Glaucoma is one of those diseases we encounter often in the prehospital setting, but don’t do anything about. The reason is that glaucoma has a slow and gradual onset, and although detrimental to the patient, it is a condition that does not affect airway, breathing, or circulation, and therefore, does not become of much concern to prehospital providers. We are actually only concerned with knowing which medications we administer that has glaucoma as a relative contraindication. Since glaucoma is a disease that affects more than 4 million Americans, and is the leading cause of blindness, it is an important possible contraindication to keep in mind.
However, this blog is not about basic facts. It is about interesting concepts! So let me tell you about some new discoveries concerning glaucoma.
First, researchers have figured out that in response to early stresses on ocular tissue, endothelial cells that line the blood vessels of the eye allow the entry of immune cells known as monocytes into the optic nerve and retina, which end up expressing molecules that damag the nerves—causing glaucoma. The good news is that other researches have figured out a way to prevent this from occurring.
The first hint came from Hiroshima survivors, who, although experiencing countless other health problems from the radiation exposure, tended to not develop glaucoma. And a decade ago, researchers discovered that a single dose of whole-body irradiation seemed to provide protection against glaucoma. Now, scientists have discovered that localized and targeted radiation exposures to the eyes of mice that tend to develop glaucoma, provides lifelong protection against this disease. The idea is that radiation changes how those endothelial cells respond to those early tissue stresses and reduces the entry of monocytes into the optic nerve and retina. No monocytes, no glaucoma!
How about that!!!
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