Viral keratitis An infection of the cornea that may involve either the epithelium or stroma, Common cause: Herpes simplex type I and varicella zoster.

Viral keratitis

An infection of the cornea that may involve either the epithelium or stroma,

Common cause:

Herpes simplex type I and varicella zoster viruses.

Less common viral etiologies:

herpes simplex type II, Epstein-Barr virus, and cytomegalovirus.

1PHRM-520-L.S.N0-4-E-1

Topical Antiviral Agents

Treatment of epithelial disease due to herpes simplex infection.

treatment of epithelial disease due to herpes simplex infection.

Treating Viral Keratitis:

There is a very narrow margin between the therapeutic topical antiviral activity and

the toxic effect on the cornea;

Patients must be followed very closely.

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Topical Glucocorticoids

Contraindicated in herpetic epithelial keratitis due to active viral replication. Why????

Immunosuppressive------

Herpetic disciform keratitis:

which is presumed to predominantly involve a cell-mediated immune reaction topical glucocorticoids accelerate recovery.

Recurrent herpetic stromal keratitis: there is clear benefit from treatment with oral acyclovir in reducing the risk of recurrence.

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Herpes Simplex keratitis

Idoxuridine: -----------Topical (1% sol.)

Trifluridine (VIROPTIC):--- Topical (1%) sol.

Vidarabine (VIRA-A):

conjunctivitis

Topical (3% ointment)

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Acyclovir (ZOVIRAX):

Herpes zoster ophthalmicus

Oral, intravenous

(200-mg capsules, Herpes simplex iridocyclitis)

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Foscarnet (FOSCAVIR):Cytomegalovirus retinitisIntravenous, Intravitreal

Ganciclovir (CYTOVENE)/(VITRASERT) :

Cytomegalovirus retinitisIntravenous, oral, Intravitreal implant

Formivirsen (VITRAVENE):Cytomegalovirus retinitis

Intravitreal injection

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Cidofovir (VISTIDE):

Cytomegalovirus retinitis

Intravenous

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Glaucoma

Information, Risk Factors and Detection

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The healthy eye

• Light rays enter the eye

through the cornea, pupil and

lens.

• These light rays are focused

directly onto the retina, the

light-sensitive tissue lining the

back of the eye.

• The retina converts light rays

into impulses; sent through the

optic nerve to your brain, where

they are recognized as images.

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What is glaucoma?• Disease of the optic nerve.

• When damage to the optic nerve fibers

occurs, blind spots develop; blind spots

usually go undetected until optic nerve is

significantly damaged.

• Leading cause of blindness in the United

States, especially for older people.

• Early detection and treatment are keys to

preventing vision loss from glaucoma.

Normal vision

Vision as it might beaffected by glaucoma

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Anatomy of glaucoma

• Clear liquid called aqueous humor circulates inside the front

portion of the eye.

• To maintain a healthy level of pressure within the eye, a small

amount of aqueous humor is produced constantly, while an equal

amount flows out of the eye through a microscopic drainage

system—the trabecular meshwork.

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Anatomy of glaucoma

• With glaucoma, aqueous humor does not flow through the trabecular meshwork properly.

• Over time, eye pressure IOP increases, damaging the optic nerve fibers.

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Types of glaucoma

Two main categories of glaucoma:

• Open-angle glaucoma: the most common form of glaucoma - (the most common form that affects approximately 95% of individuals)

• Closed-angle glaucoma: a less common and more urgent form of Glaucoma.

Other Types of glaucoma:

Normal-Tension Glaucoma

Congenital glaucoma

Juvenile glaucoma

Secondary glaucoma

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Types of glaucoma – Open-angle

Open-angle glaucoma

• Trabecular meshwork becomes less

efficient at draining aqueous humor.

• Intraocular pressure (IOP) builds up,

which leads to damage of the optic

nerve.

• Damage to the optic nerve occurs at

different eye pressures among

different patients.

• Typically, glaucoma has no

symptoms in its early stages.

Open-angle glaucoma

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Types of glaucoma – Open-angle

Open-angle glaucoma is the most common form of the disease, is progressive and characterized by optic nerve damage.

The most significant risk factor for the development and advancement of this form is high eye pressure. Initially, there are usually no symptoms, but as eye pressure gradually builds, at some point the optic nerve is impaired, and peripheral vision is lost. Without treatment, an individual can become totally blind.

