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Glaucoma by Ihor Magun, M.D., F.A.C.P. Sight is frequently taken for granted. After all, if nothing seems to be wrong, why bother look ing for trouble. Instinctively, this may seem to be the correct approach. Medically, it falls short. One of the dangers of ignoring visual integrity because there are no symptoms of a problem is that some conditions that threaten sight do not have clear and obvious symptoms. One of these conditions is glaucoma. Glaucoma is a very common, slowly pro gressive ocular problem associated with an increase in intraocular pressure leading to a continuous de struction of nerve fibers. The precise mechanism of optic nerve injury is not well understood, but its ef fects are devastating. If glaucoma is present at age forty and left untreated, for example, it may cause complete blindness by age sixty-five. Documented risk factors include age, race, and other conditions: African Americans and individuals with myopia are at risk as are people over the age of fifty. Preva lence increases with each decade, the greatest be tween sixty and seventy. There are two types of glaucoma. Primary glaucoma occurs without warning and with no ap parent cause. The affected eye is acutely red, unilat eral, painful; the affected individual sometimes sees halos around objects. This constitutes a medical emergency. Fortunately, only a handful of patients are affected by this type of glaucoma. Secondary glaucoma occurs from increased intraocular pressure that results primarily from another eye disease. The most commonly seen presentation of glaucoma is referred to as open angle glaucoma. This condition develops gradually with no out wardly visible signs. Since the pressure rises gradu ally, there is no pain. Peripheral vision is lost gradu ally, resulting in tunnel vision. Because the changes are painless and gradual, they are often not noticed until the damage has been done. In such cases, ire- versible ocular damage can occur before the patient recognizes that something is seriously wrong. The vision loss is not reversible. Screening for glaucoma requires an eye ex amination using tonometry, visual inspection of the optic disc, and automated perimetry visual field testing. The goal of treatment is to reduce the eye pressure either by increasing the amount of intra ocular fluid that leaves the eye or by decreasing the production of the intraocular liquid. Standards of care include eye drops guided by patient characteristics and associated medical conditions. Side effects of these medications also become an issue since they do affect heart rate, blood pressure, and respiratory problems. Laser or surgical interventions are occasionally needed. Glaucoma affects many individuals and, if detected early, can be controlled. Maintaining good visual health is important and an annual visit to an optometrist or ophthalmologists can make this achievable. Glucosamine/Chondroitin GAIT Study Findings. In an article entitled "W hat You N eed to Know About G lucosam ine/C hondroitin" (May 2005), I m entioned a study aim ed at determ ining the effectiveness of glucosam ine/chondroitin as an independently used herbal m edication or as a supplem ent used in com bination w ith other treatm ent for osteoarthritis. The study, sponsored by the NIH (National Institutes of Health) and com pleted in N ovem ber 2005, w as inconclusive and found an overall lack of efficacy. Flowever, the A rthritis Foundation noted that "based on the findings from this study and the supplem ents' safety and cost-effectiveness, the com bination of glucosam ine and chondroitin should be considered by patients and physicians as part of an overall treatm ent plan" for patients w ith m oderate to severe pain. W hat this m eans is that despite the overall lack of effectiveness am ong study participants, glucosam ine/chondroitin should still be considered as a possible treatm ent option. — Dr. Ihor M agun Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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