Glaucoma, a silent disease

How does glaucoma affect the eye?

Glaucoma is a disease in which retinal nerve cells and fibers are damaged, resulting in visual loss. Of the different types, chronic glaucoma is the most frequent, the one we usually refer to and the one we are going to deal with today. Its incidence tends to occur preferably after the age of 40, although it can sometimes appear earlier.

It is a disease that we can call silent, since it does not show any symptoms. In fact, it is a pathology in which the main protagonist is the aqueous humor, a liquid found inside the eye, which is constantly being produced in one part and eliminated in another. This balance between production and elimination produces a certain physiological ocular tone, the so-called ocular tension. When this balance is disturbed, usually due to a deficit in the evacuation, that is to say, “the drainage is obstructed”, an elevation of tension is produced, called ocular hypertension.

As an example, we could say that if it were a balloon, it would swell little by little, until it explodes, a fact that logically cannot occur in the eyes, because their walls are not distensible, but rigid, and the result is damage to the internal ocular structures. This results in alterations in the visual field, which, if sustained over time, can lead to blindness. The visual field lesions affect areas of the visual field that are not central, but rather between 5 and 15 degrees, as well as the periphery of the visual field, so that patients, as their central vision is not altered, do not notice the problem since they see well until the last stages of the disease, when they end up losing this central vision as well.

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What is the treatment of glaucoma?

Glaucoma can be treated medically and surgically. Medical treatment, which is the initial treatment, is carried out with topical eye drops that lower the ocular pressure. Initially there were few effective preparations for this purpose. Fortunately, however, today we have an important therapeutic arsenal that facilitates our work. But when, in spite of this, we do not achieve our objective, surgical treatment remains as an alternative. The latter includes filtering procedures, drainage devices, valves and even laser treatment. In any case, treatment should be as early as possible, since the lesions produced by this disease are irreversible, i.e., what has already been lost cannot be recovered.

How can the condition of glaucoma be detected in the eye?

The only way to detect glaucoma is through an ophthalmologic study. Ocular blood pressure is the first piece of information that can guide us towards its diagnosis. To this we should add the study of the fundus, with the assessment of the papilla (optic nerve) and perform a visual field, which is the test that will tell us what is the state of the eye at that moment.

What advice or recommendations can you give us to prevent or control it?

Undoubtedly, taking care of it. Periodic controls of our eyesight, an action that we should always carry out with an ophthalmologist. Let us not forget that it is a silent disease, chronic glaucoma does not hurt and is not noticeable.

Sometimes patients come to our office who, out of ignorance, have never had an ophthalmologic examination. It is possible that all specialists have had a patient come to them at some time because they notice that, although they “see well”, they stumble in the street with people or at home with furniture. When this situation is reached, the disease already has a significant degree of evolution and indicates that there is a great damage in the visual field. The patient can see perfectly well in the center, but not on the sides, where the field has been destroyed and there is no vision. Finally, with the passage of time, the patient will also lose this central vision.

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For all these reasons, prevention is very important and can be avoided only with a regular visit to the ophthalmologist, at least once a year. It is important to remember something very important: glaucoma cannot be cured, it can only be controlled. If a glaucomatous patient under treatment were to abandon his or her medication and leave the disease to its free evolution, with the passage of time he or she would always end up blind.