Dry eye disease (DED) is a multifactorial disorder of the ocular surface and tear homeostasis that can result in discomfort, pain, and visual disturbance. Untreated, DED can become chronic, progressive, and significantly affect an individual's quality of life. Women are disproportionately affected by DED, are diagnosed at a younger age, and experience more severe symptoms compared with men. DED is associated with a wide range of comorbid conditions; there is a strong association between DED and autoimmune disorders, especially those that affect women at many times the rate of men. Treatment response questionnaires indicate women respond better to a wellness model of treatment for DED than men. Furthermore, women's health care-seeking behaviors provide opportunities for general practitioners, specialists, and women's health centers to help identify women with DED or at risk for DED for referral to an eye care specialist. This review of the prevalence of DED in women, and gender and sex-specific aspects of DED, highlight a significant opportunity for action. Earlier diagnosis and treatment of this common but burdensome condition could significantly improve a woman's quality of life.
Glaucoma is the most common form of irreversible blindness in the world, and second only to cataract among all causes of blindness. There is still no universally agreed-upon definition of glaucoma, and as such, it remains a condition for which there are differing views on the classification of individuals within the continuum of suspicion through diagnosis. Regardless, there appears to be consensus that glaucoma refers to a group of diseases that manifest as a characteristic progressive optic neuropathy and retinal ganglion cell loss that eventually leads to a permanent loss of visual field. Glaucoma is a major public health issue because individuals are typically asymptomatic until end stages of the disease when the associated vision loss is significant and irreversible. Studies have shown that the prevalence of undetected glaucoma is as high as 50% even in high income areas including North America and Australia, increasing to 90% in middle and low income areas such as Asia and Africa. This is at least in part a result of inadequate screening tools and strategies to detect this asymptomatic disease: without more individuals accessing routine eye examinations, glaucoma will continue to go undetected. Vision loss from glaucoma imposes significant societal and economic burdens that increase with disease severity: the direct costs of vision loss from glaucoma exceed $300 million annually in Canada, and approach $2 billion across North America.
IRVAN has favorable outcomes when treated with a combination of PRP and intravitreal injections of antivascular endothelial growth factor. This case demonstrates the effectiveness of this combination treatment in a case of IRVAN with both posterior and anterior neovascularization.
Glaucoma is the most common form of irreversible blindness in the world. Lowering intraocular pressure (IOP) remains the only clinically established method of treatment to slow the progression of glaucoma. Primary open angle glaucoma is a disease of the optic nerve head and often is associated with changes to the trabecular meshwork that cause a reduction to aqueous humour outflow and an increase in intraocular pressure. Until recently, topical IOP lowering medication has been limited to the mechanisms of action of decreasing aqueous production and/or redirecting outflow to the unconventional uveoscleral outflow pathway. Both of these mechanisms neglect to treat or act on tissue that becomes altered from glaucoma. Latanoprostene-bunod 0.024%, a nitric-oxide donating prostanoid, netarsudil 0.02%, a potent Rho-associated protein kinase (ROCK) inhibitor and norepinephrine transporter inhibitor, and a once daily dosed fixed combination medication with netarsudil 0.02% and latanoprost 0.005% have recently come on the market. This paper will discuss and review the limitations to traditional IOP lowering glaucoma medications as well as the mechanism of actions and clinical efficacy of the new glaucoma medications. It will also discuss how the new class of glaucoma medications might help to overcome some known limitations in treatment and barriers to patient adherence.
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