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Glaucoma risk factors – Open-angle

Strong risk factors for open-angle glaucoma include:

High eye pressure (IOP)

Family history of glaucoma

Age 40 and older for African Americans

Age 60 and older for the general population, especially Mexican Americans

Thin cornea

Suspicious optic nerve appearance with increased cupping (size of cup, the space at the center of optic nerve, is larger than normal)

Continued

Myopia is a condition of the eye where the light that comes

in does not directly focus on the retina but in front of it.

This causes the image that one sees when looking at a distant object to be out of focus, but in focus when looking at a close object.

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Glaucoma risk factors – Open-angle (cont)

Additional risk factors for open-angle glaucoma include:

High myopia (severe nearsightedness)

Diabetes

Eye surgery or injury

High blood pressure

Use of corticosteroids (for example, eye drops, pills*, inhalers and creams)

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Types of glaucoma – Closed-angle

Closed-angle (or narrow-angle) glaucoma:

• The drainage angle of trabecular

meshwork becomes blocked by the iris.

• IOP builds up very fast.

• Symptoms include severe eye or

brow pain, redness of the eye,

decreased or blurred vision.

• Must be treated as a medical

emergency—must visit

ophthalmologist immediately.

Closed-angle glaucoma

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Types of glaucoma – Closed-angle

Closed-angle glaucoma may be acute or chronic.

In acute closed-angle glaucoma the normal flow of eye fluid (aqueous humor) between the iris and the lens is suddenly blocked.

Symptoms may include severe pain, nausea, vomiting, blurred vision and seeing a rainbow halo around lights.

Acute closed-angle glaucoma is a medical emergency and must be treated immediately or blindness could result in one or two days.

Chronic closed-angle glaucoma progresses more slowly and can damage the eye without symptoms, similar to open-angle glaucoma.

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Glaucoma risk factors – Closed-angle

Closed-Angle Glaucoma

Age

Family history

Poor short-distance vision (farsightedness)

Eye injury or eye surgery

East Asian and Inuit ethnicity

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Types of glaucoma

Normal-Tension Glaucoma

Cardiovascular disease

Family history of glaucoma

Japanese ethnicity

Low eye pressure IOP

Normal-tension glaucoma occurs when eye pressure is normal,

yet the optic nerve is damaged and peripheral vision is lost. Lowering eye pressure through medication sometimes slows the progress of the disease, but this type of glaucoma may worsen despite low pressure. Treatment is generally the same as for open-angle glaucoma with high eye pressure.

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Types of GlaucomaCongenital glaucoma: affects infants born with defects that prevent the normal drainage of fluid from the eye.

Juvenile glaucoma: is open-angle glaucoma that affects children, adolescents and young adults.

Secondary glaucoma: can be open-angle or closed-angle, and is the result of some other medical condition in the eye or the body.

Examples of secondary glaucoma include:Pigmentary glaucoma, a rare form, in which pigment granules from the iris flake off into the eye fluid (aqueous humor) and clog the eye’s drainage system (trabecular meshwork).

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Detecting GlaucomaRegular glaucoma check-ups include two routine eye tests:

1. Tonometry – eye pressure test IOP

2. Ophthalmoscopy is a test that allows a health professional to see inside the back of the eye (called the fundus) and other structures using a magnifying instrument (ophthalmoscope) and a light source.

Additional tests:

Perimetry (the perimetry test is also called a visual field test)

Gonioscopy is a painless eye test that checks if the angle where the iris meets the cornea is open or closed, showing if either open angle or closed angle glaucoma is present.

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Detecting Glaucoma

Tonometry:

The tonometry eye test measures the inner pressure of the eye also known as Intraocular Pressure or IOP.

Tonometry is carried out by an instrument called a TONOMETER.

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Types of Tonometry:

Applanation tonometry measures intraocular pressure either by the force required to flatten a constant area of the cornea (e.g. Goldmann tonometry) or by the area flattened by a constant force.

Goldmann tonometer: Stationary device requires anesthesia drops, requires contact with cornea and is attached to a slit lamp – usually is used by an

Ophthalmologist.

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Types of tonometry

non-contact tonometry or air-puff tonometry:

This type of tonometer uses a rapid air pulse to applanate the cornea. Intraocular pressure is estimated by detecting the force of the air jet at the instance of applanation.

In most cases a stationary unit, Does not require anesthetic drops

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Types of tonometry

Tono-pen - is a portable electronic, digital pen-like instrument that determines IOP by making contact with the cornea, after use of topical anesthetic eye drops – tip covers are used between the patients.

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Types of tonometry

The newest Advancement in tonometry is DIATON TONOMETER – It measures intraocular pressure (IOP) through the Eyelid.

