How does primary open-angle glaucoma progress unnoticed. What are the risk factors for developing this condition. Can early detection prevent vision loss in glaucoma patients. How is open-angle glaucoma diagnosed and treated effectively.

Understanding Primary Open-Angle Glaucoma: A Stealthy Vision Threat

Primary open-angle glaucoma (POAG) is often referred to as the “silent thief of sight” due to its insidious nature. This progressive eye condition gradually damages the optic nerve, leading to vision loss that can go unnoticed in its early stages. As the most common form of glaucoma, POAG affects millions worldwide, with many unaware they have the condition until significant damage has occurred.

Why is POAG so difficult to detect early on? The answer lies in how it affects vision:

• Vision loss typically begins in the peripheral visual field
• Central vision remains intact until late stages of the disease
• One eye may compensate for deficits in the other
• Intraocular pressure increases gradually, often without causing pain

These factors contribute to the estimated 50% of Americans with glaucoma being unaware of their condition, highlighting the importance of regular eye exams for early detection and treatment.

The Mechanics of Vision Loss in Open-Angle Glaucoma

To understand how POAG affects vision, it’s crucial to examine the disease’s progression:

1. Increased intraocular pressure damages the optic nerve fibers
2. Peripheral vision gradually deteriorates
3. Side vision deficits become more noticeable in moderate stages
4. Central vision remains largely unaffected until advanced stages

Why does central vision remain intact for so long? The optic nerve fibers responsible for central vision are more resilient to damage, allowing many patients with advanced glaucoma to maintain 20/20 central vision even as their peripheral vision deteriorates significantly.

Risk Factors: Who’s Most Susceptible to Primary Open-Angle Glaucoma?

Identifying those at higher risk for POAG is crucial for early detection and prevention. Key risk factors include:

• Age (40 years and older)
• High intraocular pressure
• Family history of glaucoma
• African American or Hispanic descent
• Myopia (nearsightedness)
• Thin central corneal thickness
• Possibly diabetes

How do these risk factors contribute to POAG development? While the exact mechanisms aren’t fully understood, they may influence the eye’s ability to regulate intraocular pressure or increase susceptibility to optic nerve damage. Regular eye exams are particularly important for individuals with multiple risk factors.

The Importance of Early Detection: Breaking the Silence of POAG

Given the asymptomatic nature of POAG in its early stages, how can individuals protect their vision? The key lies in regular comprehensive eye exams. The National Eye Institute and American Academy of Ophthalmology recommend that all adults aged 40 and older undergo dilated eye exams.

What does a comprehensive eye exam for glaucoma involve?

• Tonometry to measure intraocular pressure
• Ophthalmoscopy to examine the optic nerve
• Visual field testing to assess peripheral vision
• Gonioscopy to inspect the eye’s drainage angle
• Pachymetry to measure corneal thickness

These tests provide a comprehensive assessment of eye health and can detect POAG in its early stages, when treatment is most effective in preserving vision.

Treatment Options: Preserving Vision in POAG Patients

While there’s no cure for POAG, various treatment options can slow its progression and preserve remaining vision. The primary goal of treatment is to lower intraocular pressure. Treatment options include:

1. Prescription eye drops to reduce fluid production or improve drainage
2. Oral medications to lower eye pressure
3. Laser treatments such as trabeculoplasty to improve drainage
4. Surgery, including trabeculectomy or drainage implants, for advanced cases

How effective are these treatments? When started early and adhered to consistently, these interventions can significantly slow the progression of POAG and preserve vision for many years. However, it’s important to note that vision lost to glaucoma cannot be restored, emphasizing the critical nature of early detection and treatment.

Living with Primary Open-Angle Glaucoma: Adapting and Thriving

Receiving a POAG diagnosis can be overwhelming, but with proper management, individuals can maintain a high quality of life. How can patients effectively manage their condition?

• Adhere strictly to prescribed medication schedules
• Attend regular follow-up appointments with an ophthalmologist
• Monitor for changes in vision and report them promptly
• Maintain a healthy lifestyle, including regular exercise and a balanced diet
• Consider support groups or counseling to address emotional aspects of vision loss

By taking an active role in their treatment and overall health, POAG patients can significantly impact the course of their condition and maintain independence.

