What is glaucoma?

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Understanding Glaucoma: 
A Comprehensive Guide for Patients
 

Glaucoma is a term used to describe a group of eye diseases that damage the optic nerve, which is crucial for vision. This damage is often caused by an abnormally high pressure in the eye. Glaucoma is one of the leading causes of blindness for people over the age of 60, but it can occur at any age. 

It is a complex condition with several types and causes, and understanding it can help in its prevention and management.

What are the types of glaucoma?


There are several types of glaucoma, but the most common ones are open-angle glaucoma and closed-angle glaucoma.

Open-Angle Glaucoma

Open-angle glaucoma is the most common form of the disease, accounting for at least 90% of all glaucoma cases. It occurs when the drainage angle formed by the cornea and iris remains open, but the trabecular meshwork (the eye's drainage canals) gradually becomes less efficient at draining fluid. This leads to a slow increase in intraocular pressure

Open-angle glaucoma develops slowly and usually without any noticeable symptoms, which is why it is often called the "silent thief of sight." Regular eye exams are essential for early detection.

Closed-Angle Glaucoma

Closed-angle glaucoma or angle-closure glaucoma, also known as angle-closure or narrow-angle glaucoma, is less common but can be more severe. It occurs when the drainage angle formed by the cornea and iris is suddenly blocked, leading to a rapid increase in intraocular pressure. 

Symptoms can include severe eye pain, nausea, vomiting, blurred vision, and seeing halos around lights. Closed-angle glaucoma is a medical emergency and requires immediate treatment to prevent permanent vision loss.

What is the main cause of glaucoma?


The exact cause of glaucoma isn’t fully understood, but it generally involves the buildup of eye pressure. Here are some of the main factors that can contribute to this condition:

Increased Intraocular Pressure

The eye constantly produces a clear fluid called aqueous humor, which nourishes the eye and maintains its shape. This fluid flows out of the eye through a mesh-like channel. If these channels become blocked or if the eye produces too much fluid, the intraocular pressure can increase, damaging the optic nerve.

Genetics

Glaucoma tends to run in families. If you have a family history of glaucoma, you are at a higher risk of developing the disease. Genetic factors can influence the structure of the eye and the efficiency of the drainage system.

Age

The risk of developing glaucoma increases with age. People over the age of 60 are at a higher risk, and the risk continues to increase with each decade of life.

Medical Conditions

Certain medical conditions can increase the risk of glaucoma, including diabetes, high blood pressure, and heart disease. These conditions can affect the blood flow to the optic nerve and increase eye pressure.

Eye Injuries

Trauma to the eye can cause damage to the eye's drainage system, leading to increased intraocular pressure and glaucoma. This can occur immediately after the injury or develop years later.

Long-term Use of Corticosteroids

Prolonged use of corticosteroid medications, especially eye drops, can increase the risk of developing glaucoma. These medications can affect the eye’s drainage system and lead to increased pressure.

Other Risk Factors

Additional risk factors for glaucoma include severe nearsightedness, thin corneas, and conditions like pigment dispersion syndrome (where pigment granules from the iris are dispersed within the eye).

What are the symptoms of glaucoma?


The signs of glaucoma can vary depending on the type and stage of the disease. In the early stages, many people with glaucoma may not notice any symptoms. However, as the disease progresses, symptoms can become more apparent.

Open-Angle Glaucoma

Open-angle glaucoma typically develops slowly and without any noticeable symptoms. Vision loss usually begins with peripheral or side vision. By the time central vision is affected, the disease is often quite advanced. Regular eye exams are crucial for early detection and prevention of significant vision loss.

Closed-Angle Glaucoma

Closed-angle glaucoma or angle-closure glaucoma can cause sudden and severe symptoms, including:

  • Intense eye pain
  • Nausea and vomiting
  • Sudden onset of visual disturbance, often in low light
  • Blurred vision
  • Halos around lights
  • Redness of the eye

If you experience any of these symptoms, seek immediate medical attention to prevent permanent damage.

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How glaucoma is diagnosed?


