Glaucoma

Glaucoma is a disease in which the optic nerve is damaged by factors such as elevated intraocular pressure (or, briefly, eye pressure). Since the optic nerve is responsible for transmitting visual information to the brain, its damage (gradually) causes the visual field to defect, and if the disease goes untreated and progresses, it can eventually lead to complete blindness.

What causes glaucoma?

In some cases, causes of glaucoma can be identified, such as eye trauma, some eye surgeries and angle closure, but in many cases glaucoma is a disease of unknown etiology and many genetic and environmental factors are involved.

What are the types of glaucoma?

Glaucoma can be divided into two main categories, open-angle glaucoma and angle-closure glaucoma. It is good to know that the eye’s angle is the part of the eye that lies between the iris (the round colored part of the eye) and the cornea (the transparent part of the eye). There is usually a clear fluid in the front part of the eye; this fluid is made inside the eye and flows out through the corner of the eye. If the angle of the eye is damaged or closed, the fluid will not be able to exit the eye and may increase intraocular pressure and glaucoma. In most cases, patients face open-angle glaucoma, but a significant percentage of patients are also affected with narrow-angle or closed-angles.

What are the Symptoms of Glaucoma?

A: Congenital glaucoma: it is characterized by symptoms such as corneal whiteness, excessive tearing (epiphora), sensitivity to light (photophobia), and bulging eyes (exophthalmos).

B: Open-angle glaucoma: In most cases of chronic open-angle glaucoma (as well as closed-angle glaucoma), the patient does not notice the glaucoma unless the disease progresses greatly and there is a disorder in the visual field.

C: Acute closed-angle glaucoma: It is characterized by acute symptoms of blurred vision in the eyes, extra tears, sensitivity to light, halos and rainbows around lights, nausea and vomiting. In this condition, the patient should see an ophthalmologist in an emergency and receive immediate treatment.

How is glaucoma diagnosed?

In most cases, a complete physical examination including intraocular pressure measurement, eye angle examination (Gonioscopy), optic nerve examination and visual field testing is sufficient to diagnose glaucoma; but in some specific cases, other tests, such as optic nerve and retinal imaging, may also be needed.

What are the ways to treat glaucoma?

In most cases, except congenital and closed-angle glaucoma, the treatment begins with eye drops, but if glaucoma is not controlled by medical treatment, then other treatments such as Laser or other surgeries should be performed. Congenital glaucoma and closed-angle glaucoma often require one of the surgical procedures for glaucoma which is chosen by the ophthalmologist depending on the patient's condition.

Glaucoma treatment methods include;                       

Medical Treatment: Medications are the most common treatment for glaucoma in the early stages of the disease, which are available in the form of drops and pills. Some of these medications decrease the amount of aqueous humor in the eye, and others reduce eye pressure by improving and facilitating its outflow. Glaucoma medicines may be taken several times a day. Most patients have no problem with this. But some medications may cause headaches or have side effects on other parts of the body. Eye drops may have side effects such as burning or stinging and redness in the eyes. The patient should ask the ophthalmologist to explain how to use the eye drops, and also inform the ophthalmologist about any medications he/she has already taken. The patient should take drops and tablets regularly to control eye pressure. This is very essential because glaucoma is often asymptomatic in the early stages and patients may forget or stop taking their medication.

Laser Therapy or Laser Trabeculoplasty: Laser therapy helps the fluid in your eye drain away. Although the surgeon can perform it at any time, it is recommended that a laser therapy is performed if the disease is not controlled by medication. In many patients medication is required even after the laser. Laser is performed in doctor’s office or in an eye clinic. Before laser, the eye becomes numb with a special eye drop. The patient sits in a special chair in front of the laser machine, and the ophthalmologist places a special lens on the eye. A focused beam of high-energy light reflects on the reticular tissue of the eye’s angle. The patient sees bright spots in green and red.

The laser generates 50-100 burning points at equal distances. These burns stretch the outlet pores in the reticular tissue, so the pores open and the fluid flows away. Subsequently eye drops are prescribed to reduce the intraocular inflammation. Studies show that laser surgery is very helpful in lowering eye pressure, but in some cases its effect disappears over time, so that in more than half of the patients the eye pressure rises again two years after the laser surgery.

Surgery: The purpose of the surgery is to create new pores for the fluid to flow out of the eye. Although the ophthalmologist can perform the surgery at any time, it is recommended that it is performed when the medical therapy and laser surgery are not effective in controlling the intraocular pressure. Local (topical) anesthesia or general anesthesia is used for the surgery, which in a local anesthesia a sedative drug is prescribed, and then injections are performed for numbness around the eye. The ophthalmologist removes a small piece of the tissue around the cornea, and so a new channel is created to get the fluid out of the eye.

What is the patient's role in treating glaucoma?

The patient must have a thorough perception of their disease and be aware that glaucoma is a chronic disease that requires permanent treatment and follow-up. Regular use of medications prescribed by an ophthalmologist is also important and can prevent blindness.

Does anyone with glaucoma eventually goes blind?

Fortunately, with the advent of new medicines and new surgical methods, many glaucoma patients can lead a normal life, but if the patient does not pay attention to their disease it can lead to blindness.