathy.TheOcularHypertensionTreatmentStudy(OHTS)demonstratedtherateofuntreatedparticipantsdevelopingglaucomatousopticneuropathytobe9.5%in5yearsand22%at13years,orapproximately2%peryear.aconstellationofriskfactorsOlderageFamilyhistoryofglaucomaLowerocularperfusionpressureLowersystolicanddiastolicbloodpressureThinnercentralcorneaDischemorrhageLargercup-to-discratioLargermeanpatternstandarddeviationonthresholdvisualfieldtestingmigraineheadache,peripheralvasospasm,concurrentcardiovasculardisease,systemichypertension,andmyopia.However,theassociationbetweentheseriskfactorsandthedevelopmentofglaucomatousopticnervedamagehasnotbeendemonstratedconsistently.Whiledischemorrhage,increasedcup-discratioandlargermeanpatternstandarddeviationareconsideredtoberiskfactorsforthedevelopmentofPOAG,itcanalsobearguedthatthesesignsrepresentearlyopticnervedamageandunsuspectedglaucoma.DIAGNOSISThecomprehensiveinitialglaucomasuspectevaluation(historyandphysicalexamination)includesallcomponentsofthecomprehensiveadultmedicaleyeevaluation51inadditiontoandwithspecialattentiontothosefactorsthatspecificallybearuponthediagnosis,course,andtreatmentofPOAG.Theevaluationmayrequiremorethanonevisit.Forinstance,anindividualmightbesuspectedofhavingPOAGononevisitbutmayreturnforfurtherevaluationtoconfirmthediagnosis,includingadditionalIOPmeasurements,gonioscopy,centralcornealthicknessdetermination,visualfieldassessment,andopticnerveheadandretinalnervefiberlayerevaluationanddocumentation.OphthalmicEvaluation成人眼部综合评估+下列需要特别关注的眼部评估:病史

视力检查瞳孔检查

前节检查眼底检查眼压测量前房角镜检查

视盘和视网膜神经纤维层检查视力检查远视力：裸眼视力和矫正视力(矫正度数)近视力：必要时瞳孔检查传入性瞳孔障碍眼前节检查裂隙灯检查：窄房角（周边浅前房和前房角拥挤）角膜病变继发眼压升高的因素：剥脱综合症、色素播散、虹膜透照缺损、虹膜和房角新生血管、炎症前房角镜检查排除以下因素：房角关闭继发性原因造成眼压升高房角后退色素dispersion周边房角粘连房角新生血管炎症沉着物

视盘和RNFL检查重要性：视盘改变、RNFL改变和视盘周围的脉络膜萎缩早于视野缺损。视盘出血是重要的体征。裂隙灯：散瞳下放大的立体像观察直接检眼镜：作为补充，由于放大倍率更大，可以提供更多的细节。无赤光照明用于RNFL眼底检查散瞳下的眼底检查寻找可引起类似视盘和视野改变的眼底病变视神经苍白视盘玻璃疣视盘小凹opticnervepits中枢神经系统疾病造成的视盘水肿黄斑变性视网膜血管阻塞SupplementalOphthalmicTesting中央角膜厚度视野视盘和视网膜神经纤维层分析中央角膜厚度CCT和IOP之间相关性：没有公认的校正公式CCT是一个独立于IOP的危险因素（OHTSlevelII）视野检查自动静态视野检查Thefrequencydoublingtechnology(FDT)methodwiththecentral20-degreetestprogram(C-20)short-wavelengthautomatedperimetry(SWAP)withthecentral24-degreetestprogram(24-2)aretwoofseveralalternativetestingmethodstoscreenforadefectbeforeconductingmoredefinitivethresholdtesting比传统的白-白视野检查Carefulmanualcombinedkineticandstaticthresholdtesting(e.g.,Goldmannvisualfields)isanacceptablealternativewhenpatientscannotperformautomatedperimetryreliablyorifitisnotavailable.[A:III]Repeat,confirmatoryvisualfieldexaminationsmayberequiredfortestresultsthatareunreliableorshowanewglaucomatousdefectbeforechangingmanagement.110,111[A:III]IntheOHTS,86%ofvisualfielddefectswerenotconfirmeduponsubsequenttesting.110Itisbesttouseaconsistentexaminationstrategyforvisualfieldtesting.视盘和视神经纤维层分析Colorstereophotographycomputer-basedimagingconfocalscanninglaserophthalmoscopyopticalcoherencetomographyscanninglaserpolarimetryMANAGEMENT对于青光眼或疑似患者，眼压是唯一可调控因素

决定开始降眼压治疗是一个复杂的过程：眼科医生对检查结果的判断风险评估患者的评估患者的选择与患者（家属）探讨：危险因素的数量和严重程度，预后、诊疗计划、治疗一旦开始就要长期坚持恰当的治疗方案：降眼压效果、副作用、依从性何时开始治疗？Anypatientwhoshowsevidenceofopticnervedeteriorationbasedonopticnerveheadappearance,retinalnervefiberlayerloss,orvisualfieldchangesconsistentwithglaucomatousdamagehasdevelopedPOAGandshouldbetreatedasdescribedinthePrimaryOpen-AngleGlaucomaPPP.119[A:III]Developmentofsubtleabnormalitiesintheopticdiscandretinalnervefiberlayerarebestdetectedbycomparingperiodicfundusimagingwithdiscandretinalnervefiberlayerphotographyandcomputerizedimagingoftheopticnerveandnervefiberlayer.81,120Anewvisualfielddefectthatisconsistentwithapatternofglaucomatousvisualfielddefect,confirmedonretestingofvisualfields,mayindicatethatthepatienthasdevelopedPOAG.110,121ApatientwhodemonstratesveryhighIOPinwhichopticnervedamageislikelytooccurmayrequiretreatment.Insomecases,initia