Glaucoma (Intraocular Pressure) Treatment
What is Glaucoma?
Especially after the 40s, eye tension rise, which proceeds insidiously and gives no symptoms That is GLAUCOMA and it is a disease that can cause sudden blindness.
Glaucoma is a disease of the optic nerve, the nerve that transports images from the eye to the brain. The optic nerve is formed by the combination of a large number of nerve fibers. When there is damage to the optic nerve fibers, blind spots form in the field of vision. These blind spots are often not diagnosed early. The diagnosis is too late when most of the optic nerve is damaged. When the entire optic nerve is damaged, blindness occurs.
Early diagnosis and treatment of glaucoma play a critical role in preventing optic nerve damage and blindness that may occur from glaucoma. With early treatment, glaucoma-induced vision loss can be prevented.
What causes glaucoma?
There is a transparent liquid called an aqueous humor that fills the anterior part of the eye. In order to keep the pressure in the eye at a healthy level, while the intraocular fluid is produced at a constant rate, the same amount of fluid leaves the eye. Aqueous humor is separated from the eye by a microscopic canal system. (This fluid has nothing to do with the tear on the outer surface of the eye.)
Since this is a closed eye system, when this microscopic canal system (also called drainage angle) is clogged, excess fluid amount cannot get out of the eye and the pressure in the eye increases and creates pressure and damage to the optic nerve.
What are the different types of glaucoma?
Chronic open-angle glaucoma: It is the most common type of glaucoma. The risk of developing chronic open-angle glaucoma increases with age. Over time, as the microscopic canal system becomes insufficient, the pressure inside the eye gradually increases and the optic nerve gradually begins to be damaged. In some patients, the optic nerve may become sensitive even to normal intraocular pressure. Treatment is necessary to prevent further vision loss.
Typically, open-angle glaucoma has no signs in the early stages, and vision remains normal. When the optic nerve begins to be severely damaged, black (dark) spots begin to appear in the visual field. While initially these dark spots are not noticeable in daily activities, they can be felt when serious damage occurs and these spots expand. When all optic nerve fibers die, blindness occurs.
Angle-closure glaucoma: Closed iris glaucoma occurs when the iris, the color of the eye, blocks the microscopic canal system. These eyes are typically small and often hyperopic eyes. When the iris blocks the drainage angle, intraocular fluid cannot flow out and begins to accumulate in the eye. This situation causes the development of angle-closure glaucoma rapidly.
Among the findings can be seen:
- Vision blur,
- Severe eye pain,
- Rainbow moire around the lights,
- Nausea and vomiting
This condition is an emergency for the eye. If you experience any of these symptoms, call your ophthalmologist immediately. When this type of glaucoma is not treated urgently, blindness can occur.
Unfortunately, two-thirds of cases of angle-closure glaucoma develop without any previous glaucoma findings.
Who is at risk for glaucoma?
Among the most important risk factors include:
- High intraocular pressure,
- Glaucoma history in the family,
- Myopia or hyperopia,
- Experienced eye trauma,
- Thin cornea (glassy layer of the eye) thickness,
- Systemic health problems (eg diabetes, migraine, circulatory problems, etc.)
Your ophthalmologist will evaluate all of these factors to determine whether you need treatment for glaucoma or whether you need to be closely monitored due to suspicion of glaucoma. Detecting suspicion of glaucoma means that you have a higher risk of developing glaucoma in the future and you need regular examinations to detect the damage to your optic nerve early.
How is glaucoma detected?
Regular eye examinations by your ophthalmologist are the best method for detecting glaucoma. Measuring your eye pressure alone is not enough to determine whether there is glaucoma. The only sure way to detect glaucoma is to have a complete eye examination.
During your evaluation for glaucoma, your ophthalmologist will look for:
- Measuring your intraocular pressure (tonometry),
- Examination of the drainage angle of your eye (gonioscopy),
- Determination of damage to your optic nerve (ophthalmoscopy),
- Evaluation of the visual field of each eye (perimetry)
It is recommended to take photographs of the optic nerve or display it with another computerized method. Not all of these methods may be necessary for everyone. In addition, these tests may need to be repeated at regular intervals to monitor whether your condition changes.
How is glaucoma treated?
Eye damage caused by glaucoma is irreversible. Eye drops, laser surgery, and surgical interventions are applied to prevent further loss. In some cases, oral treatment is also applied.
Periodic control is essential to prevent vision loss in all types of glaucoma. Since glaucoma can progress without your awareness, it may be necessary to make adjustments to your treatment from time to time.
Glaucoma is usually controlled by eye drops used daily. These treatments either reduce the amount of aqueous humor fluid produced by the eye to reduce intraocular pressure or increase the outflow of eye fluid in terms of drainage.
Never change or discontinue medication without consulting your ophthalmologist. If the medications you have are running low, you should definitely check with your ophthalmologist before the medications run out.
While glaucoma medications protect your vision, it can also cause side effects. When you encounter side effects, always inform your ophthalmologist about this.
Side effects that some eye drops can cause are:
- Burning or stinging sensation,
- Redness of the eyes or skin around the eyes,
- Changes in pulse strength or number,
- Changes in your energy level,
- changes in your breathing (especially in patients with asthma and emphysema),
- Dry mouth,
- Changes in the sense of taste,
- Vision blur,
- Eye color changes,
- Elongation of Eyelashes
All drugs have a risk of side effects or interactions with other drugs. For this reason, it is very important that you make a list of all the medicines you use regularly and show this list to your doctor whenever you go for a checkup.
Laser surgery can be recommended for different types of glaucoma. In open-angle glaucoma, the microscopic canal system is directly treated. The laser is used to control intraocular pressure, causing changes in the canal system (trabeculoplasty). In angle-closure glaucoma, by creating a hole in the iris tissue with the laser (iridotomy), the flow of aqueous humor fluid from the canal system is tried to be corrected.
Considering surgical intervention for glaucoma treatment, your ophthalmologist creates a new channel (trabeculectomy) for the outflow of aqueous humor from the eye with very fine surgical instruments. When your ophthalmologist thinks that additional damage to the optic nerve must be prevented, surgery may be recommended. Other surgical procedures, such as laser surgery, are procedures that do not require hospitalization.
What is your role in treatment?
Glaucoma treatment is a condition that requires a teamwork between you and your doctor. Your optician may recommend treatment for glaucoma, but it's your job to apply them.
When you start treatment for glaucoma, your ophthalmologist will want to see you more often. On average, you should expect your ophthalmologist to go for a check every 3 or 4 months. This will vary depending on your treatment needs.
Vision loss can be prevented
You can prevent visual loss by preventing regular eye checks. The recommended time intervals for eye examinations are:
- 20-29 years old: Anyone with a family history of glaucoma should undergo an eye examination every 3-4 years.
- 30-39 years old: Anyone with a family history of glaucoma should undergo an eye examination every 2-3 years.
- 40-64 years old: Everyone should have an eye examination every 2 years.
- 65 years and older: Everyone should undergo one eye examination per year.