Introduction
Glaucoma is one of the diseases affecting broad populations a threat to the health of a nation. Normal-tension glaucoma (NTG) is one of the conditions representing the glaucoma family; however, it can also be viewed as an exception as the major factor preconditioning the emergence of issues, such as intraocular pressure, is missing (Killer & Pircher, 2018). For this reason, there are multiple debates on what factors can precondition the glaucomatous optic disc change and visual field loss (Killer & Pircher, 2018). For this reason, the selected article focuses on the review of papers devoted to NTG and discussion of possible mechanisms that can be involved in the pathophysiology of NTG and the degree to which they affect the sight and visual field of a person (Killer & Pircher, 2018). This information can help to understand the disease better and struggle with it.
There is a significant body of research explaining the mechanisms of how this condition might emerge and evolve. Among the possible causes and risk factors, scientists outline a higher sensitivity to normal pressure, vascular dysregulation, neurodegenerative processes linked to the impaired cerebrospinal fluid dynamics, and abnormally high translaminar pressure gradient (Killer & Pircher, 2018). All these factors can increase the risk of acquiring and developing NGT (Killer & Pircher, 2018). However, regardless of all these suggestions, the normal-tension glaucoma remains still not completely understood, and there is a lack of knowledge of what mechanisms can explain the appearance of NTG (Killer & Pircher, 2018). That is why it is vital to continue investigating the disease and review the literature related to it.
At the moment, there is a specific definition of the condition accepted by the majority of scientists. NTG is neuropathy of an optic nerve coming with the optic disc excavation, visual field loss (Killer & Pircher, 2018). However, at the same time, the intraocular pressure remains normal and usually constitutes about 21mm Hg (Killer & Pircher, 2018). For other patients, these numbers do not lead to the deterioration of their sight and medical interventions (Killer & Pircher, 2018). However, some mechanisms are still poorly understood or explained. Thus, Killer and Pircher (2018) state that older adults with Alzheimer’s disease also suffer from NTG. For this reason, there is a hypothesis that this type of glaucoma can be viewed as an early manifestation of some neurodegenerative disease that might precondition further changes and deterioration (Killer & Pircher, 2018). Furthermore, the article states that some patients with NTG share a common feature of vascular dysregulation (Killer & Pircher, 2018). It means that numerous factors can be linked to the emergence and progression of normal-tension glaucoma in patients and are still poorly understood.
Altogether, the paper concludes that there is broad research devoted to NTG, conditions linked to it, and risk factors. However, numerous gaps in knowledge demand further analysis. The authors assume that NTG is a complex syndrome that includes many pathological pathways, and they are different for various population groups (Killer & Pircher, 2018). Under these conditions, the effectiveness of the therapeutic approach to treating NTG among patients depends on the correct understanding of the current state of the person’s health, his/her demographic characteristics, and the possible risk factors. The researchers should continue working on the topic to ensure there is progress in managing NTG and helping patients to preserve the quality of life on the high and desired level.
Causes of Increased Intraocular Pressure: Pseudoexfoliation Syndrome
Increased intraocular pressure is a serious condition and abnormality that demands intervention to avoid the deterioration of the patient’s state and preserve the high quality of life. Thus, the selected article states that pseudoexfoliation syndrome (PES) is known as one of the causes for the emergence and development of multiple complications, including increased intraocular pressure (Tekin et al., 2019). It is a complicated and age-related systemic disorder resulting in the continuous accumulation and granular deposition of pseudoexfoliative material (PXM) in different tissues, including intraocular and extraocular ones (Tekin et al., 2019). For this reason, it is vital to understand these mechanisms to avoid the development of complications. A better vision of the nature and progression of the disease is fundamental for helping aged individuals and improving their well-being.
Considering the importance of the discussed topic, the authors want to contribute to a better vision of this disease. The central goal of the selected paper is to review the existing perspectives on working with patients who have PES and how to address ocular associations of this illness, including the increased intraocular pressure and the deterioration of sight linked to it (Tekin et al., 2019). The authors are sure that the choice of the topic is justified by the lack of knowledge related to PES and its management in terms of increased intraocular pressure, which results in the inability to avoid complications, such as glaucoma (Tekin et al., 2019). For this reason, the offered review proposes several perspectives on the disease and how it can be addressed in the modern setting.
