Ophthalmology – Chronic Visual Loss: By Sherif El-Defrawy M.D.

Ophthalmology – Chronic Visual Loss: By Sherif El-Defrawy M.D.


One condition that can cause chronic visual
loss that you cannot afford to miss is chronic open angle glaucoma. If chronic open angle
glaucoma is missed, your patient can go blind. Unlike patients with angle closure glaucoma,
who classically present with a painful red eye with nausea and vomiting, patients with
open angle glaucoma are asymptomatic. This is a very common condition which affects nearly
3 percent of the population. Patients with chronic open angle glaucoma
develop high pressures in the eye when the drainage system in the eye – known as the
trabecular meshwork – degenerates and becomes obstructed. As the disease progresses patients
may develop peripheral visual loss on visual field testing and at its end stage central
vision can also be lost.Unfortunately, 50% of patients have advanced disease at the time
of diagnosis. This is why it is so critical for at-risk patients to be screened every
1-2 years.To be considered “at risk” patients would need to have more than one of the following
risk factors: Age over 80
Being nearsighted Having high blood pressure and diabetes
Having a positive family history And those of African-American ancestry Clinical signs of open angle glaucoma include: A cup-to-disc ratio greater than 0.5
Cup-disc asymmetry between the two eyes The presence of a disc hemorrhage, and
An eye pressure that is greater than 21 millimetres of mercury. Because of its high prevalence, it is important
that even those that are not at-risk but are over the age of 45 be periodically screened
for glaucoma, typically every 2 to 4 years. At age 65 and older, all patients should have
annual eye assessments to screen for glaucoma and other eye diseases.

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