Research and Future Directions in POAG Management

The field of glaucoma research is constantly evolving, with promising developments on the horizon. What are some areas of focus in POAG research?

• Neuroprotective therapies to directly protect optic nerve fibers
• Gene therapy approaches to address underlying genetic factors
• Advanced imaging techniques for earlier and more precise diagnosis
• Novel drug delivery systems for more effective and convenient treatment
• Stem cell therapies to potentially regenerate damaged optic nerve tissue

These research directions offer hope for improved POAG management and potentially even reversal of vision loss in the future. However, until such breakthroughs become reality, early detection and consistent treatment remain the cornerstones of preserving vision in POAG patients.

The Role of Lifestyle in POAG Management

While medical interventions are crucial in managing POAG, lifestyle factors can also play a significant role. How can patients complement their medical treatment with lifestyle changes?

• Maintain a healthy weight to reduce pressure on the optic nerve
• Engage in regular, moderate exercise to promote healthy blood flow
• Avoid smoking, which can increase intraocular pressure
• Manage stress through relaxation techniques or mindfulness practices
• Protect eyes from UV radiation with sunglasses and wide-brimmed hats

These lifestyle modifications, while not a substitute for medical treatment, can contribute to overall eye health and potentially slow POAG progression.

The Psychological Impact of POAG: Addressing Mental Health

The diagnosis and management of POAG can have significant psychological effects on patients. How can individuals cope with the emotional challenges of living with a progressive vision condition?

• Seek support from family, friends, or professional counselors
• Join support groups to connect with others facing similar challenges
• Practice mindfulness or meditation to manage anxiety and stress
• Explore adaptive technologies to maintain independence and quality of life
• Focus on abilities rather than limitations, engaging in enjoyable activities

Addressing the psychological aspects of POAG is crucial for overall well-being and can positively impact treatment adherence and outcomes.

POAG in the Context of Global Eye Health

Primary open-angle glaucoma is a significant contributor to global vision loss. How does POAG impact eye health on a global scale?

• POAG affects approximately 70 million people worldwide
• It is the second leading cause of blindness globally
• Prevalence varies among different ethnic groups and geographic regions
• Access to screening and treatment remains a challenge in many areas
• Public health initiatives are crucial for raising awareness and improving access to care

Addressing POAG on a global scale requires coordinated efforts to improve access to eye care, increase public awareness, and develop more affordable treatment options.

The Economic Burden of POAG: Societal and Individual Impacts

The financial implications of POAG extend beyond individual patients to society as a whole. What are the economic considerations associated with this condition?

• Direct medical costs for treatment and management
• Indirect costs due to lost productivity and decreased quality of life
• Increased healthcare utilization and associated expenses
• Economic burden on families and caregivers
• Societal costs related to vision loss and disability

Understanding the economic impact of POAG emphasizes the importance of early detection and effective management, not only for individual health but also for broader societal well-being.

Integrating POAG Management with Overall Health Care

Effective management of POAG often requires a holistic approach to healthcare. How can POAG care be integrated with overall health management?

• Coordinate care between ophthalmologists and primary care physicians
• Address comorbidities that may impact eye health, such as diabetes or hypertension
• Consider potential drug interactions between glaucoma medications and other treatments
• Incorporate eye health into routine health screenings and check-ups
• Educate patients on the interconnections between eye health and overall well-being

By adopting an integrated approach to healthcare, patients can better manage POAG while maintaining overall health and preventing complications.

The Role of Genetics in POAG: Implications for Screening and Treatment

Genetic factors play a significant role in POAG susceptibility and progression. How does understanding the genetic basis of POAG impact patient care?

• Identification of high-risk individuals through genetic testing
• Potential for personalized treatment based on genetic profiles
• Development of gene therapies targeting specific genetic variants
• Improved understanding of disease mechanisms for novel treatment approaches
• Ethical considerations regarding genetic testing and counseling

As genetic research advances, it holds promise for more targeted screening, prevention, and treatment strategies for POAG patients.

