Introduction

Vision is the sense that requires the most “learning”, and the eye appears
to delight in being fooled; the old expression “You see what you expect to see”
is often very true. In growth and development eye starts to develop from 3rd
week of life till 10 weeks of life.
Anatomy and physiology of eye:-

The adult eye is a complex organ contained within the orbital cavity (composed
of 7 bones). Each eye has multiple layers and chambers and is surrounded by 6
extraocular muscles. Supplied with optic nerve ( 2nd cranial nerve)
STRUCTURE OF EYE :-
There are 3 layers of tissue in the walls of the eye. They are :-
1) The outer fibrous layer : Sclera and Cornea
2) The middle vascular layer or uveal tract : Coroid,Ciliary body and iris
3) The inner nervous tissue layer : Retina
Structures inside the eyeball are the lens, aqueous fluid (humour) and Vitreous
body (humour).
SCLERA:-
The sclera or white of the eye, forms the outer most layer of tissue of the
posterior and lateral aspects of the eyeball and is continuous anteriorly with the
transparent cornea. It consists of a firm fibrous membrane that maintains the
shape of the eye and gives attachment to the extra ocular or extrinsic muscles of
the eye.
Function of Sclera :-
1. The sclera is an outer fibrous layer that encases and protects the eyeball.
2. It completely envelops the globe except at the front of the eye and
maintains the shape of the globe.
3. It also provides a firm anchorage for the extra ocular muscles that
control the eye's movement.
CORNEA:-
Anteriorly the sclera continuous as a clear transparent epithelial
membrane, the cornea. Light rays pass through the cornea to reach the retina.
The cornea is convex anteriorly and is involved in refracting or bending light
rays to focus them on the retina.
Function of Cornea:-
1. It helps to shield the rest of the eye from germs, dust, and other harmful
matter. The cornea shares this protective task with the eyelids, the eye
socket, tears, and the sclera, or white part of the eye
2. The cornea acts as the eye's outermost lens. It functions like a window
that controls and focuses the entry of light into the eye. The cornea
contributes between 65-75 percent of the eye's total focusing power.
CHOROID :-
It is very rich in blood vessels and is deep chocolate brown in color. Light
enters the eye through the pupils, stimulates the nerve endings in the retina and
is then absorbed by the choroid.
Function of Choroid:-
1. It absorbs light and prevents internal reflection.
2. The choroid provides oxigen and nourishment to the outer layers of the
retina.
CILIARY BODY:-
It is the anterior continuation of the choroid consisting of ciliary muscles and
secretary epithelial cells. It gives attachment to the suspensory ligament which,
as its other end, is attached to the capsule enclosing the lens. The epithelial cells
secrete aqueous fluid into the anterior segment of the eye, i.e.the space between
the lens and the cornea (anterior and posterior chambers).The ciliary body is
supplied by parasympathetic branches of the oculomotor nerve i.e. 3rd cranial
nerve.
Functions of Ciliary Body:-
The ciliary body has three functions:
1. accommodation,
2. aqueous humor production and
3. It also anchors the lens in place.
4. Accomommodation essentially means that when the ciliary muscle
contracts, the lens becomes more convex, generally improving the focus
for closer objects. When it relaxes, it flattens the lens, generally
improving the focus for farther objects.
4. One of the essential roles of the ciliary body is also the production of the
aqueous humor, which is responsible for providing most of the nutrients
for the lens and the cornea and involved in waste management of the
areas.
IRIS :-
The iris is the visible colored part of the eye and extends anteriorly from the
ciliary body, lying behind the cornea in front of the le The eye into Anterior and
Posterior chambers, which contain aqueous fluid secreted by the ciliary body. It
is a circular body composed of pigment cells and 2 layers of smooth muscles
fibers –one circular and the other radiating. In the centre there is an aperture
called the pupil. The iris is supplied by parasympathetic and sympathetic
nerves. Parasympathetic stimulation constricts the pupil and Sympathetic
stimulation dilates it.
Functions of Iris :-
1. It controls how much light enters the eye. At night or in a dark room
for example, we need more light to see, so the pupil dilates to allow
more light to enter.
 2. Another factor plays a role here, when the pupil was constricted
(before you entered the dark room) the light was focused on the
