Presented by the Region 2 group:
Mari Garza-Facilitator
Yvette Bowerrman
Silvia Gonzalez
Lori Irvine
Susan Little
Jody Harris DeLeon
Glaucoma
 Is a complicated group of diseases in which the
intraocular pressure (IOP) of the eye is abnormally
elevated. This abnormally high pressure results in
optic nerve damage and eventually blindness.
 Glaucoma is the second leading cause of blindness.
 Sometimes it is referred to as the “silent thief of
sight”.
 Glaucoma onset can either be a steady loss of sight
or immediate due to trauma to the eye.
Types of Glaucoma
 There are several types of Glaucoma
Primary Open-Angle Glaucoma
Angle-Closure Glaucoma
Normal-Tension Glaucoma
Secondary Glaucoma
Childhood Glaucoma
Primary Open-Angle Glaucoma
 Most common type of glaucoma. It affects at least 3
million Americans annually.
 Occurs when the eye’s drainage canals congested
over time, and the aqueous fluid cannot drain
appropriately, causing the intraocular pressure of the
eye to become abnormally high.
 There are no early warning signs or symptoms. Most
people find that they have this condition during a
routine tonometry (the puff test) test.
 If not treated Open-Angle Glaucoma will result in a
gradual loss of vision.
Angle-Closure Glaucoma
 Also known as “Acute Glaucoma” or “Narrow-Angle
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Glaucoma”.
This type of Glaucoma occurs when the drainage
canals are blocked or covered by the edge of the Iris
because it is not as wide or open as it should be.
Occurs most often when the pupil dilates to quickly or to
much. This can happen when entering a dark room.
Symptoms include: headache, eye pain, nausea,
rainbows around lights at night, and very blurred vision.
Treatment includes surgery to unblock the drainage
canals by removing the outer edge of the iris. Surgery is
usually successful and long lasting. However, it is
recommend that patients continue with their regular eye
doctor visits.
Normal-Tension Glaucoma
 Also called “low tension” or “normal-pressure
glaucoma”
 This form of Glaucoma in which the optic nerve is
damaged without the IOP being outside the “normal
range” of 10-20 mm Hg.
 Causes for this form of Glaucoma are still unknown.
 People who are at risk for this type of Glaucoma: are
ones with a family history of this type of glaucoma,
people of Japanese ancestry, and people with a
history of systematic heart disease such as an
“irregular heart rhythm”
 Diagnosis is done by looking for signs of optic nerve
damage. This can be done one of two ways:
Normal-Tension Glaucoma (cont)
 First procedure is to use an ophthalmoscope. Your Optometrist
or Ophthalmologist will hold the scope up close to your eye, and
examine the shape and color of the optic nerve. This procedure
is normally done during a routine exam and in a dark room.
 Second procedure is the Visual Field Test. This test creates a
map of your complete field of vision. The doctor uses this “map”
to check for any scotoma that is caused by damage to the optic
nerve.
 Symptoms include: slight changes in a person’s visual field that
might occur near the center or to the edge of the visual field.
 Treatment includes: medications, laser treatments and in some
cases conventional surgery
Secondary Glaucoma's
 Secondary Glaucoma's occur when another disease
causes or contributes to a rise in IOP.
 Secondary Glaucoma's can also occurs during a eye
injury, inflammation, tumor, or in advanced cases of
cataract or diabetes
 There have been cases where drugs, such as
steroids, causing a mild or severe form of secondary
glaucoma.
 There are 6 types of Secondary Glaucoma:
pigmentary glaucoma, pseudoexfoliative glaucoma,
traumatic glaucoma, neovascular glaucoma, irido
corneal endothelial syndrome (ICE), and congenital
glaucoma (childhood glaucoma).
Secondary Glaucoma (cont)
 Pigmentary Glaucoma occurs when the pigment
granules in the iris break into the aqueous humor and
flow toward the drainage canals of the eye and clog
them. Treatment is medication, laser or conventional
surgery.
 Pseudoexfoliative Glaucoma occurs when a dandruff
like substance peels off of the outer layer of the lens.
This substance collects in the angle between the
cornea and the iris, causing the drainage system to
clog and the IOP to rise. This type of Glaucoma
occurs most often with people of Scandinavian
descent. Treatment is medication or surgery.
Secondary Glaucoma (cont)
 Traumatic Glaucoma occurs immediately after a blunt,
bruising or penetrating injury to the eye. It can also occur
years later after this injury has healed.
 Conditions such as severe myopia, previous injury or infection
or prior surgery can make the eye more vulnerable to this
type of glaucoma.
 Treatment includes medication, filtration surgery, laser
surgery, and tube shunt devices.
Secondary Glaucoma (cont)
 Neovascular Glaucoma occurs when there is an
abnormal formation of new blood vessels on the iris
and drainage canals.
 Neovascular Glaucoma is always associated with
other abnormalities such as diabetes.
 The new blood vessels block the ability of the eye to
drain fluid from the trabecular meshwork causing the
IOP to rise.
 Very difficult to treat. Some treatments include
treatment for underlying disease, filtration surgery,
transscleral diode laser retinopexy, or if needed, a
lensectomy.
