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Optic nerve head drusen are congenital calcium deposits located in the prelaminar section of the optic nerve head. Their association with visual field defects has been classically described, but the diagnosis of glaucoma is not easy in these cases of altered optic nerve head anatomy.We describe the case of a 67-year-old man with optic nerve head drusen complicated by glaucoma, which was confirmed by visual field and OCT examination of the peripapillary retinal nerve fiber layer (RNFL), but the measurement of the minimum distance between the Bruch membrane opening and the internal limiting membrane (minimum rim width, BMO-MRW) by OCT was normal.OCT of the BMO-MRW is a new diagnostic tool for glaucoma. Superficial optic nerve head drusen, which are found between the internal limiting membrane and the Bruch's membrane opening, overestimate the value of this parameter.BMO-MRW measurement is not adapted to cases of optic nerve head drusen and can cause false-negative results for this parameter, and the diagnosis of glaucoma in this case should be based on other parameters such as the presence of a fascicular defect in the retinal nerve fibers, RNFL or macular ganglion cell complex thinning, as well as visual field data.

Satisfaction and compliance of ocular hypertensive and glaucoma patients topically treated with a combination therapy A. Bron, C. Baudouin, P. Denis, J.-P. Nordmann, J.-P. Renard, J.-F. Rouland, E. Sellem Objectives: To evaluate satisfaction and compliance in glaucoma and ocular hypertensive patients receiving a fixed combination treatment. Materials and methods: After instilling a fixed combination, patients were asked to fill out a questionnaire about their satisfaction and compliance at baseline and 15 days after the onset of new therapy. Results: 1693 glaucoma patients (G) and 621 ocular hypertensive (OHT) patients were included. Mean age was 65.6±11.7 years. Onset of disease was 7.2±6.6 years and 5.2±4.9 years for G and OHT patients, respectively. Insufficient efficacy of the previous topical treatment (monotherapy in 55 % of cases) was the main cause for shifting to a fixed combination in 70 % of cases. Satisfaction was increased in 15 % of the patients and compliance was increased in 25 % of the patients. Discussion: Fixed combination provides an easier regimen and therefore encourages better compliance, a key issue in a chronic disease such as glaucoma.

Myelinated retinal nerve fibers observed rarely on ocular fundus examination, usually adjacent to the optic disc, are known to be stable throughout life. However, the possibility of rarefaction, and even disappearance, of these myelinated fibers has been pointed out in very rare cases of ocular or neuro-ophthalmological pathologies. We report such a regression, identified after a six-year period, in one case of primary open-angle glaucoma.

Cinq points essentiels doivent etre analyses lors de l’examen d’une papille : la mesure de sa taille, l’appreciation de l’anneau neuroretinien et de l’excavation, la presence d’hemorragies du disque optique, la recherche d’un deficit en fibres et enfin la comparaison des deux papilles.

Certain causes of unilateral ocular hypertension (including glaucoma) are relatively frequent and/or can be problematic at the time of etiological diagnosis. Although the pseudo-exfoliative syndrome is often easily identified by the presence of typical whitish formations on the anterior crystalloid and by the atrophy of the pupillary margin of the iris, it can at times be difficult to recognize (use high magnification, pupillary dilatation, and gonioscopy). The diagnosis of pigmentary dispersion is classically based on the discovery of a Krukenberg spindle and iris transillumination, but these signs may be missing, and the diagnosis can only be made by observation of the anterior hyaloid angle. Questioning the patient can lead to the suspicion of an old ocular contusion, usually confirmed by thorough bilateral gonioscopic observation. Outside of crisis periods, Posner-Schlossman syndrome can only be strongly suspected by the persistence of very fine and rare retrocorneal precipitates visible on high magnification. Iridocorneal endothelial syndromes (causes of unilateral glaucoma by evolutive goniosynechia) affects women from 25 to 50 years of age with no notable antecedent; they evolve more or less rapidly and are expressed in three ways: essential atrophy of the iris and Cogan-Reese disease, with the anatomical features easily identified on the iris, while Chandler disease can only be confirmed by gonioscopy, high-magnification observation of the cornea, and corneal endothelial cell count and analysis.

Dans le cas d’un glaucome debutant ou avance, le probleme majeur n’est plus diagnostique, mais il est d’evaluer sa reponse au traitement. Outre l’interrogatoire du patient, le bilan comprend la mesure de l’acuite visuelle et de la pression intra-oculaire, l’examen du segment anterieur et de la papille, et enfin le releve du champ visuel. Ce dernier examen reste le moins contestable, quoique subjectif, pour evaluer l’evolutivite d’un glaucome avere. L’examen de la papille par stereoscopie doit s’accompagner d’un dessin, au mieux d’une photographie. Enfin, trois analyseurs recents sont disponibles et en cours d’evaluation: HRT II, GDx, OCT-3. Selon les resultats (de la pression, du champ visuel, de la papille), le traitement sera modifie ou non, et/ou le bilan complete.