central retina, where there are almost no rods (rods are sensitive to
light, basically we need the to see where there is minimum
illumination). Now, the cones in the central retina are not sensitive to
light, so when the iris dilates the pupil so the light could get to the
rods.
LENS :-
The lens is a highly elastic circular biconvex body, behind the pupil. It
consists of fibers enclosed thin a capsule. Its thickness is controlled by the
ciliary muscles through the suspensory ligament. The lens has three main parts:
the lens capsule, the lens epithelium, and the lens fibers. The lens capsule
forms the outer most layer of the lens and the lens fibers form the bulk of the
interior of the lens. The cells of the lens epithelium located between the lens
capsule and the outermost layer of lens fibers, are found only on the anterior
side of the lens.
Functions of lens :-
1. It focuses the image by bending the light to strike the retina correctly.
This is also called refraction.
2. The cells of the lens epithelium regulate most of the homeostatic
functions of the lens.
3. The iris controls the size of the pupil. It controls the amount of light
entering the eye.
RETINA:-
The retina is the inner most layer of the wall of the eye. it is an extremely
structure and is specially adapted for stimulation by light rays. It is composed of
several layers of nerve cells bodiesand their axons, lying on a pigmented layer
of epithelial cells,
which attach it to the choroid. The layer highly sensitive to light is the layer of
sensory receptor cells: rods and cones. The rods and cones contain
photosensitive pigments that
convert light rays into nerve impulses. The small area of retina where the optic
nerve leaves the eye is the optic disc or blind spot. It has no light sensitive cells.
Functions of retina:-
1. The retina is the photosensitive part of the eye. The light sensitive nerve
cells are the Rods and Cones. Light rays cause chemical changes in
 photosensitive pigments in these cells and they generate nerve impulses
which are conducted to the occipital lobes of the cerebrum via the optic
nerves.
2. The Rods are more sensitive than the Cones. They are stimulated by low
intensity or dim light.eg. by the dim light in the interior of a darkened
room.
3. The Cones are sensitive to bright light and color. The different wave
length of visible light stimulates photosensitive pigments in the cones,
resulting in the perception of different colors. The rods are more
numerous towards the periphery of the retina. Visual purple (Rhodesian)
is a photosensitive pigment present only in the rods. It is bleached
(degraded) by bright light and is quickly regenerated when an adequate
supply of vitamin A is available.
CHAMBERS IN EYE
The anterior cavity is divided into the anterior and posterior chambers.
The anterior chamber lies between the iris and the posterior surface of the
cornea, and the posterior chamber lies between the anterior surface of the lens
and the posterior surface of the iris.
The posterior cavity lies in the large space behind the lens and in front of
the retina.
Aqueous humor, a clear watery fluid, fills the anterior and posterior
chambers of the anterior cavity of the eye. Aqueous humor is produced from
capillary blood in the ciliary body. It is drained away by the scleral veins
(canal of Schlemm), which enter the circulation of the body. The aqueous
humor bathes and nourishes the lens and the endothelium of the cornea.
Maintains intraocular pressure ranges 10 to 21 mm Hg.
DEFINITION
“A disease of the eye in which the pressure of fluid inside the
eyeball is abnormally high, caused by obstructed outflow of the fluid. The
increased pressure can damage the optic nerve and lead to partial or complete
loss of vision.”
www.the freedictionary.com
Glaucoma is a group of ocular conditions characterized by optic nerve
damage. The optic nerve damage is related to the intra ocular pressure (IOP)
caused by congestion of aqueous humor in the eye.
Brunner and siddarth’s
Glaucoma is a group of disorders characterized by increased IOP and the
consequences of elevated pressure, optic nerve atrophy, and peripheral visual
field loss
Sharon.L.Lewis

INCIDENCE
Glaucoma is the second leading cause of blindness worldwide, according
to the World Health Organization, affecting 60.5 million in 2010. Given the
aging of the world's population, this number may increase to almost 80
million by 2020. More than three million Americans are living with
 glaucoma, 2.7 million of whom aged 40 and older are affected by its most
common type, open-angle glaucoma. There is no cure for glaucoma, but the
disease can be controlled

