Glaucoma

Glaucomul reprezintă o afecțiune oculară serioasă, caracterizată prin deteriorarea nervului optic și pierderea progresivă a vederii. Cauzele glaucomului pot fi multiple, iar printre cele mai comune se numără presiunea intraoculară crescută și drenajul inadecvat al fluidului ocular. Un subtip de glaucom, cunoscut sub numele de glaucom cu unghi închis, apare atunci când unghiul dintre iris și cornee este îngustat, împiedicând drenajul normal al fluidului. Această formă de glaucom poate duce rapid la o creștere a presiunii intraoculare și la apariția simptomelor severe.

Diagnosticul precoce și tratamentul adecvat sunt esențiale în managementul glaucomului. Tratamentul poate include utilizarea de picături oculare care reduc presiunea intraoculară, administrarea de medicamente orale sau chiar intervenția chirurgicală.

1. What is glaucoma?

Glaucoma is defined as a group of diseases that share a common feature, namely optic neuropathy. Increased intraocular pressure is the main risk factor for glaucoma, but the existence or absence of increased intraocular pressure does not define the disease. Glucoma is characterised by progressive destruction of the optic nerve fibres, which are responsible for transmitting visual information from the eye to the brain.

According to the Romanian Society of Ophthalmology, the number of glaucoma patients worldwide is estimated to be between 65 and 105 million. Of these, 10% are currently in bilateral blindness. There are an estimated 7.5 million patients with primary open-angle and angle-closure glaucoma out of a population of 1150 million(1).

In Romania, there are no official statistics on the number of glaucoma patients. In correlation with European data, it can be approximated that the number of patients in Romania is about 140,000, of which 132,000 are patients with primary open-angle glaucoma.

Glaucoma treatment continues to focus on reducing intraocular pressure, which is the only modifiable risk factor. Traditional glaucoma surgical methods aim to increase aqueous humor clearance, either through surgery to improve aqueous humor filtration or by fitting drainage valves/stents/implants.

In recent years, more and more minimally invasive alternatives have emerged that provide a higher safety profile than the classic surgical treatment of glaucoma. These alternatives refer to various laser procedures and implants/stents to increase aqueous humour drainage with the aim of lowering intraocular pressure.

2. How many types of glaucoma are there?

There are several types of glaucoma classifications, but they are usually divided into the two major classes, primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (POAG).

3. How does glaucoma occur?

Doctors and researchers do not yet know exactly what causes glaucoma. The disease is often associated with increased pressure in the eye, caused by a fluid called aqueous humor. Aqueous humor is a clear fluid that is constantly produced inside the eye to nourish the eye.

In a healthy eye, this fluid is produced and eliminated from the eye in roughly equal proportions. This maintains a constant pressure inside the eye, called intraocular pressure (IOP). Intraocular pressure is considered normal when it is between 6 and 20 mm Hg.

In patients with elevated intraocular pressure (over 21 mm Hg), the eye continues to produce aqueous humor, but is unable to eliminate it at a normal rate. Over time, this increased intraocular pressure can damage the optic nerve, leading to gradual vision loss. If the intraocular pressure does not decrease, blindness may even result.

4. What are the risk factors?

Ophthalmologists have concluded that some people are more likely to get glaucoma. These are people who :

They are over 40 years old;
They have blood relatives with glaucoma;
They are known to have increased intraocular pressure;

Suffers from:

diabetes;
hypertension;
hypotension;
migraine-type headaches;
Raynaud's syndrome;
Au miopie avansata.

Although there are types of glaucoma without elevated intraocular pressure, the main risk factor for glaucoma is elevated intraocular pressure.

5. Correct diagnosis of glaucoma.

The diagnosis of glaucoma is relatively simple and does not involve unpleasant investigations for the patient. The major difficulty is that glaucoma has no symptoms close to the spot until vision is greatly impaired. Thus, the vast majority of patients are diagnosed in the advanced stages of the disease when, despite correct treatment, the progression to blindness is difficult to stop.

To establish the diagnosis, the ophthalmologist uses 4 simple tests:

Intraocular pressure measurement;
Examinarea papilei nervului optic, investigatia de electie fiind tomografia in coerenta optica
Drainage angle examination (this is necessary to determine the type of angle-closure or open-angle glaucoma, as the therapeutic modalities may be different);
Examinarea câmpului vizual (stabilește in ce măsura este afectată capacitatea pacientului de a vedea ; în mod caracteristic, in glaucom se produce o îngustare a câmpului vizual dinspre periferie către centru).

From the data obtained from these investigations, the doctor can determine the diagnosis of glaucoma, its type and how advanced the disease is.

6. How do we treat glaucoma?

There are no drugs capable of curing glaucoma in the sense that vision lost through glaucoma cannot be restored. All the drugs currently used to treat glaucoma are able to stop or delay the worsening of the disease and prevent blindness. They do this by lowering IOP, regardless of the form of glaucoma, with increased intraocular pressure or not.

That's why early diagnosis of the disease, when vision is not much affected, is essential!

Most glaucoma medications come in the form of eye drops. If eye drops cannot sufficiently reduce intraocular pressure, other available therapeutic alternatives are used. These may include laser treatment or even surgical treatment. Sometimes it may be necessary to combine eye drop treatment and laser or surgical treatment to further reduce intraocular pressure.

7. Can glaucoma be cured?

Glaucoma is a lifelong progressive disease and there is no known cure. Any vision loss that has occurred before glaucoma is diagnosed and treated is irreversible. The good news is that most glaucoma medications are effective in reducing IOP, thus keeping glaucoma under control.

Este foarte important ca pacienții sa meargă regulat la control la medicul oftalmolog, astfel încât presiunea intraoculara si afectarea câmpului vizual sa poată fi monitorizate, deoarece glaucomul se poate agrava fără ca pacientul să-și dea seama. De asemenea, este foarte important ca tratamentul prescris sa fie urmat consecvent.

In conclusion, glaucoma should not be a problem for anyone. With the right treatment, anyone can lead a normal and active life without the risk of going blind.

Descoperiți mai multe informații valoroase despre oftalmologie și sănătatea ochilor vizionând materialele realizate de experți în domeniu de pe canalul nostru de YouTube.

- 19th December 2022

Glaucoma

Glaucoma

1. What is glaucoma?

2. How many types of glaucoma are there?

3. How does glaucoma occur?

4. What are the risk factors?

5. Correct diagnosis of glaucoma.

6. How do we treat glaucoma?

7. Can glaucoma be cured?

Head of Work Dr. Alexandra Preda, PhD

From 30 years with our patients!