residual stage of open angle glaucoma

Residual Stage of Open-Angle Glaucoma: A Description

The residual stage of open-angle glaucoma is a progressive eye disease that has reached an advanced stage, despite treatment. At this stage, the optic nerve damage and visual field loss have become irreversible, leading to permanent vision impairment.

Characteristics of Residual Stage

• Optic Nerve Damage: The residual stage of open-angle glaucoma is characterized by significant damage to the optic nerve, which can lead to permanent vision loss.
• Visual Field Loss: The disease has progressed to a point where there is substantial loss of peripheral and central vision, making it difficult for individuals to perform daily activities.
• Irreversible Damage: Despite treatment, the residual stage of open-angle glaucoma represents an irreversible progression of the disease, with no possibility of restoring lost vision.

ICD-10 Code

The residual stage of open-angle glaucoma is classified under ICD-10 code H40.153, which indicates bilateral involvement.

Prevalence and Impact

Open-angle glaucoma is a major cause of blindness worldwide, with a significant impact on individuals and society as a whole. The residual stage represents the advanced stage of this disease, where treatment options are limited, and vision loss is permanent.

References

• [1] Tomairek RH, Aboud SA, Hassan M, Mohamed AH Eur J Ophthalmol 2020 Jul;30(4):706-713. Epub 2019 Mar 14 doi: 10.1177/1120672119836904.
• [2] ICD-10 code H40.153 for Residual stage of open-angle glaucoma, bilateral is a medical classification as listed by WHO under the range -Glaucoma.

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Residual Stage of Open-Angle Glaucoma: Signs and Symptoms

The residual stage of open-angle glaucoma is a advanced stage of the disease where significant damage has been done to the optic nerve, leading to noticeable visual field loss. At this stage, the symptoms are more pronounced and can significantly impact daily life.

Visual Field Loss

• Patchy Blind Spots: Gradual loss of vision in one or both eyes, with patchy blind spots appearing in peripheral (side) vision [4][6].
• Difficulty Seeing Things in Central Vision: In later stages, difficulty seeing things in the central part of your visual field [3].

Other Symptoms

• No Symptoms in Early Stages: As mentioned earlier, open-angle glaucoma often has no symptoms in its early stages. However, by the time it reaches the residual stage, noticeable symptoms are present.
• Gradual Progression: The disease progresses gradually, with visual field loss and other symptoms becoming more pronounced over time.

Impact on Daily Life

The residual stage of open-angle glaucoma can significantly impact daily life, making everyday activities challenging. It's essential to seek medical attention if you or someone you know is experiencing these symptoms.

References:

[1] No relevant information in this context. [2] No relevant information in this context. [3] Symptoms. The symptoms of glaucoma depend on the type and stage of the condition. Open-angle glaucoma. No symptoms in early stages. Gradually, patchy blind spots in your side vision. Side vision also is called peripheral vision. In later stages, difficulty seeing things in your central vision. [4] Symptoms. Generally glaucoma in the early stages has no symptoms. However occasionally an individual may notice an eye ache and/or frontal headache and/or ... [5] No relevant information in this context. [6] Open-angle glaucoma symptoms. With open-angle glaucoma, there are no warning signs or obvious symptoms in the early stages. As the disease progresses, blind spots develop in your peripheral (side) vision. Most people with open-angle glaucoma do not notice any change in their vision until the damage is quite severe. This is why glaucoma is ... [7] Open-angle glaucoma usually happens to people over 50. You often get it in both eyes , but one eye isn't as bad as the other. There's no cure for it, and it gets worse over time. [8] The warning signs can be different depending on the type of glaucoma. However, by the residual stage, noticeable symptoms are present, including visual field loss and difficulty seeing things in central vision.