Secondary Glaucoma (cont)
 ICE (Irido Corneal Endothelial Syndrome) is rare and occurs in one
eye, rather than both. Corneal cells spread over the eye’s drainage
canals and across the iris, causing canal blockage and an increase in
the IOP. These “cells” form adhesions that bind the iris to the cornea
causing more blockage in the drainage canals. Occurs more
frequently in “light-skinned” females. Symptoms include: hazy vision
when awaken and halo’s around lights. Treatment can include
medications and filtration surgery.
Childhood Glaucoma
 Refers to the presence of glaucoma in a child. This
secondary form of glaucoma occurs in 1 out of 10,000
births in the United States.
 Also known as Congenital Glaucoma.
 Childhood Glaucoma is diagnosed in either infancy or
early childhood.
 This Glaucoma is caused by an abnormal intraocular
fluid drainage that results in a blocked or defective
trabecular meshwork.
 Congenital Glaucoma can be contributed to abnormal
development during pregnancy or a hereditary genetic
defect.
Symptoms of Childhood Glaucoma
 Symptoms of Childhood Glaucoma include Epiphora (
impairment of the elimination of tears), blepharospasm
( the involuntary muscle spasm of the eyelid caused
by a progressive neurological disorder)
 Most common symptoms are excessive tearing, light
sensitivity, closure of one or both eyes in the light,
cloudy, enlarged cornea ( large eye), vision loss in one
or both eyes.
 If IOP rapidly increases pain or discomfort may occur
as evident by the child becoming irritable, fussy and
poor appetite.
Diagnosis of Childhood Glaucoma
 Childhood Glaucoma is diagnosed by a completing a
full medical history and an eye examination of the
child.
 The Ophthalmologist will conduct a visual acuity test,
a pupil dilation to allow the doctor a close-up view of
the retina and optic nerve, a visual field test ( to
determine the child’s loss of peripheral vision), and
tonometry.
 Many children are diagnosed before they are 6
months old. It is very important for early detection to
prevent loss of vision.
Treatment of Childhood Glaucoma
 If the case is uncomplicated, microsurgery can correct the
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structural defects of the eye.
Other cases maybe treated with medication and surgery.
Types of surgery may include trabeculotomy, goniotomy, a
trabeculectomy, iridotomy, and cyclophotocoagluation.
In trabeculotomy, a outer surgical opening is made in the
trabecular meshwork system that establishes a more normal
interior chamber angle that allows the aqueous fluid to drain
more freely.
A goniotomy creates an inner surgical opening of the trabecular
meshwork system to help establish a more normal flow.
A trabeculectomy removes part of the meshwork drainage
system to allow fluid to flow normally.
Treatments (cont)
 An iridotomy is when a small hole is made
through the iris to relieve the IOP. Iridotomy is
often with a laser.
 A cyclophotocoagulation is often used in cases of
severe childhood glaucoma. A laser beam
freezes selected parts of the ciliary body to
reduce production of the aqueous humor.
 Both medications and surgery have been
successful with most cases.
Alternative Treatments
 Micro puncture
 As of 2011 there are 5 states in the Union that allow
the use of medicinal marijuana for the treatment/
management of Glaucoma.
Educational Implications of Chilhood
Glaucoma
 Early intervention is very important in managing childhood glaucoma.
Early intervention is designed to assess the child’s needs and create a
program that fits that individual. Early intervention will also help the
child transition into a preschool or early childhood program at the local
school district.
 During early intervention, a consult with a teacher of the visually
impaired is important so that IEP can be developed to fit that child’s
educational needs in the classroom.
 It is important during the development of the IEP, that parents consider
what works at home for the child. With these adaptations in mind, the
TVI can develop more appropriate IEP goals and accommodations for
the student and the teacher(s). Parents should make sure that all
goals, accommodations and medical history should be written down
during the IEP/ARD process.
Educational Implications (cont)
 Accommodations that could be considered for classroom use are
1. having the child sit with his/her back to a bright
light to avoid glare
2. Simple background for assignments.
3. An uncluttered work area
4. Flexible seating if visual props are used during
direct instruction.
5. Have the child wear sunglasses or hats during outdoor
playtime to reduce glare.
6. Wear protective goggles during physical activities.
7. Use a Closed Circuit Television (CCTV) to enlarge printed material.
8. Use various muted colors of paper and enlarged writing for
assignments.
9. Most importantly, parents need to develop a support network that
includes family, friends and various glaucoma support agencies.
Case Study
 Student: JV
 Aransas Pass ISD
 Presented by Lori Irvine
Resources
Children’s Hospital Boston(2011)”Glaucoma(disease information) "Retrieved July 27, 2011 from
http://www.childrenshospital.org/az/site961/mainpageS961POhtml.
Glaucoma Research Foundation.(2011)”What is Glaucoma?” Retrieved July 27, 2011
from http://www.glaucoma.org.
Griggs, Paul, B.,M.D. and PubMed Health ( August 6,2009) “Glaucoma”. Retrieved July 27, 2011
from http://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0002587.
Mayo Clinic Staff. (1998-2011). “Glaucoma”. Retrieved July 27,2011
from http://mayoclinic.com/health/glaucoma/DS00283.
Piedmont Hospital.(2011)”Childhood Glaucoma” Retrieved July 27, 2011 from
http://www.piedmonthospital.org/diw/content/asp?pageid=P01206.
Willis Eyes(2004-2009)”Childhood Glaucoma”. Retrieved July 27,2011 from
http://www.williseye.org/patients/services/glaucoma/childhood/index.html.
Individual/Family Support Group
Information
 See brochure and Support Group List.