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New Orleans Academy of Ophthalmology

GLAUCOMA

IN THE NEW MILLE

edited by Jonathan D. Nussdorf

Kugler Publications / The Hague / The Netherlands

GLAUCOMA IN THE NEW MILLENNIUM

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GLAUCOMA

IN THE

NEW MILLENNIUM

edited by Jonathan D. Nussdorf

Proceedings of the 50th Annual Symposium on Glaucoma,

New Orleans, LA, USA, April 6-8, 2001, organized by the

New Orleans Academy of Ophthalmology

Kugler Publications/The Hague/The Netherlands

ISBN 90 6299 193 9

Distributors:

For the U.S.A. and Canada:

Pathway Book Service

4 White Brook Road

Gilsum, NH 03448

Telefax (603) 357 2073

For all other countries: Kugler Publications P.O. Box 97747

2509 GC The Hague, The Netherlands Telefax (+31.70) 3300254

http://www.kuglerpublications.com

© Copyright 2003 Kugler Publications

All rights reserved. No part of this book may be translated or reproduced in any form by print, photoprint, microfilm, or any other means without prior written permission of the publisher. Kugler Publications is an imprint of SPB Academic Publishing bv, P.O. Box 97747

2509 GC The Hague, The Netherlands

Table of contents

v

 

 

Table of contents

Preface

vii

Editor

viii

Contributors

ix

Defining Glaucoma

 

An approach to glaucoma pathogenesis

 

H.A. Quigley

3

How do we kill the idea of low-tension glaucoma?

 

H.A. Quigley

13

How much glaucoma damage is pressure-dependent?

 

P. Palmberg

21

Ocular blood flow and glaucoma

 

G.A. Cioffi

29

Microvascular changes of the human anterior optic nerve in glaucoma

 

G.A. Cioffi and D.-Y. Zhao

37

Neuroprotection and glaucoma. How do I tell if a drug is neuroprotective?

 

G.A. Cioffi

43

The Angle

 

The true nature of angle-closure glaucoma

 

H.A. Quigley

51

Gonioscopy in the laser age

 

P. Palmberg

65

Round table: How I make the decision to do a peripheral iridotomy:

 

my laser, lens and settings

 

(P. Palmberg, presiding)

77

Round table: How I make the decision to do ALT: my laser, lens and

 

settings

 

(C.F. Burgoyne, presiding)

89

The Optic Nerve Head

 

Evaluation of optic disc and nerve fiber layer in glaucoma. Clinical

 

techniques

 

J. Caprioli

107

Round table: How I follow the optic nerve head and nerve fiber layer:

 

my step by step approach

 

(C.F. Burgoyne, presiding)

115

Workshop: Imaging the optic nerve head and nerve fiber layer in

 

glaucoma

 

(J. Caprioli and H. Quigley)

129

vi

Table of contents

 

 

 

Round table: My most confusing optic nerve head

 

 

(J. Nussdorf, presiding)

 

133

Psychophysics

 

 

Update on psychophysical tests for glaucoma

 

 

J. Caprioli

 

151

The variability of perimetry. Reassessing an important clinical tool

 

E.J. Higginbotham, N. Ellish and R. Kalsi

 

165

Round table: Visual field

 

 

(E.J. Higginbotham, presiding)

 

183

Update on perimetry. New developments

 

 

C.A. Johnson

 

185

Questions directed to Chris Johnson in his absence

 

207

Treatment Issues, Problems & Repairs

 

 

Using combination drugs in glaucoma management

 

 

E.J. Higginbotham

 

213

The use of topical anesthesia for a combined cataract and glaucoma

 

procedure

 

 

A.S. Crandall

 

223

Update on antimetabolic use

 

 

A.S. Crandall

 

235

Plumbing pearls. An effective method for reversing hypotony maculopathy

 

and how to save failing filtering blebs at the slit lamp

 

 

P. Palmberg

 

237

Round table: My procedure and antimetabolite dose of choice for a

 

primary trabeculectomy

 

 

(A. Etienne, presiding)

 

243

Round table: Refractive surgery: thin corneas, inaccurate intraocular

 

pressures, and the myopic disc at risk

 

 

(D.A. Long, presiding)

 

257

Duke-Elder lectures

 

 