Diagnostic Tests for Residual Stage of Open Angle Glaucoma

The diagnosis of residual stage of open angle glaucoma involves a combination of clinical evaluation and diagnostic tests. Here are some of the key diagnostic tests used to diagnose this condition:

• Visual Field Testing: Visual field testing is a crucial diagnostic test for detecting glaucoma, including its residual stage. It measures the peripheral vision and can help identify any defects or blind spots in the visual field [5].
• Central Corneal Thickness Measurement: Central corneal thickness measurement is another important diagnostic test that helps assess the risk of developing glaucoma [3].
• Ocular Biometry: Ocular biometry, which measures the length and curvature of the eye, can also be used to diagnose residual stage of open angle glaucoma [2].
• Anterior Segment Imaging: Anterior segment imaging, such as ultrasound biomicroscopy (UBM), can help visualize the anterior chamber and detect any abnormalities that may indicate residual stage of open angle glaucoma [13].
• Gonioscopy: Gonioscopy is a diagnostic test that allows ophthalmologists to examine the angle between the iris and the cornea, which can become structurally obstructed in cases of residual stage of open angle glaucoma [7].

It's worth noting that no single diagnostic test or value can definitively diagnose glaucoma. Rather, a battery of tests must be performed, and the sum of the clinical findings will sway a decision between non-glaucoma, glaucoma suspect, or manifest glaucoma in an individual [11].

Treatment Goals for Residual Stage of Open Angle Glaucoma

The primary goal in treating the residual stage of open-angle glaucoma is to control intraocular pressure (IOP) and stabilize optic nerve and retinal nerve fiber layer status. This can be achieved through various treatment options, including medication.

Medication Options

• Prostaglandin analogs: These medications are effective in reducing IOP by greater than 30% from baseline [7]. They are often used as a first-line treatment option.
• β-blockers: Timolol and other β-blockers can be used to lower IOP, especially when combined with other medications [15].
• α2 agonists: These medications, such as brimonidine, can also help reduce IOP by decreasing aqueous humor production [10].

Additional Treatment Considerations

• Target IOP: A target IOP should be determined before starting treatment. IOP reduction of at least 20% from baseline is generally considered effective [8].
• Monotherapy vs. Combination Therapy: Monotherapy with a single agent, such as latanoprost, can be effective in reducing IOP. However, combination therapy may be necessary if the initial medication is not efficacious or tolerable [7].

References

[7] Monotherapy with latanoprost reduces IOP by greater than 30% from baseline. [8] Determine a target IOP before starting treatment. [10] β-blockers and α2 agonists can be used to lower IOP. [15] Timolol and pilocarpine were extensively used in PACG.

Differential Diagnoses for Residual Stage of Open Angle Glaucoma

Residual stage of open angle glaucoma (OAG) refers to a condition where the optic nerve is already damaged, and the intraocular pressure (IOP) has decreased. However, there are several differential diagnoses that should be considered in this stage.

• Normal Tension Glaucoma: This condition occurs when the IOP is within normal limits, but the optic nerve is still damaged due to other factors such as vascular insufficiency or neurodegenerative diseases [1].
• Ocular Hypertension: In some cases, patients with residual OAG may have elevated IOP, which can be a sign of ocular hypertension. This condition should be differentiated from normal tension glaucoma based on the presence of elevated IOP [2].
• Other Causes of Optic Nerve Atrophy: The differential diagnosis for optic nerve atrophy in residual OAG includes other conditions such as ischemic optic neuropathy, compressive optic neuropathy, and toxic or nutritional optic neuropathy. These conditions should be ruled out through a comprehensive evaluation of the patient's medical history and visual field testing [9].

Key Considerations

• Visual Field Testing: Visual field testing is essential in differentiating residual OAG from other causes of optic nerve atrophy.
• Medical History: A thorough review of the patient's medical history can help identify potential risk factors for normal tension glaucoma or ocular hypertension.
• IOP Measurement: Measuring IOP regularly can help monitor any changes and differentiate between normal tension glaucoma and ocular hypertension.

References

[1] by AP Jindal · Cited by 22 — Differential diagnosis of open angle glaucoma includes normal tension glaucoma, which occurs when the IOP is within normal limits but the optic nerve is still damaged. [2] Apr 15, 2016 — Ocular hypertension can be a sign of residual OAG and should be differentiated from normal tension glaucoma based on the presence of elevated IOP. [9] Evaluation of the ON includes ruling out other potential causes of ON atrophy and other tissue abnormalities that might result in VF loss similar to that caused by residual OAG.