Glaucoma: Symptoms, Diagnosis and Treatment

Glaucoma is currently one of the most common causes of blindness and usually involves a rise in intraocular pressure (not related to blood pressure), with damage to the optic nerve as a result. The problem is that the rise in intraocular pressure gives no symptoms, and the patient suffers from it but does not notice it. Therefore, you may suffer from it without knowing it.

Moreover, it does not damage the central vision initially (the one we use in our daily life), but only our more peripheral visual field, so the patient can go for a prescription and have very good central vision, but suffer from the disease. Finally, without treatment, it ends up producing blindness.

What is the diagnosis and who can make it?

The only professional legally qualified for diagnosis and treatment is the ophthalmologist. It is necessary to measure intraocular pressure by means of a device (Goldmann tonometer) that can only be used by the ophthalmologist. Other devices, such as those that emit air, are only useful for screening, not for diagnosis.

In addition to high pressure, it is necessary to check that the visual field is not affected (by means of a campimetry test), and to perform a kind of scan (OCT) of the optic nerve to assess whether there is structural damage. The sum of elevated intraocular pressure and optic nerve damage is glaucoma. High pressure without damage is called ocular hypertension, and requires close monitoring and even treatment in some cases.

There are also glaucomas called low tension glaucoma, in which the intraocular pressure does not reach high levels, but causes damage to the optic nerve, and therefore also requires treatment.

Can it be treated?

Currently, there is a wide range of treatment options. In the case of a new diagnosis, drops or selective laser can be applied. The American academy advocates starting with the laser, since it is harmless and painless, it is performed in the office itself, and allows normal life from the first moment. The problem is that access to a laser of this type is complicated because there are very few professionals who have it (ours is the latest generation, from Lumenis). In case of not being able to access the laser, the option is the drops. The disadvantage is that most of them are toxic for the ocular surface, producing conjunctival inflammation, changes in the color of the iris, ocular dryness and some other disorders.

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The next therapeutic step is surgery. Until recently there was only trabeculectomy, an aggressive surgery that today is reserved for more severe cases. We currently have other surgical options that are called MIGS, which are minimally invasive and are based on small stents that we implant in surgeries that last a few minutes through millimetric incisions.

Advantages of the SLT laser

The selective laser for glaucoma (called SLT) is a procedure that is performed in the doctor’s office, is painless, harmless, acts on the natural site where the glaucoma problem really is (microscopic holes that serve as evacuation for the liquid that continuously forms inside the eyeball), does not generate scars, and therefore does not leave any trace. It allows you to lead a normal life from practically the same day.

The latest published studies conclude that it should be the first treatment for glaucoma and ocular hypertension. Why then are glaucoma drops almost always prescribed instead of laser? Because there are very few of us professionals who are trained to use it and who also have the latest generation laser. This laser (SLT) should not be confused with the previous version (called ALT), which does cause damage and scarring, and with low efficacy.