Glaucoma, Open-angle
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Evaluation
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General—an optic neuropathy that leads to death of optic nerve tissue; decrease in peripheral vision
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Clinical—progressive disease of the optic nerve with an increase in intraocular pressure (IOP) and optic disc cupping
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Peripheral vision gradually declines, is asymptomatic, and is irreversible.
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Mechanism—impaired outflow of aqueous humor results in increased IOP (” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1bcfb4c1af3e27e08eb9dd4712526cc1cb}/ID(AB1-M10)”>>21 mm Hg); gradually, optic nerve cells die leading to enlargement of the optic nerve cup (cup-to-disc ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1bcfb4c1af3e27e08eb9dd4712526cc1cb}/ID(AB1-M10)”>>0.5)
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Epidemiology—3% of those aged older than 55 years in the United States have glaucoma; ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1bcfb4c1af3e27e08eb9dd4712526cc1cb}/ID(AB1-M10)”>>90% of cases are open angle
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Risk factors—old age, African American, family history, increased IOP, topical eye steroids
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Diagnostic algorithm—those with risk factors or clinical findings should go to ophthalmology
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Perimetry displays a printout of visual fields.
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Treatment
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Nonpharmacologic management
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Aerobic exercise can lower IOP.
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Pharmacologic management
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