ETIOLOGY
Aqueous humor is a clear fluid in the front part of the eye.
Vitreous humor is a clear, jelly-like substance that fills the eye behind the lens
and helps the eyeball keeps its shape.
In a normal eye, aqueous humor is produced, circulates through the eye and
then drains out through the trabecular meshwork, which is the eye's filtration
system. This is a series of tiny channels near the angle formed by the cornea, the
Iris and the Sclera .If there is any sort of blockage in these channels, pressure
builds up inside the eyeball. Main causes are as follows
1) Eye injury
2) Eye surgery
3) Eye tumors
4) Diabetes
5) Cataract
6) Trauma
7) Steroid use
8) Emotional stress
9) Anti-histamine use
10) Hypothyroidism
11) Sleep apnea
12) Leukemia
13) Sickle cell anemia

RISK FACTORS

1) Age over 45 years

2) Family history of glaucoma
3) Diabetes
4) History of elevated intra-ocular pressure
5) Near-sightedness (Myopia)
6) Use of steroids
7) Thin cornea
8) A history of severe anemia or shock
9) Cardiovascular disease
10) Eye trauma
11) Race
12) Abnormally high intra-ocular pressure
13) Peripheral vision is decreased.
 14) Provision eye injury
15) Not seeing a rainbow.

TYPES OF GLAUCOMA

CONGENITAL INFANTILE BUPHTHALMOS

HYDROPHTHALMOS

It is characterized by elevation of intra ocular pressure (IOP) associated with

developmental abnormalities of the angle of anterior chamber depending
upon the age of onset.
This developmental glaucoma’s are termed as:
1. True or primary congenital glaucoma (IOP is raised during
intrauterine life)
2. Infantile glaucoma’s (Diseases manifests prior to the child)
3. Juvenile glaucoma (Children develop pressure rise between 3-16 yrs
of life)
OPEN ANGLE GLAUCOMA:-
It is the most common form of the disease and generally does not affect
people until they are in their 40s.
1) Primary chronic open angle glaucoma (COAG) :-
It is the most common type of the glaucoma. Its frequency increases
greatly with age. The aqueous fluid does not drain from the eye properly. The
pressure within the eye, therefore, builds up painlessly and without
symptoms.
2) Normal tension (pressure) glaucoma or low tension glaucoma :-
This type of glaucoma is thought to be due to decreased blood flow to
the optic nerve. This condition is characterized by progressive optic-nerve
damage and loss of peripheral vision (visual field) despite intraocular
pressures in the normal range or even below normal.
3) Childhood glaucoma :-
Childhood glaucoma is an uncommon paediatric condition often
associated with significant visual loss. It may most commonly be caused by
trauma, surgery or other acquired or secondary causes or abnormal increase
intra ocular pressure.
4) Secondary open angle glaucoma :-
It can result from an eye (ocular) injury, inflammation in the iris (iritis),
retinal vein blockage etc.
5) Pigmentary glaucoma :-
In this, granules of pigment detach from the iris, which is the colored
part of the eye. These granules then may block the trabecular meshwork, is a
key- element in the drainage system of the eye. Finally, the blocked drainage
system leads to elevated intraocular pressure which results in damage to the
optic nerve.
6) Exfoliative glaucoma:-
This type of glaucoma is characterized by deposits of flaky material on
the front surface of the lens (anterior capsule) and in the angle of the eye.
The accumulation of this material in the angle is believed to block the
drainage system of the eye and raise the eye pressure.

