WHAT IS GLAUCOMA?
Glaucoma, or the “silent killer of vision,” is one of the most dangerous eye conditions,
and it is among the top three causes of blindness in the world. The term “silent killer of
vision” best describes this disease because its symptoms are very hard to notice. It
involves an increase in intraocular pressure above the maximum normal value of 21
mmHg, which leads to irreversible damage to the optic nerve, vision impairment, and
ultimately, blindness. Pain, which could indicate the onset of the disease and the
possibility of vision impairment, is extremely rare (except in one form).
How to Detect Glaucoma?
Although some types of glaucoma occur without symptoms, certain signs such as loss
of peripheral vision, blurry vision, nausea, and eye pain require immediate medical
attention. Regular eye examinations are essential, especially if you have risk factors for
glaucoma:
- Age over 45
- Family history of glaucoma
- High myopia
- High blood pressure, hypothyroidism, diabetes
- Frequent and long-term corticosteroid therapy
- Eye injuries
So far, it has only been proven that certain forms of glaucoma have a hereditary
component. The occurrence of glaucoma in the family does not necessarily indicate a
hereditary component of the disease, but it is advised for descendants to have regular
check-ups after the age of 25.
Glaucoma Diagnosis
The diagnosis of glaucoma depends on the stage of the disease when it is detected.
Until recently, it was believed that high eye pressure was the primary parameter for
diagnosing glaucoma. However, it has been proven that in some people, damage to the
optic nerve can occur even if the pressure is normal, i.e., its value is less than 21 mmHg.
Similarly, not every increase in eye pressure above this value automatically means the
person has glaucoma. Therefore, several diagnostic parameters are analyzed today to
help definitively diagnose this disease. These are:
- Eye pressure values
- Visual field findings
- The appearance of the optic nerve head
- The thickness of the optic nerve fibers (RNFL)
- Pachymetry (corneal thickness of the eye)
If treatment begins in time, it is possible in most cases to retain sight without significant
damage.
Glaucoma Treatment
Glaucoma treatment is based on controlling eye pressure and reducing the chances of
optic nerve damage. The first line of treatment involves the use of eye drops that aim to
reduce the production of aqueous humor or increase its outflow from the eye. However,
glaucoma surgeries are becoming more prevalent, especially in patients who have
been on eye drops for many years, or in whom they cause allergic reactions.
Laser glaucoma surgery is a temporary solution that “cleans” the trabecular meshwork
through which aqueous humor naturally drains from the eye. However, in most patients
after a certain time, the trabecular meshwork closes again, and eye pressure rises.
Ex-Press Glaucoma Shunt
To simplify, this procedure creates a new outflow of the aqueous humor through a tiny
tube that is implanted into the eye. Compared to the classic trabeculectomy, it is much
less invasive and with less degree of complications. The intraocular pressure stabilizes
within seven to ten days postoperatively, and more than 70% of patients never have to
use antiglaucoma eyedrops, or any other form of treatment.
MIGS
A completely new entity in glaucoma treatment has emerged in recent years called
Micro Incision Glaucoma Surgery (MIGS). It’s a set of different procedures that have one
common component: to ensure control of eye pressure surgically with minimal
invasiveness and as little chance of damaging healthy eye tissue as possible.
Small stents and tubes are implanted into the trabecular meshwork making it more
permeable to aqueous humor and making the intraocular pressure much stable and
controllable.