Diaton Tonometer is intended for use by Inpatient & Outpatient Clinics such as Hospitals, Emergency Rooms, Nursing & Elderly Homes,

General & Specialty Practitioners as well as Ophthalmologists and Optometrists.

DIATON Requires No Contact with Cornea No Anesthetic Drops, No Risk of Infecting

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Diaton Tonometry

•Safe•Quick•Efficient•Painless•Noninvasive

Can be used on Children and Adults

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Four Key Facts About Glaucoma

Glaucoma is a leading cause of blindness:Glaucoma can cause blindness if it is left untreated. And unfortunately approximately 10% of people with glaucoma who receive proper treatment still experience loss of vision.

There is no cure (yet) for glaucomaGlaucoma is not curable, and vision lost cannot be regained. With medication and/or surgery, it is possible to halt further loss of vision. Since glaucoma is a chronic condition, it must be monitored for life.

Screening, detection and prevention is the first step to preserving your vision.

Everyone is at risk for glaucoma

Everyone is at risk for glaucoma from babies to senior citizens. Yes, older people are at a higher risk for glaucoma but babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in the United States).

Young adults can get glaucoma, too. African-Americans in particular are susceptible at a younger age.

There may be no symptoms to warn you

With open angle glaucoma, the most common form, there are virtually no symptoms. Usually, no pain is associated with increased eye pressure.

Vision loss begins with peripheral or side vision. You may compensate for this unconsciously by turning your head to the side, and may not notice anything until significant vision is lost. The best way to protect your sight from glaucoma is to get tested. If you have glaucoma, treatment can begin immediately.

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Statistics About Glaucoma

It is estimated that over 4 million Americans have glaucoma but only half of those know they have it. (1)

Approximately 120,000 are blind from glaucoma, accounting for 9% to 12% of all cases of blindness in the U.S. (2)

About 2% of the population ages 40-50 and 8% over 70 have elevated IOP.

Glaucoma is the second leading cause of blindness in the world, according to the World Health Organization.

Glaucoma is the leading cause of blindness among African-Americans. (2)

Glaucoma is 6 to 8 times more common in African-Americans than Caucasians. (3)

African-Americans ages 45-65 are 14 to 17 times more likely to go blind from glaucoma than Caucasians with glaucoma in the same age group.

The most common form, Open Angle Glaucoma, accounts for 19% of all blindness among African-Americans compared to 6% in Caucasians. (4)

Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted.

Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide. (5)

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Statistics About Glaucoma cont

Prevent Blindness America Survey found that:

Blindness ranked third (after cancer and heart disease) as people’s major fear.

20% of people knew that glaucoma was related to elevated pressure within the eye. Most of them mistakenly thought people could tell if they had glaucoma due to symptoms, or that it was easily cured, or that it did not lead to blindness.

50% had heard of glaucoma, but weren’t sure what it was.

30% had never heard of glaucoma.

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Statistics About Glaucoma

Economic Impact:

Glaucoma accounts for over 7 million visits to physicians each year. (1)

In terms of Social Security benefits, lost income tax revenues, and health care expenditures, the cost to the U.S. government is estimated to be over $2.5 billion annually. (6)

Sources: (1) Prevent Blindness America; (2) National Eye Health Program/National Institutes of Health; (3) American Academy of Ophthalmology; (4) Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med. 1991 Nov 14;325(20):1412-7; (5) Quigley, “Number of people with glaucoma worldwide,” 1996; (6) NEI, Report of the Glaucoma Panel, Fall 1998

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Statistics About Glaucoma

as per University of Washington Department of Ophthalmology.

In U.S. - there are ONLY:

17,000 Ophthalmologists & 30,000 Optometrists

There is a great NEED for ADDITIONAL screening locations…

60 million Americans are at RISK for developing Glaucoma,

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FLORIDA AGE DEMOGRAPHICS:

Florida National % National

Households

All 6337929 1054801016%

Age 65+ 1943478 24672708 7.9%

Alone 710025 9722857 7.3%

Not Alone 1233453 14949851 8.3%

45 to 54 years 2069479 37677952 5.5%

55 to 59 years 821517 13469237 6.1%

60 to 64 years 737496 10805447 6.8%

65 to 74 years 1452176 18390986 7.9%

75 to 84 years 1024134 12361180 8.3%

85 years and over 331287 4239587 7.8%

TOTAL AT RISK (45 years and older) 6,436,089

As population ages the impact of the disease will increase…

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Glaucoma Prevention Initiative

Thank you for your attention

and your openness to challenge the “silent thief of sight”!