ANGLE CLOSURE GLAUCOMA :-

Angle-closure glaucoma may be acute or chronic. The common element
in both is that the entire drainage angle becomes anatomically closed, so that
the aqueous fluid within the eye cannot even reach all or part of the
trabecular - meshwork.
1) Acute angle closure glaucoma :-
When the drainage angle of the eye suddenly becomes completely
blocked, pressure builds up rapidly, and this is called acute angle-closure
glaucoma.The symptoms include severe eye pain, blurred vision, headache,
nausea and vomiting.
2) Chronic angle closure glaucoma:-
When the drainage angle of the eye gradually becomes completely
blocked, pressure builds up gradually, and this is called chronic angle-
closure glaucoma. The drainage tissues gradually start to scar. This condition
is generally silent, and severe glaucoma damage can occur without the
person's knowledge.
PATHOPHYSIOLOGY
A proper balance between the rate of aqueous production (referred to as
inflow) and the rate of aqueous reabsorption (referred to as outflow) is essential
to maintain the IOP within normal limits. The place where the outflow occurs is
called the angle because it is the angle where the iris meets the cornea. When
the rate of inflow is greater than the rate of outflow, IOP can rise above the
normal limits. If IOP remains elevated, permanent vision loss may occur.
Primary open-angle glaucoma (POAG) is the most common type of
glaucoma. In POAG the outflow of aqueous humor is decreased in the
trabecular meshwork. The drainage channels become clogged, like a clogged
kitchen sink. Damage to the optic nerve can then result.
Primary angle-closure glaucoma (PACG) is due to a reduction in the
outflow of aqueous humor that results from angle closure. Usually this is caused
by the lens bulging forward as a result of the aging process. Angle closure may
also occur as a result of pupil dilation in the patient with anatomically narrow
angles. An acute attack may be precipitated by situations in which the pupil
remains partially dilated long enough to cause an acute and significant rise in
the IOP.

Theories related to relation between optic nerve damage and IOP

 There are 2 accepted theories regarding how increased IOP damages the
optic nerve in glaucoma.
 The direct mechanical theory suggests that high IOP damages the retinal
layer as it passes through the optic nerve head.
 The indirect ischemic theory suggests that high IOP compresses the
microcirculation in the optic nerve head, resulting in cell injury anddeath.
 Some glaucoma’s appear as exclusively mechanical and some are
exclusively ischemic types. Typically most cases are a combination of both.
 Regardless of the cause of damage, glaucomatous changes typically evolve
through clearly stages
 Etiology/Cause

Lens bulge/pupil dilatation

Trabecular mesh damage

Accumulation of aqueous humor in anterior chamber

Disproportion in inflow and outflow of aqueous

humor

Optic nerve damage

Loss of eyesight
STAGES OF GLAUCOMA
1. Initiating Events: - Precipitating factors include illness, emotional stress,
congenital narrow angles, long term use of corticosteroids and mydriatics
(medications causing papillary dilation).These events lead to second stage.
2. Structural alterations in the aqueous outflow system : - Tissue and
cellular changes caused by factors that affect aqueous humor dynamics
lead to structural alterations and to the third stage.
3. Functional alterations: - Conditions such as increased IOP or impaired
blood flow create functional changes that lead to fourth stage.
4. Optic nerve damage: - Atrophy of the optic nerve is characterized by
loss of nerve fibers and blood supply and this fourth stage inevitably
progresses to the fifth stage.
5. Vision loss: - Progressive loss of vision is characterized by visual field
defects
DIAGNOSTIC EVALUATION
1) Ocular and medical history to investigate the history of predisposing
factors.
2) Tonometry: - It determines the pressure in the eye by measuring the tone
or firmness of its surface.
3) Ophthalmoscope: - This procedure is done to examine the optic nerve
(seen as the optic disc) at the back of the eye.
4) Gonioscopy: - To examine the filtration angle of the anterior chamber.
The purpose of this test is to examine the drainage angle and drainage
area of the eye.
5) Perimeter:-To assess the visual fields. The visual fields to detect any
early (or late) signs of glaucomatous damage to the optic nerve. Visual
fields are measured by a computerized assessment.
6) Pachymetry :-It is a relatively new test being used for the diagnosis and
treatment of glaucoma. Pachymetry determines the thickness of the
cornea.
After the eye has been numbed with anaesthetic eyedrops,the pachymeter
tip is touched lightly to the front surface of the eye (cornea).Recent studies
have shown that corneal thickness can affect the measurement of
intraocular pressure.
7) Dilated pupil examination