First of all, the investigators admit the systemic nature of the disease. PES affects the liver, heart, kidneys, lungs, cerebral meninges, skin, and vessel walls (Tekin et al., 2019). However, along with these parts of the body, PXM can also be accumulated in all ocular tissue, which poses a serious threat to the health of patients and increases the risks of problems with sight (Tekin et al., 2019). The researchers also admit that PES can be a complicating factor when there is a need for cataract surgeries or glaucoma treatment (Tekin et al., 2019). It increases the risk of intraoperative and postoperative complications and should be considered by specialists when treating such patients (Tekin et al., 2019). Under these conditions, it is vital to consider this condition when working with such patients.
Furthermore, speaking about PES and the accumulation of PXM, the investigators emphasize the necessity of close monitoring. Tekin et al. (2019) state that the appropriate treatment of glaucoma preconditioned by the increased intraocular pressure for patients with PES is impossible without paying attention to risks associated with the discussed condition. Being one of the known causes for problems with sight, PES demands special interventions and treatment as surgery linked to glaucoma might be more complex for patients with PES.
Altogether, the selected article outlines PES as one of the reasons for increased intraocular pressure. The problem is caused by PXM accumulating in all tissues, including ocular ones, and progressing cataracts or glaucoma. For this reason, when working with aged people suffering from this syndrome, it is vital to introduce improved monitoring techniques and ensure that all clients are managed considering the existence and effects of PES. Otherwise, there is a high risk of complications and decreased quality of life. PES can be a serious threat to global health, and the article concludes that further research is necessary to enhance the understanding of how it works and affects people.
Microinvasive Glaucoma Surgery
The annual growth in the number of patients with glaucoma demands the introduction of an effective approach to treatment and its addressing. For this reason, researchers and specialists today offer multiple paradigms on how to help patients with the disease and avoid the emergence of adverse effects. The selected paper focuses on microinvasive glaucoma surgery (MIGS) as a novel approach to treating glaucoma. The authors discuss its advantages and disadvantages and the perspectives on the future of the procedure and its ability to help people. Being one of the innovative methods, MIGS still triggers many debates and attracts the attention of investigators as a possible method to help patients with the disease.
The increased intraocular pressure is one of the central factors leading to the emergence and development of glaucoma. That is why the reduction of this pressure is one of the first steps in managing the condition. The authors state that MIGS procedures help to attain the goal by using four mechanisms, such as increasing trabecular outflow, subconjunctival filtration, increasing outflow via suprachoroidal shunts, and reduction of aqueous production (Schehlein et al., 2017). The given options are novel and offer several benefits that are linked to MIGS. First of all, it is an improved safety profile meaning that specialists can make interventions at earlier stages of glaucoma (Schehlein et al., 2017). Moreover, MIGS can be combined with cataract surgery, which is vital for treatment and better outcomes (Schehlein et al., 2017). Furthermore, this sort of intervention presupposes that patients are less dependant on compliance with topical agents (Schehlein et al., 2017). The existing statistics show that MIGS has high efficacy and demonstrates promising results, which can be used as the justification of its further use in practice (Schehlein et al., 2017). The authors are sure that this sort of surgery provides therapists with new opportunities for glaucoma treatment.
The article also focuses on the peculiarities of MIGS and how they are made today. Thus, the procedure refers to any manipulation involving a self-sealing, clear corneal incision resulting in minimal trauma to surrounding tissues (Schehlein et al., 2017). The characteristics also presuppose short surgical time, decreased intraocular pressure, and a quick recovery because of the reduced damage done to the eye (Schehlein et al., 2017). Data collected during the two past decades show the increased number of MIGS done to patients, meaning it becomes a serious option for all clients with glaucoma (Schehlein et al., 2017). Because of the effectiveness of the intervention, the authors predict the further growth in the popularity of MIGS as it helps to make surgeries less complex and risky (Schehlein et al., 2017). At the same time, there are no clear counterarguments or rejections towards using MIGS in different settings (Schehlein et al., 2017). For this reason, this sort of treatment remains popular among ophthalmologists.
