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Glaucoma is a disease of the main nerve of the eye that causes irreversible loss of vision. It is usually associated with an excessively high pressure within the eye.
In its early stages, glaucoma affects peripheral vision and may go unnoticed. However, in its later stages, it can also affect central vision, affecting the ability to recognise faces and read.
Glaucoma can be treated to prevent its progression; this involves reducing the pressure inside the eye. A wide range of treatments is available including medicines, laser treatments, and surgery.
• Glaucoma still has no cure: the first crucial step in preserving your sight is to get a diagnosis. With treatment, it is possible to halt further loss of vision but once vision is lost, it cannot be restored.
• Everybody is at risk of vision loss due to glaucoma, from babies to senior citizens. However, you’re more at risk if you’re over the age of 60 or have a family member diagnosed with glaucoma. Also, if you’re diabetic, very near-sighted (highly myopic) or are of African / East Asian descent.
• There are virtually no warning symptoms that you have glaucoma. Getting tested by an ophthalmologist or eye care specialist is the best way to prevent blindness as a result of untreated glaucoma.
Often, although not always, it’s associated with increased fluid pressure in the eye, commonly referred to as intraocular pressure (IOP). It is a complicated disease that is made up of a group of ocular (eye) disorders where damage to the optic nerve leads to progressive and irreversible loss of sight.
• Primary open-angle glaucoma
• Angle-Closure Glaucoma
• Normal-Tension Glaucoma
• Other Types of Glaucoma
Primary Open-Angle Glaucoma
The most common disorder of the disease, in this form the eye’s drainage canals gradually clog over a period of time. As it develops slowly and with virtually no symptoms, the progressive loss of sight may go unnoticed over some years.
As the eye’s drainage canals become clogged over time, the inner eye pressure (Intraocular Pressure or IOP) rises because the correct amount of fluid is unable to drain out of the eye. It’s this increase in IOP which can be detected by the ophthalmologist or eye care specialist, using specialist measurement tools.
Any loss of vision can also be assessed and monitored using perimetry – the visual field test. This condition is treatable, and it usually responds well to medication, especially if detected early and treated.
Also known as acute or narrow-angle glaucoma, the eye pressure rises very quickly for this condition. Fortunately, it’s relatively uncommon with the symptoms including a painful eye, headaches, nausea, halos around lights, and blurry vision.
In this form, there is a blockage of the drainage canals. This is associated with the iris not being as wide and open as it should be. When the pupil suddenly or excessively enlarges, the outer edge of the iris bunches up and obstructs the eye’s drainage canals. Using a specialist viewing device, an ophthalmologist can tell if your angle is normal and wide or abnormal and narrow.
Treatment involves surgery or laser to create an opening through a small part of the outer edge of the iris. This unblocks the eye’s drainage canals. Glaucoma surgery may also be recommended as a precautionary measure for the other eye. Although this is usually successful and long lasting for acute glaucoma, it’s sensible to undertake regular follow-up checks as a chronic form could still occur.
This form is diagnosed when the optic nerve is damaged, even though the pressure in the eye isn’t very high. The optic nerve damage is revealed by a direct examination of the eye and assessment of the appearance of the optic nerve by an ophthalmologist. A nerve that appears cupped or does not look a healthy pink colour could raise concerns.
As would an abnormal visual field test, which involves mapping out the person’s whole field of vision, using specialist equipment.
The cause of damage to the optic nerve, even though they have almost normal pressure levels of between 12-22 mm Hg., is unclear. However, it seems to be associated with people with a family history of the same condition. Or, people with a history of systemic heart disease and those of Japanese descent.
Typically, ophthalmologists today would treat this by reducing the eye pressure as low as possible using medications, laser treatments and conventional surgery. Although, research is still underway to clarify why some eyes are susceptible to damage even when the IOP appears to be within the normal range.
Other Types of Glaucoma
These other types can occur in either one or both eyes. They could also be like either the open-angle or the angle-closure kind. They include the following:
Where the raised IOP is a result of another disease process such as eye inflammation, eye trauma and injury, diabetes mellitus, tumour, advanced cataract.
Or, taking prescribed drugs like steroids, and it still results in damage to the optic nerve and loss of sight. The severity of this type is variable and the treatment depends on whether it is found to be of the open-angle or the angle-closure variety.
Also a type of secondary open-angle glaucoma. This occurs when the pigment granules in the back of the iris are shed into the clear eye fluid. These tiny pigment granules subsequently clog up the drainage canals in the eye, resulting in a raised IOP. Treatment could involve medications, laser, or surgery.
This occurs when a flaky material is shed from the outer layer of the lens within the eye. The material clogs the drainage system of the eye by collecting in the angle between the iris and the cornea. This causes the IOP to rise and produces a form of secondary open-angle glaucoma. It is treated usually with medications or surgery.
This happens typically in diabetic patients when abnormal formation of new blood vessels on the iris occur. They form over the eye’s drainage canals causing a form of secondary open-angle glaucoma, which is difficult to treat.
Measures the pressure within your eye using an instrument called a tonometer. Eye drops to numb the surface of the eye are first instilled into the eye. Then, a small amount of pressure is applied to the eye by a tiny device or by a warm puff of air.
A pressure of 12-22 mm Hg (“mm Hg” refers to millimetres of mercury, a scale used to record eye pressure) is considered to be within the normal range. Most glaucoma cases are diagnosed with pressures greater than 20mm Hg. However, some people with Normal-Tension Glaucoma can have optic nerve damage even at pressures between 12 -22mm Hg.
Eye pressure can vary during the course of the day and is unique to each person.
Slit Lamp Examination:
This diagnostic procedure is a direct visual examination of your optic nerve for glaucoma damage. The shape and colour of the optic nerve can be assessed by the ophthalmologist by looking through the pupil of the eye, which often first needs to be dilated using eye drops.
Perimetry and gonioscopy may then additionally be recommended, should there be a concern about the outcome of the tests above.
Perimetry is a visual field test. It maps your whole field of vision so your ophthalmologist can tell whether your vision has been affected by glaucoma. The test involves looking straight ahead and indicating when a moving light passes your peripheral vision.
It is very helpful if you can relax and respond as accurately as possible during the test. It is common practice to repeat the test to see if the results have changed the next time you take it. This will help to monitor any changes in your vision.
Gonioscopy helps the ophthalmologist determine if the angle where the iris meets the cornea is wide and open or narrow and closed. First, eye drops are used to numb the eye. Then, a hand-held contact lens with an integrated mirror is placed gently on the eye.
The ophthalmologist can then tell if the angle between the iris and cornea is wide and open (a possible sign of open-angle glaucoma) or closed and blocked (a possible sign of angle-closure glaucoma).
The simple, pain-free test that measures the thickness of the cornea. It involves the placing of a probe, called a pachymeter, on the front of the eye.
Corneal thickness can potentially influence eye pressure readings. This needs to be taken into account when evaluating your IOP reading, so your treatment plan can be uniquely personalised. It takes only about a minute to perform pachymetry for both eyes.
If your condition is particularly difficult to diagnose or treat, you may be referred to an ophthalmologist who specializes in glaucoma screening and treatment.
As early detection is the key to protecting your vision from damage, a complete eye examination which includes the following common tests should be performed at regular intervals. This is best discussed with your own doctor, optician or ophthalmologist as there is currently no national glaucoma screening programme in the UK.
Your Consultant will discuss treatment options on a personalised basis, as patients’ needs vary.
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