1

Flame Shape HemorrhageFlame Shape Hemorrhage

Drance Hem

Normal Nerve Fiber LayerNormal Nerve Fiber Layer

Wedge Shaped Nerve Fiber LayerWedge Shaped Nerve Fiber Layer

DefectDefect Visual Fields in GlaucomaVisual Fields in Glaucoma

Confirms glaucomaConfirms glaucoma

Severity of glaucoma: early, mild,Severity of glaucoma: early, mild,moderate & severemoderate & severe

PrognosisPrognosis

Effectiveness of treatmentEffectiveness of treatment

Rules out other causes that can mimicRules out other causes that can mimic

glaucomaglaucoma

Progression of Open-Angle GlaucomaProgression of Open-Angle Glaucoma

Symptoms as Seen Through the Eyes ofSymptoms as Seen Through the Eyes ofthe Patientthe Patient

This is an example of normal vision. It is also an example ofThis is an example of normal vision. It is also an example ofhow someone sees during the beginning stages of open-anglehow someone sees during the beginning stages of open-angle

glaucoma. Because there are no symptoms initially, regularglaucoma. Because there are no symptoms initially, regular

eye examinations are very important.eye examinations are very important.

Early Symptoms

Intermediate Symptoms

Advanced Symptoms

Early Symptoms

Early symptoms may include a gradual and oftenEarly symptoms may include a gradual and oftenimperceptableimperceptable failing of peripheral (side) vision. failing of peripheral (side) vision.

Intermediate Symptoms

Early Symptoms

As the disease progresses, the center of vision may still beAs the disease progresses, the center of vision may still beclear; however, peripheral vision begins to fail.clear; however, peripheral vision begins to fail.

Advanced Symptoms

Intermediate Symptoms

During the advanced stages of glaucoma, only a small centralDuring the advanced stages of glaucoma, only a small centralarea of vision remains. If the entire optic nerve is destroyed,area of vision remains. If the entire optic nerve is destroyed,

then total blindness will result.then total blindness will result.

Visual Field DefectsVisual Field Defects

•• Early/Mild: Nasal step or depression,Early/Mild: Nasal step or depression,

isolated isolated paracentralparacentral scotomasscotomas, or, ordiffuse depressiondiffuse depression

•• Moderate: Moderate: ArcuateArcuate BjerrumBjerrum scotomascotoma in in

one one hemifieldhemifield

•• Severe: Complete Severe: Complete arcuatearcuate scotomascotoma in in

both both hemifieldshemifields or or hemifieldhemifield altitudinal altitudinal

•• Far Advanced: Small central and/orFar Advanced: Small central and/ortemporal island of vision remainingtemporal island of vision remaining

2

Worsening of Visual FieldsWorsening of Visual Fields

New defectsNew defects

Enlarging of original defectEnlarging of original defect

Deepening of original defectDeepening of original defect

3

The SecondaryThe Secondary

GlaucomasGlaucomasPigmentaryPigmentary Dispersion Syndrome (PDS) Dispersion Syndrome (PDS)

Exfoliation Syndrome (XFS)Exfoliation Syndrome (XFS)

UveiticUveitic

Steroid InducedSteroid Induced

NeovascularNeovascular

Trauma: Trauma: HyphemaHyphema/Angle Recession/Angle Recession

PigmentaryPigmentary Glaucoma Glaucoma

4+ pigment in TM

Ciliary Body

Schwalbe’s line

XFS

4

XFS

Angle Closure GlaucomaAngle Closure Glaucoma

Primary & Secondary ACG withPrimary & Secondary ACG with

pupillarypupillary block block

Primary & Secondary ACG withoutPrimary & Secondary ACG without

pupillarypupillary block block

5