Altogether, the authors are sure that microinvasive glaucoma surgery can be viewed as the future of struggling with glaucoma. In their paper, Schehlein et al. (2017) state that it will continue to become more popular among all parties, including patients and specialists. At the same time, they emphasize the fact that there is a lack of randomized control trials devoted to the theme, meaning that future study is needed to ensure there are no serious disadvantages of using MIGS and it can be recommended to all groups of patients.
Management of dry ARMD
Blindness is one of the aspects critically affecting the well-being of a person and his/her quality of life. For this reason, there are multiple attempts to understand the factors leading to it and find ways to eliminate them. Thus, the selected paper revolves around age-related macular degeneration, improved understanding, management, and therapy. The authors state that ARMD is a third leading cause of blindness globally and the main leading cause of the complete loss of vision in the Western world (Miller et al., 2017). The given spread of the disease and its scope result in the necessity to find an effective way to manage it and avoid the development of complications. The authors are sure that in the future, more practical approaches for addressing this issue will be found.
The paper states that the key to creating therapies is the better vision of the pathogenesis of the disease. The current research on the topic helps to understand why and how ARMD evolves and affects patients. In general, the condition causes blurred or reduced central vision because of the thinning of the macula (Miller et al., 2017). For this reason, the existing therapies are focused on preventing these effects. The emergence and development of anti-vascular endothelial growth factor (anti-VEGF) to treat the disease became a serious success for addressing the problem (Miller et al., 2017). At the same time, the authors admit the need to develop enhanced biomarkers and clinical endpoints to identify therapeutic targets as the key to better treatment (Miller et al., 2017). That is why future advancements are linked to looking for ways to acquire the improved vision of pathogenesis and how the disease evolves.
Furthermore, the authors speak about targeting lipids in age-related macular degeneration. It is a method helping to detect specific proteins and lipoprotein levels that are vital for the correct treatment and addressing the disease. Thus, possessing the given information, it is possible to improve outcomes significantly and prevent the complete loss of sight. The researchers also state that inflammation is central to all stages of ARMD, meaning that specialists should be ready to address it and work with its effects (Miller et al., 2017). For this reason, there are attempts to find the most appropriate treatment scheme and apply it to ensure that the processes are managed effectively (Miller et al., 2017). In such a way, today, there are serious advances in managing ARMD due to more effective investigation and controlling tools.
The ability to delay vision loss by applying relevant therapies and practices is one of the fundamentals of modern care linked to ARMD. The researchers state that the application of anti-VEGF can also be effective in achieving this goal as the current statistics show the correlation between the utilization of this form of treatment and attained results (Miller et al., 2017). For this reason, it is possible to be optimistic about the future of the problem, and as treatments like this one can help millions of patients globally. Miller et al. (2017) conclude that in the future, better therapies will emerge and help to treat ARMD in different groups of patients. However, it is vital to be ready to detect it at early stages and apply the appropriate measures to avoid the critical deterioration of vision and complete blindness. For risk groups, advances in therapy are vital as they provide them with the chance to preserve the desired quality of their lives.
References
Killer, H. E., & Pircher, A. (2018). Normal-tension glaucoma: review of current understanding and mechanisms of the pathogenesis. Eye, 32(5), 924–930. Web.
Miller, J. W., Bagheri, S., & Vavvas, D. G. (2017). Advances in age-related macular degeneration understanding and therapy. US Ophthalmic Review, 10(2), 119–130.
Schehlein, E. M., Kaleem, M. A., Swamy, R., & Saeedi, O. J. (2017). Microinvasive glaucoma surgery: An evidence-based assessment. Expert Review of Ophthalmology, 12(4), 331–343.
Tekin, K., Inanc, M., & Elgin, U. (2019). Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives. Clinical Ophthalmology, 13, 453–464.