Glaucoma in the eye, what is it?
The term glaucoma is used to describe a group of diseases that have in common a chronic progressive optic neuropathy (a disease of the optic nerve) that causes characteristic changes in the shape of the nerve and in the layer of nerve fibers, responsible for transmitting the image from the retina to the brain.
These changes are associated with the progressive and irreversible death of retinal ganglion cells (one of the innermost layers of the retina) and loss of visual field. Intraocular pressure is a key modifiable factor, actually the only risk factor that ophthalmologists can control to reduce the probability of disease progression.
A common disease after 40
Glaucoma affects 2-3% of people over the age of 40, although it is likely that up to 50% of cases may remain undiagnosed. It is an important problem worldwide, since it is the second worldwide cause of blindness. Primary open-angle glaucoma is the most common form in whites, Hispanics/Latinos, and blacks, with the prevalence being especially high in the latter. Worldwide, primary angle closure (PAC) accounts for up to half of cases, and is particularly common in individuals of Asian descent.
Types of glaucoma
Glaucoma can be congenital, children are born with glaucoma, or acquired (develops later in life).
Among the types of acquired glaucoma, the most common type in people of European and African descent is primary open-angle glaucoma. It is a disease that affects men and women equally, in which elevated intraocular pressure causes thinning of the nerve fibers of the optic nerve, characteristic changes of the nerve (called “cupping”) and also typical lesions in the visual field..
Therefore, the most common types of glaucoma are: open angle, closed angle, normal tension and congenital glaucoma.
Open angle glaucoma
It is a chronic disease that affects the nerve that carries information from the eye to the brain. It results in a progressive loss of vision.
Angle closure glaucoma
Primary angle closure glaucoma may account for up to half of all glaucoma cases worldwide and is especially common in Asia.
Normal tension or low tension glaucoma
It is a type of glaucoma that occurs when the intraocular pressure is at normal levels (below 21 mmHg), but even so the fibers of the secondary optic nerve show damage, and loss of the visual field occurs.
Congenital and/or childhood glaucoma
The term congenital glaucoma encompasses a series of diseases, most of which are of hereditary origin. They are characterized by an ocular abnormality that exists from birth, and that causes an increase in intraocular pressure.
Secondary glaucoma
This type of glaucoma is said to have been caused by another disease, such as neovascular glaucoma due to the formation of new vessels in the iris, phacolytic glaucoma, produced by a long-standing cataract, or phantom cell glaucoma due to a vitreous hemorrhage.
Frequent questions
How often should I have my vision checked?
From the age of 60, an annual visit to the ophthalmologist is recommended to carry out a complete ophthalmological examination and rule out the possibility of suffering or not glaucoma.
If I have high eye pressure, does that mean I have glaucoma?
Glaucoma is not high intraocular pressure in the eye. The specialist must carry out a personalized diagnosis of each patient and examine the intraocular pressure that they have since glaucoma is a set of important symptoms and signs that must be taken into account, but not only intraocular pressure.
How does increased pressure damage the eye?
The eye needs to have a certain amount of pressure to maintain its shape and function properly. When there is a balance between the production and elimination of the aqueous humor, a transparent liquid that nourishes and oxygenates the lens and the cornea, the intraocular pressure (IOP) remains constant. But if the production of aqueous humor increases or if it is removed insufficiently, the pressure rises and the optic nerve can be put under pressure, increasing the risk of vision difficulties. Having elevated IOP is a risk factor for glaucoma.
What symptoms does glaucoma give?
Unfortunately, most types of glaucoma presentation do not usually cause any symptoms (except in the case of angle-closure glaucoma, whose pain is compared to “nail pain”) until very advanced stages where field loss of vision is already remarkable.
Is it true that you can’t heal and only be controlled?
Indeed, we cannot speak of eradicating the disease but of controlling and slowing down its evolution.
How is glaucoma treated?
First, blood pressure can be controlled with eye drops by combining up to three or four medications. There are four large groups of medicines and various combinations of medicines in the same eye drops. If this does not lower the tension, surgical intervention can be performed to control it with minimally invasive modern techniques and even tension regulating devices.
Is the treatment forever?
Glaucoma damage is permanent and therefore has no cure. However, its progression can be stopped with medication or surgery. The greater or lesser success of the results will also depend on the case that the patient makes to the indications of his ophthalmologist after the treatment received. A glaucoma patient must be very rigorous with these indications to be well controlled and achieve good visual quality despite having this disease.
With glaucoma, can you drive?
A glaucoma patient may have 100% visual acuity but a tiny visual field. If the terms of legal blindness are reached, that is, vision less than 10 degrees central, not only will you not be able to drive, since it could endanger your life and that of others, but you will also be unable to perform other types of tasks daily.
How does the loss of vision from glaucoma differ from that suffered, for example, in cataracts?
The fundamental difference is the lack of reversibility, what we lose, unlike a cataract, cannot be recovered. On the other hand, initially what is lost is the field of vision to finally lose frontal vision.
What happens if the drops make me intolerant?
If drop treatment is not possible or insufficient, the specialist will assess the possibility of laser treatment in cases where it is indicated, as well as surgical treatment.
How should the drops be used?
Eye drops should always be prescribed by your ophthalmologist. Those who use drops as a treatment for chronic glaucoma to control IOP at the desired levels for each patient. Strict and controlled compliance by the patient in the use of drops is a fundamental requirement to be able to continue adequately and effectively with medical treatment.
