Glaucoma

Description

Glaucoma refers to a group of eye diseases characterized by progressive damage to retinal cells and, in advanced stages, the optic nerve.

If glaucoma is not detected in time and appropriate treatment is not started promptly, it can lead not only to impaired vision but also to vision loss. Glaucoma usually progresses unnoticed over many years and passes through several stages. It is a truly insidious disease because it causes little to no pain. Visual field loss is a typical sign of glaucoma.

There are two primary forms of glaucoma: angle-closure and open-angle.

Angle-closure glaucoma accounts for 10-20% of cases. The main risk group includes people over the age of 30 who have hyperopia, or farsightedness. The specific feature of this form is that the iris blocks the anterior chamber angle of the eye. As a result, the natural drainage system is impaired, and pressure inside the eye increases. This may be accompanied by:

• severe headache;
• eye redness;
• nausea and vomiting;
• blurred vision and other visual disturbances, including complete blindness.

Patients often mistake an acute glaucoma attack for a migraine, hypertension-related symptoms, or poisoning, as these conditions may present with similar symptoms. A glaucoma attack can be recognized by one characteristic sign: due to a sharp increase in intraocular pressure, the eyeball becomes very hard and firm. During this time, the pupil is dilated and irregular in shape, the eyelids are swollen, and the cornea becomes cloudy.

Open-angle glaucoma is diagnosed in approximately 80-90% of people with elevated intraocular pressure. In this case, access to the eye’s natural drainage system remains open, but the system does not function properly. As a result, pressure inside the eye gradually increases. This disease may be asymptomatic, which makes it particularly dangerous, as a person may suddenly notice a significant decline in vision without any clear or obvious reason.

Symptoms

The most common symptoms include:

• elevated intraocular pressure;
• blurred vision;
• halos or rainbow-colored circles around bright light sources;
• eye fatigue and redness;
• epiphora, or excessive tearing;
• concentric narrowing of peripheral vision, also known as tunnel vision;
• sporadic headaches;
• a sudden, sharp decline in visual acuity;
• recurring sensations of grittiness, aching, or heaviness in the affected eye;
• reduction of the visual field;
• impaired vision at dusk or at night.

Most types of glaucoma usually do not cause pain or produce any symptoms until noticeable vision loss occurs.

Causes and Risk Factors

The development of this disease may be influenced by factors such as:

• heredity;
• abnormalities of intrauterine development, in cases of congenital glaucoma;
• individual anatomical features, such as a thin cornea, and specific structural characteristics of the visual organs in a particular person;
• myopia, which contributes to the development of open-angle glaucoma;
• hyperopia, which contributes to the development of angle-closure glaucoma;
• eye diseases: inflammatory conditions such as uveitis, keratitis, and scleritis; cataract; dystrophic changes such as progressive iris atrophy or previous hemophthalmos;
• various disorders of the cardiovascular, nervous, and endocrine systems;
• injuries and complications after ophthalmic surgery;
• neoplasms, including tumors.

Among all the causes that lead to glaucoma, the primary one is elevated intraocular pressure, also known as intraocular hypertension.

Examination and Diagnosis

A diagnosis of glaucoma can only be made by an ophthalmologist based on a specialized examination, including measurement of intraocular pressure, assessment of the optic nerve head, and evaluation of the aqueous humor outflow pathways. We diagnose and treat all types and forms of glaucoma, including primary and secondary glaucoma, as well as open-angle and angle-closure glaucoma.

• Modern methods of measuring intraocular pressure: PASCAL® tonometer, Ocular Response Analyzer®, rebound tonometry with iCare®, as well as methods of intraocular pressure measurement
• Measurement of corneal thickness, or pachymetry
• Visual field testing: static perimetry with Octopus and kinetic perimetry with Goldmann
• Photographic documentation of the optic nerve
• Optic nerve biomorphometry using HRT 3 and OCT
• Scanning laser polarimetry using GDx-VCC and Spectralis-OCT
• Electrophysiology: pattern electroretinography, or pERG, for early diagnosis of retinal ganglion cell damage caused by glaucoma
• Corvis® ST (Corneal Visualization Scheimpflug Technology)

Treatment

Depending on the severity of the condition, glaucoma treatment may include surgery, laser treatment, or medication.

Surgical treatment covers the full range of anti-glaucoma procedures, from minimally invasive interventions to intraocular implants.

• Filtering glaucoma surgery: trabeculectomy
• Anterior chamber angle procedures: trabecular aspiration, excimer laser trabeculotomy, Trabectome, argon laser trabeculoplasty, or ALT
• Baerveldt implant
• Cyclodestructive procedures: cyclocoagulation, cyclocryocoagulation, endoscopic cyclophotocoagulation
• Iridectomy and laser iridectomy
• Combined cataract and glaucoma surgery, including minimally invasive procedures for reducing intraocular pressure, known as MIGS

Progression and Prognosis

Although glaucoma is a serious condition, early diagnosis often allows it to be managed with medication and minor dietary or lifestyle adjustments.

Because glaucoma is often painless, patients may not take the strict use of eye drops seriously enough, even though these drops are necessary to control intraocular pressure and prevent irreversible eye damage. Optic nerve atrophy can lead to partial or complete loss of vision.

Regular physical exercise can help reduce the likelihood of developing glaucoma. It improves blood circulation throughout the body, including in the eyes. Quitting smoking, maintaining a healthy diet, and keeping a healthy weight also help lower the risk of glaucoma.

Regular examinations by an ophthalmologist, especially after the age of 40, can help preserve your vision for many years.

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Disclaimer: This information is provided for informational purposes only and does not constitute medical advice. Please consult a qualified healthcare professional for diagnosis and treatment.