Glaucoma caused by primary closure of the iridocorneal angle accounts for half of the glaucoma cases in the world, 9 out of 10 in patients of Sino-Mongolian origin. The most frequent mechanism involved is anterior chamber angle blockage, but glaucoma can also be the result of a plateau iris structure, ciliary blockage, and exceptionally microphthalmos. Other than these forms, closure of the iridocorneal angle can be secondary to acquired iridopathies, or caused by crystallin anomalies or therapeutic interventions.

Several clinical and experimental studies have demonstrated that ocular surface disease is common in glaucoma patients receiving chronic glaucoma drops, and that the preservatives in these drops play a major role in the occurrence of ocular surface disease. These ocular surface changes may induce both symptoms reported by the patients and anterior segment clinical signs, and should be systematically assessed by history and exam in all glaucoma patients. In these patients with ocular surface disease, reducing the amount of preservatives administered to the eye should be strived for, rather than adding additional eye drops to alleviate or mask the side effects of the glaucoma drops.

The diagnosis of unilateral glaucoma essentially requires an etiologic investigation primarily to make sure that the deterioration is truly glaucomatous, thus specifically ruling out other optical neuropathies and papillary abnormality, such as tilted disc or drusen, which can mimic glaucomatous perimetric defects. Nonetheless, some apparent unilateral glaucomas can become bilateral later, as with primary open-angle glaucoma, though more frequently with primary closed-angle glaucoma in the absence of prophylaxis, and with exfoliative glaucoma. Genuine unilateral glaucomas concern the pigmentary glaucomas, the contusive glaucomas, the secondary closed-angle glaucomas, which encompass iridocorneoendothelial syndromes, ocular inflammations with opened angle, and glaucomas with an increase in the venous episcleral pressure.

Lowering intra-ocular pressure is always a necessity to treat glaucoma. Others identified risks factors may be fought, with the hope to favourably act on the disease: arteriosclerosis worsening parameters, low diastolic arterial pressure, vasospastic or sleep apnea syndrome, inverse pupillary block in pigmentary dispersion. On the other hand, ignoring a noctural closure of the irido-corneal angle or a non-compliance to the medical treatment may lead to glaucoma worsening.

The main objection to argon laser trabeculoplasty is collateral tissular injury, requiring hazardous repeated sessions if tonometric efficacy decreases. Selective trabeculoplasty could allow reliably effective iterative sessions because it is relatively harmless to tissues. Two other physical methods are on the market, although they are still being investigated, which also allow repeated treatments with minimal trabecular impairment. Titanium:sapphire laser trabeculoplasty consists of a very short pulse duration, with a wavelength penetrating deeply into the trabecula meshwork; the first results indicate similar intraocular pressure reduction as that obtained with argon trabeculoplasty and selective trabeculoplasty, but point out a possible risk of a paradoxical pressure rise during the days following the procedure. Pneumotrabeculoplasty is a procedure that uses ocular stretching by suction, which could finally provide a long-lasting decrease in intraocular pressure, less than that obtained with lasers, but its harmlessness is proved and its cost much lower.

Five points should be evaluated during optic disc examination: the size of the optic disc, the condition of the neuroretinal rim, the presence of optic disc hemorrhages, the appearance of the retinal nerve fiber layer, and the comparison between the two discs.

The first objective of the present study was to estimate the prevalence of patients treated for glaucoma or ocular hypertension (OHT) with an IOP (intraocular pressure) -lowering topical medication. Subjects were 40 years old and living in continental France. The second objective was to describe the type of therapy, compliance, and the quality of life of the subjects treated.This study was a telephone survey conducted in a general population on a representative sample of 5726 subjects in 2004. Subjects treated for glaucoma or OHT were defined as those declaring use of eye drops for more than 1 month and mentioning one of the 52 registered IOP-lowering topical medications and/or stating that they were taking eye drops for glaucoma or OHT. Quality of life was measured using the GlauQOL-17 questionnaire.237 subjects (4.1%) corresponded to this definition. The prevalence increased with age, from 0.7% in subjects aged 40-44 years to 10.6% in those aged 80 years or more. The age-standardized prevalence was higher in the Paris area (5.3%), the Mediterranean (4.5%), and the Southwest (4.7%), and lower in rural areas (3.2%), and in subjects with less than high school education (2.9%). Beta-blockers (49.5%) and prostaglandins (37.4%) were the most frequent treatments, followed by carbonic anhydrase inhibitors (15.3%), sympathomimetics (5.7%), and myotics (1.3%). Compliance was not total in 39% of the patients (22% of those treated with once-a-day dosage).The results of the present study are in line with French health authority data and with the results of the French "Glaucoma and intraocular high pressure, one day" study results. Moreover, the lower prevalence in regions with low medical density, low socioeconomic level, and rural areas, suggest that glaucoma or OHT might be underdiagnosed.On the basis of this first nationwide study, it can be estimated that the prevalence of subjects treated with IOP-lowering topical medications is about 1.2 million in France. The number of daily doses appears to influence compliance.