Early detection of glaucoma is crucial to prevent significant vision loss. Regular comprehensive eye exams are the best way to detect glaucoma in its early stages. Several tests and procedures can be used to diagnose glaucoma:

Tonometry

Tonometry measures eye pressure. It is usually one of the first tests performed. The most common method is applanation tonometry, where a small amount of pressure is applied to the cornea to measure intraocular pressure.

Ophthalmoscopy

Ophthalmoscopy allows the doctor to examine the optic nerve for damage. This is done using a special instrument called an ophthalmoscope, which shines a light into the eye and magnifies the optic nerve.

Perimetry

Perimetry, or visual field testing, measures the peripheral vision. This test can help detect areas of vision loss that may be caused by glaucoma.

Gonioscopy

Gonioscopy is used to examine the drainage angle of the eye. A special lens is placed on the eye to allow the doctor to see the angle where the iris meets the cornea.

Pachymetry

Pachymetry measures the thickness of the cornea. Corneal thickness can affect intraocular pressure readings, so this information is important for accurate diagnosis and treatment planning.

Ultrasound Biomicroscopy (UBM)

Ultrasound biomicroscopy (UBM) uses high-frequency ultrasound to create detailed images of the eye's anterior segment, including the drainage angle, ciliary body, and iris. This test is particularly useful in diagnosing and managing closed-angle glaucoma and other conditions affecting the front part of the eye.

Optical Coherence Tomography (OCT)

OCT is a non-invasive imaging test that uses light waves to take cross-section images of the retina. It helps to measure the thickness of the retinal nerve fiber layer, which can be affected by glaucoma.

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How to treat glaucoma?


While there is no cure for glaucoma, treatment can help lower eye pressure, prevent further optic nerve damage, and slow the progression of the disease. 

Depending on your situation, your options may include medications, laser treatment, surgery or a combination of any of these.

Medications

Medications, usually in the form of eye drops, are often the first line of treatment for glaucoma. These drugs help reduce eye pressure by either decreasing the production of aqueous humor or improving its outflow. 

It is important to use these drugs as prescribed by your doctor to effectively manage eye pressure.

Laser therapy

Laser treatment can be used to treat different types of glaucoma and at different stages of the disease:

  • Laser trabeculoplasty: Commonly used for open-angle glaucoma, this procedure helps to improve drainage through the trabecular meshwork.
  • Laser iridotomy: Often used for closed-angle glaucoma, this procedure creates a small hole in the iris to improve fluid drainage.
  • Laser cyclophotocoagulation: Used in advanced cases, this procedure reduces the production of aqueous humor by treating the ciliary body.

Surgery

If medications and laser therapy are not effective, surgery may be necessary to lower intraocular pressure. Surgical options include:

  • Trabeculectomy: This procedure creates a new drainage pathway for the aqueous humor to leave the eye, thereby reducing intraocular pressure.
  • Drainage implants: Small tubes are implanted in the eye to help drain excess fluid.
  • Minimally invasive glaucoma surgery (MIGS): These procedures are less invasive than traditional surgery and have a faster recovery time. They include a variety of techniques to improve fluid outflow.

Lifestyle and Home Remedies


In addition to medical treatment, people with glaucoma can adapt their lifestyle and opt for remedies to help them manage their condition:

  • Healthy diet: Eating a balanced diet rich in fruits and vegetables can support eye health. Foods high in antioxidants, like leafy greens, can be particularly beneficial.
  • Regular exercise: Moderate exercise can help lower intraocular pressure and improve overall health.
  • Avoiding excessive caffeine: High amounts of caffeine can increase intraocular pressure.
  • Protecting your eyes: Wearing protective eyewear during sports or activities that could cause injury can prevent trauma-related glaucoma

The Importance of Consulting an Ophthalmologist


If you suspect you may have glaucoma or are at risk due to family history, age, or other medical conditions, it is crucial to consult an ophthalmologist promptly. Early detection and treatment are key to preventing significant vision loss and managing the disease effectively.

Regular comprehensive eye exams can help detect glaucoma in its early stages, even before symptoms appear. Your eye doctor can provide personalized advice, conduct necessary tests, and recommend appropriate treatments to protect your vision. Don't wait for symptoms to worsen; schedule an appointment with an ophthalmologist if you have any concerns about your eye health.

For more detailed information about glaucoma, discover our dedicated website: www.glaucoma-slt.com