CLINICAL MANIFESTATION:-

1) Severe eye pain

2) Eye redness
3) Blurred vision
4) Severe headache
5) Nausea
6) Vomiting
7) Dry eyes with itching or burning
8) Dark spot at the centre of viewing
9) Excess tearing or watery eyes
10) Difficulty focusing on near or distant object
MEDICAL MANAGEMENT:-
 The aim of glaucoma treatment is prevention of optic nerve damage
through medical therapy.
 Lifelong therapy is almost always necessary because glaucoma cannot be
cured.
 The treatment goal is to maintain an IOP within a range unlikely to cause
further damage.
 The patient is monitored for the stability of the optic nerve.
 Medical management relies on systemic and topical ocular medications
that lower IOP.
 The patient is usually started on the lowest dose of topical medication and
then advanced to increased concentration until the desired IOP level is
reached and maintained.
 Several types of ocular medications are used to treat glaucoma.
1. Cholinergic 1%, 2% - It - Per orbital - Caution
(Miotics): or increasesaqueous pain, blurry vision, pts about
Pilocarpine, 4% / 3- fluid outflowby difficulty seeing in diminished
Carbachol 4 contracting the ciliary the dark. vision in dimly
times/ muscles and causing lit areas.
day meiosis (constriction
of the pupil) and
openingof -
the Eye
2. Adrenergic trabecular meshwork.rednessand - Teach pt
agonists : 0.5%, burning, anxiety punctual
Dipivefrin, 1% or - Reduces palpitation, occlusion to
Epinephrine 2% /12 productionof aqueous elevated B.P., limit systemic
times / humorand increases headache and effects.
day outflow.
3. Beta - Bradycardia, Contraindicated
blockers : 0.25 or hypotension in pts with
Betaxolol, 0.5% / asthma, COPD
Timolol 2 - Decreases or cardiac
times / aqueous humor failure.
day production.
4. Alpha - Eye redness, - Teach pt
adrenergic 0.5% / dry mouthand punctual
agonists : 2-3 nasal passage occlusion to
Apraclonidin times/ limit systemic
Brimonidine day - Decreases effects
aqueous humor
5. Carbonic production. - Electrolyte - Monitor
anhydrase 250 mg loss, depression, electrolyte
inhibitors : / tds or lethargy, GI upset, levels and Do
Acetazolami qid weight loss and not administer
de, topical allergy to pts with
methazolam - Decreases sulfa allergies
ide aqueous humor
production.
SURGICAL MANAGEMENT
Laser trabeculoplasty :- ( for glaucoma)
In this laser burns are applied to the inner surface of the
trabecular meshwork to open the intra trabecular spaces. Thereby, promoting
outflow of aqueous humor and decreasing IOP. The procedure is indicated when
IOP is inadequately controlled by medication’s serious complication is a
transient rise in IOP (usually 2 hours after surgery).

Laser iridotomy: (for papillary block glaucoma)

In this an opening is made in the iris to eliminate the papillary
block. This procedure is contraindicated in pts with corneal oedema.
Potential complication is burns to the cornea, lens or retina, transient
elevated IOP.
Filtering procedure: (for chronic glaucoma)
These are used to create an opening or fistula in the trabecular meshwork
to drain aqueous humor from the anterior chamber to the sub-conjunctival
space, thereby bypassing the usual drainage structures. This allows the aqueous
humor to flow and exit by different routes.
Trabeculectomy :-
It is the standard filtering technique used to remove part of the trabecular
meshwork. Complication include hemorrhage, low or elevated IOP, cataract etc.
Drainage implants or shunts
These are an opentubes implanted in the anterior chamber to shunt
aqueous humor to an attached place in the conjunctiva space. A fibrous
capsule develops around the episcleral plate and filters the aqueous humor,
thereby regulating the outflow and controlling IOP.

