Glaucoma

What is glaucoma?

Glaucoma is an eye disease that causes the progressive loss of nerve fibers in the optic nerve, whose correct functioning is essential to be able to see clearly.

• Primary open-angle glaucoma or chronic simple glaucoma: This is the most common type of glaucoma, affecting approximately 80% of patients with this disease.
• Angle-closure glaucoma or narrow-angle glaucoma.
• Normal tension, low tension or normotensive glaucoma.
• Congenital glaucoma: appears in newborns or young children in whom there has been incorrect or incomplete development of the eye’s drainage system during the prenatal period.
• Secondary glaucoma: appears in association with other visual problems (tumors, cataracts, inflammation, etc.) or is caused by an external agent (use of certain drugs).

Prognosis of the disease

Depending on the type of glaucoma, the prognosis will depend on the type of glaucoma:

• Open-angle glaucoma cannot be cured, although it can be coped with by following the indications of a specialist.
• Closed-angle glaucoma is considered a medical emergency, so immediate treatment can save the patient’s vision.
• Babies with congenital glaucoma usually recover well when surgery is done in time.
• The outlook for secondary glaucoma depends on what is causing the condition.

Symptoms of glaucoma

Depending on the type of glaucoma the patient has, he or she will feel some symptoms or others:

• Open-angle glaucoma:
  • Most people have no symptoms.
  • Once vision loss is noticed, the damage is already severe.
  • There is a slow loss of side (peripheral) vision (also called tunnel vision).
• Angle-closure glaucoma: Symptoms may come and go at first or steadily worsen. You may notice:
  • Sudden, severe pain in one eye.
  • Blurred or decreased vision, called “blurred vision”.
  • Nausea and vomiting
  • Rainbow-like halos around lights
  • Redness of the eyes
  • Sensation of swelling in the eye
• Congenital glaucoma: Symptoms are almost always noticed within a few months of age in children:
  • Clouding in the front of the eye
  • Enlargement of one or both eyes
  • Redness of the eyes
  • Sensitivity to light
  • Tearing

Glaucoma causes progressive loss of nerve fibers in the optic nerve.

Medical tests for glaucoma

The only way to diagnose glaucoma is to perform a complete eye examination.

• Tonometry: An examination to check eye pressure.
• Gonioscopy: An examination using special lenses to look at the angle of the eye.
• Photographs or laser scan images of the inside of the eye (optic nerve images)
• Laser-scanned images of the angle of the eye
• Examination of the retina
• Examination of pupillary reflex response, i.e. how the pupil responds to light.
• Three-dimensional view of the eye – slit lamp examination
• Assessment of visual acuity, i.e. clarity of vision
• Visual field assessment: measurement of the visual field

What are the causes of glaucoma?

Among its causes, which are several, vascular diseases and high blood pressure stand out.

• Open-angle glaucoma: The cause is unknown and this type of glaucoma tends to be passed from parents to children. People of African descent also have a higher risk of this disease.
• Closed-angle glaucoma: Dilating eye drops as well as certain medications can trigger an acute glaucoma attack.
• If you have had acute glaucoma in one eye, you are at risk for glaucoma in the second eye. Your health care provider will likely treat your second eye to prevent a first attack in that eye.
• Secondary glaucoma occurs because of a known cause. Both open-angle and angle-closure glaucoma can be secondary when they are caused by something known. Causes include:
  • Drugs such as corticosteroids.
  • Eye diseases such as uveitis (an infection of the middle layer of the eye)
  • Diseases such as diabetes
  • Eye injury.
• Congenital glaucoma occurs in infants due to hereditary causes.

Can it be prevented?

As it is a generative ailment, it is important to make an early diagnosis. In this sense, specialists advise to check your eyesight from the age of 40, although the age of highest risk for glaucoma is established from the age of 60 onwards. In addition, a comprehensive eye exam can help detect open-angle glaucoma early, when it is easier to treat. It is also recommended to have regular eye exams as directed by your doctor.

Treatments for glaucoma

Although vision loss due to glaucoma cannot be restored, you can prevent glaucoma from progressing by lowering intraocular pressure. This can be done, depending on the patient and medical recommendations, with the administration of drugs, laser techniques or non-invasive surgery.

Treatment depends on the type of glaucoma the patient has:

• Open-angle glaucoma:
  • Eye drops
  • Pills to lower the pressure in the eye
  • Laser therapy: A painless laser is used to open the channels through which the fluid exits. This treatment is applied when eye drops have not worked.
  • If drops and laser treatment do not work, you may need surgery.
• Angle-closure glaucoma:
  • You may be given drops, pills, and medicine through a vein (intravenously) to lower your eye pressure.
  • Some people also need an emergency operation, called an iridotomy. The doctor uses a laser to open a new channel in the iris. Sometimes this is done with surgery. The new channel relieves the attack and will prevent another attack.
• Congenital glaucoma:
  • By surgery: this is done under general anesthesia.

What specialist treats it?

Ophthalmology specialists are in charge of preventing, diagnosing and treating diseases that affect the eyes and the patient’s visual capacity, such as glaucoma.

The eyes are the essential organ of vision and are susceptible to many abnormalities throughout life. Ophthalmology is in charge of preserving the patient’s visual capacity, through medical treatment techniques, surgery or with the help of external elements such as glasses or contact lenses.