Ocular hypertension is defined. The decision to initiate treatment depends on the estimate of the benefit to injury ratio with a given treatment and the risk without treatment. Factors that determine our perception of the former are discussed. The key to the latter is the identification and evaluation of the ocular and systemic risk factors for the development of glaucomatous visual field loss. Discussion of these risk factors in the author's clinical practice is presented; overall, approximately 5% of his patients with ocular hypertension are treated. A review of his four-and-a-half year study on uniocular pilocarpine treatment in 59 ocular hypertensive patients is presented. The results suggest that one should be conservative in prescribing pilocarpine.

Cataract↗

PubMedDate not supplied

Low tension glaucoma: a critical review and new material.

Low tension glaucoma (LTG) is a condition consisting of typical gluacomatous disc and field changes, an open angle and pressures within the statisticaly normal range. The controversy surrounding low tension glaucoma pertains not only to the definition and characteristics of the entity itself, but to the fundamental questions it raises regarding the causal relationship between intraocular pressure and disc and field changes. This review of LTG is based on material from three major sources: Sjögren's review from 1857 to 1946; the author's review of the world literature from 1947 through 1979; and an analysis of 32 of the author's cases. 767 cases from clinic and private practice and 241 cases from defined populations are considered. Definitions, incidence, characteristics, differential diagnosis and management of LTG are discussed, as are its relationship to primary open angle glaucoma and its possible association with various other entities. Pathogenesis and possible mechanisms are also explored.

Adult↗

PubMedDate not supplied

Uniocular miotic therapy.

The beneficial and harmful effects of 2% pilocarpine and 0.125% echothiophate iodide were evaluated on the prospective study of uniocular miotic therapy using the fellow eye as a control. Thirty primary open-angle glaucoma patients were treated with pilocarpine alone over a median time of 55 months. Twenty-nine similar patients were treated initially with echothiophate iodide and subsequently with pilocarpine over a median time of 54 months. Pilocarpine is cataractogenic but the changes are less marked and require more time than those induced by echothiophate iodide. In the combined group of 118 eves of 59 patients there were 11 optic disc changes and dix glaucomatous field defects. There was no difference in incidence between the treated and control eyes. The results suggest that one should be conservative in prescribing miotics, including pilocarpine alone, for patients suspected of having glaucoma.

Aged↗

PubMedDate not supplied

6-Hydroxydopamine therapy in glaucoma.

At the inception of this study, 6-hydroxydopamine (6-HD) was administered to 137 eyes of 100 glaucoma patients by subconjunctival injection (27 applications) and later by iontophoresis (202 applications). Eighty-four patients were receiving maximum medical therapy, and 24 had had previous glaucoma surgery. Seventy-seven had primary open-angle glaucoma. In 49 patients with data adequate for analysis, 6-HD therapy was effective in 41%, questionable in 31%, and not effective in 28%. The median peak-pressure drop was 13 mm Hg from a baseline of 26 by subconjunctival injection and 6 mm Hg from a baseline of 24 by iontophoresis. The median effective period before return to baseline pressure was 2.5 months. There was a direct correlation between the effectiveness of epinephrine therapy with and without 6-HD. Iontophoresis is a much more practical method for the administration of 6-HD.

Conjunctiva↗