Glaucoma

Glaucoma

WHAT IS GLAUCOMA?

Glaucoma is a summary term used for eye diseases resulting in damage to the optic nerve (in the past, a terminally damaged optic nerve appeared to the ophthalmologist as being greenish - hence the word glaukos, meaning green in Greek). It is most commonly caused by high intraocular pressure, which presses on the optic nerve and causes narrowing of the visual field, loss of spatial vision and finally complete blindness. However, glaucoma with normal or low intraocular pressure also exists.

It usually occurs in patients older than 40 years, risk factors include family history of glaucoma incidence, diabetes, nearsightedness, smoking, fluctuating or very low blood pressure, cold feet syndrome or even treatment with corticosteroids. It can also occur after an eye surgery, trauma to the eye, and it also congenital forms.


Normal vision

Normal vision

correction of presbyopia

Vision with glaucoma

 

Glaucoma has several forms:
  • Primary open-angle glaucoma: this type of glaucoma is the most widely spread; initially, it has no significant symptoms and many times the patient notices a problem once a substantial part of visual nerves has died and the visual field is significantly narrowed.
  • Primary angle closure glaucoma or narrow-angle glaucoma: this type of glaucoma more commonly occurs in farsighted eyes, in which the anatomical ratios are very narrow. The first manifestation tends to be a glaucomatous attack - associated with a sharp headache, in particular in the area of the eye due to a sudden increase in intraocular pressure. It tends to be accompanied by redness in the eye, blurred vision, nausea and vomiting, and an immediate medical intervention is needed.
  • Congenital glaucoma: the child’s affected eye is enlarged, sensitive to light, watery, and the cornea is greyish.
  • Secondary glaucoma: presence of secondary glaucoma is caused by an increase in intraocular pressure due to other diseases of the eye, after an eye surgery or trauma to the eye.


HOW TO TREAT GLAUCOMA

The disease cannot be cured, its progress can only be slowed down or stopped thanks to early detection and deployment of treatment. At present, there are three types of treatment. The goal of each is to reduce intraocular pressure to values at which no damage to the optic nerve will occur.

  1. Conservative treatment: an effort to reduce the intraocular pressure using eye drops or medications.
  2. SLT (selective laser trabeculoplasty) laser surgery: laser surgery can be the next step in case of failure of conservative treatment in less significant increase in intraocular pressure. It is done under local anaesthesia, and the doctor aims the laser beams at specific tissues in the eye whose modification will lead to better drainage of intraocular fluid (humour) and reduced pressure in the eye. The surgery takes only a few minutes and is almost painless. Complications are less common than in the classical surgical treatment.
  3. The surgical procedure. Surgery is done only in case of failure of the other options. The procedure is done under local anaesthesia, and its essence is to create artificial connections between the inside of the eye and the area below the conjunctiva, where the intraocular fluid can continuously drain out to.
 

WHO IS THE SURGERY SUITABLE FOR

Laser surgery, and especially a surgical procedure, are the last resort in the treatment of glaucoma. They are considered only when drug therapy is unsuccessful or the patient has difficulties with its application. However, the procedure is recommended immediately in the case of late detection of the disease, so that it doesn’t become worse.

Untreated glaucoma leads to blindness. Therefore, it is important to not neglect preventive check-ups at the doctor, especially in patients older than 40 years. Only an eye doctor can diagnose the problem and suggest a treatment promptly.


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