What is glaucoma and how to treat it?

Glaucoma is one of the main causes of blindness in developed countries. The main risk factor is elevated intraocular pressure, which causes progressive damage to the optic nerve.

There are many types of glaucoma. The most common is open-angle glaucoma. While in patients with high hyperopia, angle-closure glaucoma is more common. Other less common types of glaucoma are normal tension glaucoma, pseudoexfoliative glaucoma, pigmentary glaucoma (typical of young and myopic males), etc.

How does it manifest itself?

Except in very specific cases, glaucoma is a disease that does not produce symptoms. The damage to the optic nerve produces a decrease in the amplitude of the visual field, and does not cause a loss of vision until it is in a very advanced stage. Visual field loss is very slow, so it goes unnoticed by the patient until very advanced stages of the disease.

Acute glaucomas with very high pressures may produce intense pain in the eye and in the periocular region, as well as blurred vision and very red eyes. In some cases they may even be accompanied by vomiting and nausea.

What guidelines should a patient diagnosed with glaucoma follow?

The only way to detect glaucoma is by means of a complete ophthalmological examination, which includes at least the measurement of intraocular pressure and an examination of the fundus. In suspected cases, this examination should be completed with a visual field analysis and/or with an examination of the retinal nerve fiber layer.

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The prevalence of glaucoma increases with age. Annual examinations are recommended for all persons over 40 years of age. Once the specialist in Ophthalmology has the diagnosis, the patient should follow controls every 4-6 months depending on the severity.

What is the treatment?

Currently, glaucoma treatment is based on lowering intraocular pressure. This can be achieved with drugs (drops), laser or surgery. These treatment options are usually used in this order depending on the severity of the disease, although nowadays laser (trabeculoplasty) can also be used as a first-line treatment.

The surgeries usually consist of making an alternative drainage pathway for the fluid that fills the anterior part of the eye. These surgeries manage to stabilize glaucoma in a high percentage of cases, although sometimes it is necessary to continue treatment with drops or even perform new surgeries. When necessary, this surgery can be performed at the same time as cataract surgery. Nowadays, there are less invasive options that lower intraocular pressure by means of small bypass implants.

When conventional surgeries fail or the eye is in poor condition to perform them, other types of surgeries such as drainage implants (valves) can be used.