No abstract

Glaucoma is a medical term describing a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and retinal nerve fibre layer and resulting in changes in the optic nerve head. Glaucoma is a leading cause of irreversible vision loss worldwide. With the aging population it is expected that the prevalence of glaucoma will continue to increase. Despite recent advances in imaging and visual field testing techniques that allow establishment of earlier diagnosis and treatment initiation, significant numbers of glaucoma patients are undiagnosed and present late in the course of their disease. This can lead to irreversible vision loss, reduced quality of life, and a higher socioeconomic burden. Selection of therapeutic approaches for glaucoma should be based on careful ocular examination, patient medical history, presence of comorbidities, and awareness of concomitant systemic therapies. Therapy should also be individualized to patients' needs and preferences. Recent developments in this therapeutic field require revisiting treatment algorithms and integration of traditional and novel approaches in order to ensure optimal visual outcomes. This article provides an overview of recent developments and practice trends in the medical management of glaucoma in Canada. A discussion of the surgical management is beyond the scope of this paper.

Relative deprivation (RD) theory states that the perception of the relative positions of one's group and an out-group in terms of status and privilege is psychologically important. RD theory predictions for members of oppressed groups include increased endorsement of militant acts, decreased feelings of control and life-satisfaction as a function of perceived relative deprivation and perceived discrimination. In the present study, these predictions were tested with 74 members of Toronto's gay male and lesbian community. RD measures encompassed the cognitive-affective (i.e. concerned with knowledge vs. feelings about the deprivation) and egoistical-fraternal (i.e. concerned with the status of the individual vs. the in-group) dimensions, with a measure of concrete fraternal discrimination (CFD) also included for comparison. The results indicated that CFD was the best predictor of increased militancy, decreased control and decreased satisfaction. Implications for RD theory are discussed.

Increased preoperative exposure to ophthalmic solutions preserved with BAK is a risk factor for earlier surgical failure, independent of the number of medications used. This study extends earlier findings of potential adverse effects of ophthalmic preservatives on surgical outcomes to the modern pharmacopeia used in the medical management of glaucoma.

ALT and SLT are equivalent in lowering IOP at 6 months posttreatment in patients with PXF.

Topical anti-glaucoma medication will continue to be used in the management of this blinding disease for the foreseeable future. Treatment outcomes will benefit from minimized exposure to benzalkonium chloride. The development of alternative preservatives, preservative-free topical options, and non-drop therapeutics such as drug-eluting systems for the delivery of ocular medications, will be very helpful in the care of glaucoma patients.

In younger patients, both ALT and SLT have a significant ocular hypotensive effect 2 years after treatment, with no differences in outcome identified between the laser modalities.

Late 5FU needling is an effective method to control IOP and avoid further surgery in a high proportion of patients with medically uncontrolled nonfiltering blebs.