What is Glaucoma
Glaucoma is a progressive eye condition that leads over time to irreversible vision loss through progressive optic nerve degradation. It is the second cause of blindness after diabetes. Optic nerve health is vital for maintaining good vision throughout life.
In fact, glaucoma is a progressive optic neuropathy.
Causes
Elevated intraocular pressure (IOP) is the most common cause of glaucoma, leading to optic nerve destruction. There are cases where glaucoma occurs even though ocular pressure is within normal limits, in which case vascular factors are implicated.
Risk Factors for Glaucoma
- heredity (genetic transmission is frequently encountered)
- elevated intraocular pressure
- myopia, hyperopia
- existence of chronic diseases such as diabetes mellitus
- prolonged corticosteroid treatment
- eye trauma
- age over 40 years
Symptoms
The onset of glaucoma usually has no symptoms, the condition progresses slowly, without the patient realizing disease progression. In most cases, glaucoma does not hurt, but the patient may describe the appearance of ocular signs: presence of halos around light sources, retro-ocular pain, eye redness, visual field narrowing in advanced stages of the disease.
Types (Based on the Cause of the Disease)
Primary Open-Angle Glaucoma (POAG)
This is the most common type of glaucoma, characterized by an increase in intraocular pressure greater than 21mm HG, with the iridocorneal angle being open.
Chronic Narrow-Angle Glaucoma (CNAG)
Caused by elevated IOP above 21mmHG, but in an eye with an anatomical particularity of the iridocorneal structure.
Narrow-Angle Glaucoma (Acute Form – Glaucoma Attack)
Starts suddenly, with high intraocular pressure, intense pain, vision decrease, severe visual field narrowing, possibly accompanied by periocular pain, nausea; requires emergency treatment.
Normal-Tension Glaucoma
Discovered incidentally during a routine ophthalmological consultation through the particular appearance of the optic nerve, but with intraocular pressure below 21mmHG, however with changes on paraclinical investigations; the cause of this type of glaucoma is vascular.
Secondary Glaucoma
This is a large subclass of glaucomas, with various causes of secondary glaucoma, e.g., pigmentary glaucoma, exfoliative glaucoma, neovascular glaucoma, post-traumatic glaucoma.
Congenital Glaucoma
Observed immediately at the child's birth, characterized by buphthalmic eye.
Glaucoma Diagnosis
The main tests/investigations indicated in glaucoma are:
- intraocular pressure measurement (tonometry)
- gonioscopy (measuring the degree of opening of the anterior chamber angle); with the Pentacam tomograph, important parameters can be precisely evaluated – corneal pachymetry, anterior chamber volume, chamber angle measurement
- pachymetry (measures corneal thickness, giving a more exact IOP value)
- fundus examination, observing the optic nerve appearance
- performing computerized perimetry (visual field) – efficient in evaluating optic nerve function and tracking disease progression
- performing optic nerve tomography (OCT ON) – the most sensitive test in evaluating the degree of structural damage to the optic nerve
Computerized perimetry and optic nerve tomography are performed repetitively, at regular intervals, established by the ophthalmologist, depending on the disease stage.
Glaucoma Treatment
The goal of treatment in Glaucoma is preservation of visual function and quality of life of the patient for as long as possible, because once the optic nerve is affected, the effects are irreversible. Progression is slow, potentially leading to blindness, however, adequate and consistent treatment can help keep disease evolution under control.
Treatment is individualized depending on the degree of optic nerve damage, intraocular pressure as well as the severity of functional impairment (specific investigations are very important here).
Treatment in glaucoma can be:
- medicinal – with drops that lower IOP (drops are administered at a fixed time, according to the ophthalmologist's instructions); in some more severe situations, tablets or infusions are necessary, with substances that rapidly and significantly reduce ocular pressure
- laser treatments – both in open-angle glaucoma and narrow-angle glaucoma (trabeculoplasty, iridotomy)
- surgical treatment of glaucoma is indicated in advanced stages of the disease and has a strict role in lowering IOP and preventing further vision degradation; no type of glaucoma treatment RESTORES VISION, but has the role of PRESERVING VISUAL FUNCTION
Unfortunately, visual function lost through glaucoma cannot be regained, therefore early diagnosis and adequate treatment ensure the patient good vision for as long as possible. Complete periodic ophthalmological consultation that mandatorily includes ocular pressure measurement helps detect glaucoma and institute necessary treatment.
Frequently Asked Questions
Glaucoma is a progressive eye condition that leads over time to irreversible vision loss through progressive optic nerve degradation. It is the second cause of blindness after diabetes.
The onset of glaucoma usually has no symptoms, the condition progresses slowly. The patient may describe the presence of halos around light sources, retro-ocular pain, eye redness, visual field narrowing in advanced stages.
Treatment can be medicinal (drops that lower IOP), laser treatment (trabeculoplasty, iridotomy) or surgical treatment in advanced stages. The goal is preservation of visual function.
Unfortunately, visual function lost through glaucoma cannot be regained. No treatment RESTORES VISION, but has the role of PRESERVING VISUAL FUNCTION. That is why early diagnosis is essential.