Lecture 1: Maintenance and pathophysiology of intraocular pressure

271

Lecture 2: Natural history of simple open-angle glaucoma

 

279

Lecture 3: Natural history of congestive narrow-angle glaucoma

288

Appendix 1

 

 

Glaucoma Symposiums of the New Orleans Academy of Ophthalmology

297

Appendix 2

 

 

Sponsors

 

300

Preface

vii

 

 

Preface

The 50th annual symposium of the New Orleans Academy of Ophthalmology was held from April 6th – 8th, 2001. This was the Academy’s ninth meeting devoted to glaucoma and consisted of formal lectures, round table discussions, and workshop presentations. The New Orleans Academy of Ophthalmology maintains a strong tradition of providing the ophthalmologist with a venue for learning from exceptional mentors and innovative leaders. Inspection of the list of Academy meetings pertaining to glaucoma will highlight the fact that we have been privileged to have outstanding contributors and notable repeat performers (Appendix 1). The first symposium of this Academy was held in 1952 and, with its focus on glaucoma, the contributors were Sir Stewart Duke-Elder, Paul A. Chandler, MD, and Peter C. Kronfeld, MD. The first three lectures from that 1952 meeting were presented by Sir Stewart Duke-Elder and are published for the first time, from a copy of the original transcript, in this collection of papers. I think you will find his discussion of ‘simple’ and ‘congestive’ glaucoma enlightening and instructive.

The Program Committee chairpersons, Claude F. Burgoyne, MD and Katherine Loftfield, MD, were instrumental in putting together a strong assembly of contributors and a well-balanced meeting. Special acknowledgment for their hard work in organizing this symposium goes to committee members Rameish Ayyala, MD, Annemarie Etienne, MD, Kenneth Haik, MD, Jill B. Koury, MD, and Daniel A. Long, MD, and to executive secretaries, Emily Busby and Amber Howell. For his dedicated and thoughtful leadership, much appreciation is given to the president of the New Orleans Academy of Ophthalmology, 2000-2002, George S. Ellis, Jr, MD, and to the board of directors. The Academy acknowledges its sponsors for providing unrestricted financial support, which helped to defer the expense of this medical education meeting and subsequent publication. Special thanks go to Peter Bakker at Kugler Publications for his guidance and wisdom, as well as his unending support for the task of publishing this glaucoma specialty symposium.

The contributors to this symposium on glaucoma are outstanding. They provided chapters covering a wide range of issues that confront the general ophthalmologist, as well as the glaucoma specialist. Due to an unfortunate circumstance, Chris A. Johnson, PhD, was unable to attend the meeting; however, he was gracious enough to provide his written contribution, which is included in this compilation of papers. You will find that the lectures, round table discussions, and workshop sessions are filled with pearls of wisdom that will help guide you toward a modern, common sense approach in addressing the special needs of your glaucoma patients.

Jonathan D. Nussdorf, MD

Ochsner Clinic Foundation

New Orleans, Louisiana, USA

Contributors

ix

 

 

Contributors

JOSEPH CAPRIOLI, MD

Professor of Ophthalmology

Chief, Glaucoma Division

Jules Stein Eye Institute

Los Angeles, California

GEORGE CIOFFI, MD

Director, Glaucoma Service

Director, Discoveries in Sight

Portland, Oregon

ALAN S. CRANDALL, MD

Professor of Ophthalmology and

Vice Chair of Clinical Services

Director of Glaucoma and Cataract

John A. Moran Eye Center

Salt Lake City, Utah

x

Contributors

 

 

EVE J. HIGGINBOTHAM, MD

Professor and Chair

Department of Ophthalmology

University of Maryland

School of Medicine

Baltimore, Maryland

CHRIS A. JOHNSON, PhD

Director of Diagnostic Research

and Senior Scientist

Oregon Lions Anderson-Chenoweth-Ross

Discoveries in Sight/Devers Eye Institute

Portland, Oregon

PAUL PALMBERG, MD, PhD

Professor of Ophthalmology

Bascom Palmer Eye Institute

University of Miami School of Medicine

Miami, Florida

HARRY A. QUIGLEY, MD

Director, Glaucoma Service and Director

DANA Center for Preventive Ophthalmology

Edward Maumenee Professor of Ophthalmology

Wilmer Eye Institute

Baltimore, Maryland