Canaloplasty
Canaloplasty utilizes a micro catheter or tube placed in the Canal of
Schlemm (the natural site of drainage for healthy eyes) to enlarge the drainage
canal, relieving pressure inside the eye. Studies have been published
demonstrating long term efficacy and safety
Diode laser cycloablation
When trabeculectomy or glaucoma drainage tube(seton) has failed to
control glaucoma, then the treating physician may consider cycloablation
(ablation or destruction of the ciliary body which produces the aqueous fluid).
Because, cycloablation involves permanent destruction of the ciliary body, it is
usually the last line of treatment for uncontrolled glaucoma. Before the advent
of laser, this was done using a cry probe (freezing probe) to freeze the ciliary
body (cyclocryotherapy).

NURSING MANAGEMENT

1. Assessment:- Evaluate patient for severe pain.

Nursing diagnosis :- Acute pain related to increased intra-ocular pressure.
Nursing goal:- Provide medication, thereafter Client will have Reducing
pain.
Nursing Intervention:-
S. NURSING INTERVENTION RATIONALE
N.
1. Administered Opioids and other  Opioids reduce the pain.
medications as directed.
2. Explain the patient that the goal of  To reduce anxiety.
treatment is to reduce IOP as quickly as
possible.
3. Reassure patient that, with reduction in  Reassurance is essential to reduce fear
IOP, pain and other sign and symptoms and anxiety of the patient. Fear and
should subside. anxiety increases the perception of
pain.

Evaluation:- Patient will relieve from pain, after giving opioids.

2.Assessment: - Assess patient’s level of anxiety andknowledge.
Nursing diagnosis: - Fear related to pain and potential loss of vision.
Nursing goal: - Provide emotional support, thereafter Client will have reduced
fear

Nursing intervention
S. NURSING INTERVENTION RATIONALE
N.
1. Provide reassurance and calm Reassurance is essential to reduce fear and
2. Presence to reduce anxietyand fear. anxiety of the patient
Provide emotional support. Emotional support is essential to reduce
fear and anxiety of the patient. Fear and
anxiety increases the perception of pain.

Evaluation: - Patient’s fear and anxiety will reduce.

3Assessment: - Evaluate patient for nausea and vomiting.

Nursing diagnosis: - Nausea and vomiting related to opioids and other
medications.
Nursing goal: - Provide antiemetic drugs, thereafter Client will have
Relieving from nausea and vomiting.

Nursing intervention:-
S. NURSING INTERVENTION RATIONALE
N.
1. Patient may be medicated with  Antiemetic reduced nausea and vomiting.
antiemetic.
2. Explain the patient and provide  Explanation and support are reduced the
support. fear and anxiety.

Evaluation: - Patient will relieve from Nausea and vomiting, after taking
antiemetic drugs.
4.Assessment: - Assess the level of knowledge of the patient regarding disease.
Nursing diagnosis: - Knowledge deficit related to disease.
Nursing goal: - Provide knowledge regarding glaucoma.
Nursing intervention:-
S. NURSING INTERVENTION RATIONALE
N.
1. Provide knowledge regarding Patient is able to understand regarding
glaucoma, their sign and symptoms disease.
and Management.
Provide knowledge regarding Patient is able to understand regarding
2. medication and their side effects. medication.
Evaluation: - Patient is able to understand regarding glaucoma.

HOME CARE

 Explain patient about intraocular pressure (IOP) measurement and

the desired range.
 Informe about the extent of vision loss and optic nerve damage.
 Monitor visual changes and inform physician if any marked changes
 Review all medications (including over-the-counter and herbal
medications) with ophthalmologist, and mention any side effects during
each follow up
 Regular monitoring for any potential side effects and drug interactions of
eye medications if any
 Participate patient and family in the decision-making process like dosing
schedule preferences regarding eye care.
 demonstrate and supervise re demonstration of care giver on instilling eye
medication to avoid complications.
 Explain possible adverse effects if used inappropriately.
 Teach eye drops are to be administered as prescribed, not when eyes feel
irritated.
 Teach importance of regular follow-up.
 Explain family about glaucoma and its possibility of congenital incidence
 Educate patient those lost their vision due to glaucoma about visually
chanlenged groups , its functions and benefits.
SUMMARY

So far we were discussing about glaucoma definition, cause, riskfactors,

pathophysiology, clinical features, diagnostic evaluations and its management.

