If we ask “what is glaucoma” to people who suffer from it or have family members, most will say that it is an eye disease in which the eye has high pressure. But this is not entirely true. In fact, glaucoma is a generally chronic degenerative disease of the optic nerve, which is responsible for carrying visual information to the brain.
It is currently the leading cause of non-reversible blindness in the world. And why is everyone talking about eye pressure? Because the main risk factor is high eye pressure, although there are other risk factors and personal predisposition that can lead to people with high eye pressure without glaucoma (with a healthy nerve) and people with low or normal eye pressure with glaucoma (with a diseased nerve).
Consequences of not treating glaucoma
Glaucoma initially causes peripheral visual field defects creating a slight haze, but many patients maintain perfect central vision and are unaware of visual impairment. It is believed that up to 50% of patients with glaucoma are unaware that they have glaucoma.
Gradually, if the disease is not controlled, these defects will become deeper and deeper until they cause blind areas and grow from the peripheral vision until they reach the central zone of vision, which is when the patient begins to perceive that he or she does not see well.
The big problem for ophthalmologists who work in the world of glaucoma is that, although there are treatments to slow down the disease, there is no treatment to cure it and give back to the patient the vision that glaucoma has already taken away. That is why it is very important to perform ophthalmologic check-ups with the appropriate studies to assess the visual field and the state of the optic nerve, in order to detect cases of glaucoma in its early stages.
How to control glaucoma
In order to control the disease, it is important to know what type of glaucoma the patient has, since the term glaucoma includes different entities that have different anatomical characteristics, present a more or less strong family association and even be associated with other diseases of the eye or body.
For example, there are eyes at risk of presenting narrow-angle glaucoma, in which the first step is a laser iridotomy to avoid a sudden and severe rise in eye pressure, which can cause headache and nausea, as well as severe visual sequelae within a few hours, known as acute glaucoma.
In our environment, fortunately, the most frequent is open-angle glaucoma in which the first treatment is generally with drugs that are applied once or twice a day by means of eye drops, to lower the eye pressure. Currently there are four families of drugs that can be given separately or in combination, adapting the type of drug to the characteristics of the patients, since despite being treatments with drops, it should never be forgotten that they are drugs and may present contraindications with other drugs or with pulmonary or cardiac diseases, among others.
Advances in glaucoma surgery
The next step in the treatment would be surgery. In the past, glaucoma surgical techniques were quite aggressive and had a significant risk of complications, but the situation has changed with the appearance of non-penetrating deep sclerectomy, a technique that integrates a membrane that helps the eye itself to self-regulate ocular pressure. Its efficacy is very high and with a very good safety level, but like all glaucoma surgeries it may lose some of its efficacy over the years. In addition, a wide variety of devices are being introduced to lower ocular pressure, which can be associated with cataract surgery or performed alone, and can be very interesting in certain cases.
Another great innovation in the treatment of glaucoma is the micropulse diode laser, a laser modification that has been applied in the operating room under local anesthesia for many years in cases of terminal glaucoma with very high ocular pressure to reduce the production of fluid inside the eye when applied externally or internally on the ciliary body (which is the area where the fluid inside the eye is produced).
The modification in the parameters of the laser and the probe with which it is applied, allows it to be applied over an area called pars plana in a way that stimulates the natural drainage of the eye. It is a treatment that is applied by contact but without entering the eye, thus avoiding the risk of intraocular surgery. Its efficacy is very high, reducing the pressure allowing to replace in many cases up to two or three drugs, although its efficacy may decrease over time. The treatment can be repeated, and since it respects the normal anatomy of the eye, glaucoma surgery can be performed if necessary.
Although there is no perfect treatment for glaucoma, every day there are more and more tools and techniques that allow individualizing the treatment to stop the disease, adapting it to each person and his or her needs.