Certain causes of unilateral ocular hypertension (including glaucoma) are relatively frequent and/or can be problematic at the time of etiological diagnosis. Although the pseudo-exfoliative syndrome is often easily identified by the presence of typical whitish formations on the anterior crystalloid and by the atrophy of the pupillary margin of the iris, it can at times be difficult to recognize (use high magnification, pupillary dilatation, and gonioscopy). The diagnosis of pigmentary dispersion is classically based on the discovery of a Krükenberg spindle and iris transillumination, but these signs may be missing, and the diagnosis can only be made by observation of the anterior hyaloid angle. Questioning the patient can lead to the suspicion of an old ocular contusion, usually confirmed by thorough bilateral gonioscopic observation. Outside of crisis periods, Posner-Schlossman syndrome can only be strongly suspected by the persistence of very fine and rare retrocorneal precipitates visible on high magnification. Iridocorneal endothelial syndromes (causes of unilateral glaucoma by evolutive goniosynechia) affects women from 25 to 50 years of age with no notable antecedent; they evolve more or less rapidly and are expressed in three ways: essential atrophy of the iris and Cogan-Reese disease, with the anatomical features easily identified on the iris, while Chandler disease can only be confirmed by gonioscopy, high-magnification observation of the cornea, and corneal endothelial cell count and analysis.

In the case of early-stage or advanced glaucoma, the major problem is no longer diagnostic, but evaluating its response to treatment. Other than questioning the patient, assessment includes measuring visual acuity and intraocular pressure, examining the anterior segment and the optic disc, and finally an analysis of the visual field. This latter examination remains the least contestable, although subjective, in evaluating how a confirmed case of glaucoma is evolving. Examination of the optic disc using stereoscopy should include a drawing or, at best, a photograph. Finally, three recent analyzers are available and being evaluated: HRT II, GDx, OCT-3. Depending on the results (of intraocular pressure, the visual field and the optic disk), treatment can be modified and/or the assessment completed.

Glaucoma caused by primary closure of the iridocorneal angle accounts for half of the glaucoma cases in the world, 9 out of 10 in patients of Sino-Mongolian origin. The most frequent mechanism involved is anterior chamber angle blockage, but glaucoma can also be the result of a plateau iris structure, ciliary blockage, and exceptionally microphthalmos. Other than these forms, closure of the iridocorneal angle can be secondary to acquired iridopathies, or caused by crystallin anomalies or therapeutic interventions.

Several clinical reasons induced Campbell to propose an iridotomy in cases of pigmentary dispersion: removing the inverse pupillary block, balancing pressures through the iris, and finally stopping the posterior erosion of the iris leading to pigmentary release. It is likely that certain failures in this method stem from an erroneous evaluation of the cases that could benefit from iridal perforation. Three conditions are required for this procedure to be successful: established ocular hypertension, an abnormally concave iris base, and absence of patent glaucoma.

Glaucoma is a serious ocular disorder potentially leading to blindness. Measuring the quality of life of patients with glaucoma is important because it makes it possible to evaluate the impact of the disease and its treatment on the patient's everyday life. Hitherto, this was done using generic scales, or those developed for other diseases; but no scale suitable for glaucoma was available. The recently developed GlauQOL scale is now available. We present the short version of this questionnaire adapted to individual use within an ophthalmology consultation setting.

The methods for developing Health-Related Quality-of-Life (HRQoL) measures and their application in medical research have demonstrated their utility in various chronic, progressive, or life-threatening diseases. The efforts made to allow the patient's perspective to be included in the methodological framework of evidence-based medicine have been successful. The assumption of a strong relationship between clinical status and daily life is certainly valid in ophthalmology. However, there is a lack of specific HRQoL measures dedicated to ophthalmic diseases. Our work aimed at creating the first Glaucoma-specific Quality of Life scale - the Glau-QoL questionnaire - to provide researchers and physicians with a comprehensive, practical, and validated tool. This article describes the first stage of the process, which consisted in generating items and formatting them in order to create a questionnaire that exhaustively covers the relevant concepts. The whole process was conducted by an expert committee including clinicians and methodologists. The standard recommendations in the development of a HRQoL questionnaire were followed: we first identified existing tools and performed a preliminary collection of concepts from the published literature; we then designed an interview guide with the help of clinicians; a trained psychologist interviewed 22 patients at various disease severity stages (from isolated hypertonic to severely impaired); the interviews were tape-recorded and scripted; general domains and related detailed concepts were identified from the script; they were then analyzed and organized; the format of the questionnaire was set up; and questions were derived from the patient's verbatim to capture the identified detailed concepts. The test questionnaire was applied to seven patients for cognitive debriefing. We finally amended the test questionnaire and designed the pilot questionnaire according to the patients' tests and the clinician's review. The test questionnaire was well accepted by the patients, despite a completion duration ranging from 14 to 35 minutes. The pilot questionnaire contained 151 items, grouped into 5 sections: (1) vision problems, physicians, and daily treatment (49 items); (2) activities of daily living (37 items); (3) self-expression (37 items); (4) vision problems and mood (14 items); and (5) other questions (14 items). The next step of our work will be the item reduction process and the psychometric validation of the Glau-QoL questionnaire.