RESEARCH ABSTRACT

Comparison of Vision-related Quality of Life Between

Normal Tension Glaucoma and Primary Open-angle
Glaucoma

Chun, Yeoun Sook MD, PhD*; Sung, Kyung Rim MD, PhD†; Park, Chan Kee
MD, PhD‡; Kim, Hwang Ki MD, PhD§; Yoo, Chungkwon MD, PhD∥; Kim,
Yong Yeon MD, PhD∥; Park, Ki Ho MD, PhD¶; Kim, Chan Yun MD, PhD#;
Choi, Kyu-Ryong MD, PhD**; Lee, Kyoo Won MD, PhD††; Han, Seungbong
PhD‡‡; Kim, Chang-sik MD, PhD§§
Journal of Glaucoma: May 2022 - Volume 31 - Issue 5 - p 322-328
Although there was little difference in overall vision-related quality of life
(VRQOL) between patients with normal tension glaucoma (NTG) and primary
open-angle glaucoma (POAG) after controlling for confounding factors, POAG
tended to have poorer VRQOL, especially in social functioning and
dependency, than NTG.
Purpose:
The fundamental goal of treatment of patients with glaucoma is to preserve their
VRQOL. The aim of this study was to compare VRQOL between patients with
NTG and those with POAG.
Materials and Methods:
The self-reported National Eye Institute Visual Function Questionnaire (NEI
VFQ-25) survey was performed, including clinical, demographic, and
socioeconomic data from 506 Korean patients with NTG and 287 with POAG.
The mean deviation of the integrated binocular visual field was calculated using
the best location method. The NEI VFQ-25 results were evaluated by Rasch
analysis to control item difficulty and variation in individual response ability.
Propensity score matching was used to control for various confounding factors
affecting VRQOL.
Results:
Although patients with POAG tended to have worse VRQOL than those with
NTG, there was no statistically significant between-group difference in ocular
pain, near and distance activities, mental health, role difficulties, ability to drive,
and the overall composite score. However, the social functioning ( P =0.016)
and dependency ( P =0.026) were significantly poorer in POAG patients.

Conclusions:
Overall VRQOL in patients with NTG and POAG was found to be similar.
However, social functioning and dependency were significantly worse in those
with POAG. These findings are relevant to supporting glaucoma patients.
CONCLUSION

Hope you all have understood about glaucoma and its disease process, if
you have any doubts you can ask now. Thank you

REFERENCE

BIBLIOGRPHY

1) Black Joyce M.,Howks Jane Hokanson (2009),Medical Surgical

Nursing,8th Edition,Volume-2, Newdelhi :Elsevier Page No 399- 342

2) Smeltzer Suzannec., Bare Brenda (2004), Brunner& Suddarth’s

Textbook Of Medical Surgical Nursing, 10th Edition, London:
Lippincott Williams & Wilkins. Page 1770-1773

3) Waugh Anne,Allison Grant(2007),Ross And Wilson anatomy and

Physiology in Health & Illness,10th Edition, London:Elsevier Page 117-
120

NET REFERENCE

1) www.glaucomafoundation.org
2) Medicaldictionary.thefreedictionary.com
3) www.emedicinehealth.com
4) www.webmd.com
 5) Chun, Yeoun Sook MD, PhD et al, Journal of Glaucoma: May 2022 -
Volume 31 - Issue 5 - p 322-328
https://journals.lww.com/glaucomajournal/pages/currenttoc.aspx

INDEX
S.NO CONTENT PAGE.NO
1 Introduction
2 Anatomy and physiology of eye
3 Definition of glaucoma
4 Incidence of glaucoma
5 Etiology
6 Risk factors
6 Types of glaucoma
7 Pathophysiology
8 Stages of glaucoma
9 Diagnostic evaluation
10 Clinical manifestation
11 Medical management
12 Surgical management
13 Nursing management
14 Home care
16 Summary
17 Conclusion
18 Journal abstract
19 Reference
 SEMINAR CONTENT
Subject Medical surgical nursing
Unit
Topic Glaucoma
Method of Teaching Lecture cum Discussion
AV Aids LCD, chart, leaflet, whiteboard, model
Date
Time