POAG and Aging: Navigating Vision Health in Later Life

As the risk of POAG increases with age, managing the condition becomes an important aspect of healthy aging. How can older adults maintain eye health and quality of life with POAG?

• Regular comprehensive eye exams, even in the absence of symptoms
• Adapting living spaces to accommodate changing vision needs
• Exploring assistive technologies for maintaining independence
• Balancing POAG management with other age-related health concerns
• Engaging in activities that promote cognitive and social well-being

By proactively addressing POAG and overall eye health, older adults can maintain independence and quality of life as they age.

The Future of POAG Management: Emerging Technologies and Approaches

As medical technology advances, new approaches to POAG management are on the horizon. What innovative techniques show promise for improving POAG care?

• Artificial intelligence for early detection and progression monitoring
• Minimally invasive glaucoma surgeries (MIGS) for less invasive treatment
• Sustained-release drug delivery systems for improved medication adherence
• Telemedicine and remote monitoring for enhanced patient follow-up
• Regenerative medicine approaches for optic nerve repair and regeneration

These emerging technologies and approaches offer hope for more effective, convenient, and personalized POAG management in the future.

Primary open-angle glaucoma remains a significant challenge in eye health, but with ongoing research, improved detection methods, and evolving treatment options, the outlook for patients continues to improve. By raising awareness, promoting regular eye exams, and advancing our understanding of the disease, we can work towards a future where the “silent thief of sight” no longer poses such a significant threat to vision and quality of life.

Open-Angle Glaucoma Symptoms | BrightFocus Foundation

Yvonne Ou, MD

University of California, San Francisco, UCSF Medical Center

• Expert Advice

Published on:

July 15, 2021

During the early stages of glaucoma, vision loss is often imperceptible (red arrow).

Learn why open-angle glaucoma, often called the “silent thief of sight,” rarely causes symptoms in the early stages of the disease.

The loss of vision from open-angle glaucoma typically starts from the peripheral visual field, or “side vision,” which means it is often unnoticeable.

Only in moderate stages of the disease do these side vision deficits become more noticeable, but even then some patients do not know notice the symptoms. If one eye is more affected by glaucoma than the other, the healthier eye compensates since most visual activities involve the use of both eyes. Furthermore, only in late stages of glaucoma is the central vision affected, which means that many patients with advanced glaucoma still have 20/20 vision in the center. Because of this lack of symptoms, it has been estimated that of the 3 million Americans with glaucoma, 50 percent do not know they have it.

One of the major risk factors for glaucoma is high eye pressure. However, in the case of primary open-angle glaucoma, most patients do not experience symptoms from high eye pressure. This is another reason why glaucoma is called the “silent thief of sight.”

For many open-angle glaucoma patients, the eye pressure gradually increases over time, and because the change in eye pressure is not abrupt, there is often no eye pain. This is not to say that high eye pressure does not result in pain. However, eye pain is more typical in acute glaucomas, such as an acute angle-closure glaucoma attack. In this situation, the eye pressure suddenly spikes, and this results in eye pain or headache, cloudy vision due to corneal swelling, and eye redness. This is very different from primary open-angle glaucoma where, as mentioned above, there is typically no eye pain, central vision is good, and the eyes are not red.

Other Forms of Open-Angle Glaucoma

What about other forms of open-angle glaucoma? Some forms of secondary open-angle glaucoma include pseudoexfoliation or pigmentary glaucoma. However, like primary open-angle glaucoma, these glaucomas are also often symptomless. Sometimes, in pigmentary glaucoma, the eye pressure can abruptly increase when eye pigment is released, such as during intense exercise. In this case, the vision can also become cloudy. But overall, open-angle glaucomas do not cause symptoms until late stages of the disease.

Risk Factors

Risk factors of primary open-angle glaucoma other than high eye pressure and age include family history, race (African American or Hispanic), myopia (nearsightedness), thin central corneal thickness, and possibly diabetes.

Because open-angle glaucoma is often symptomless, the National Eye Institute and the American Academy of Ophthalmology recommend that all adults age 40 or older have a dilated eye exam.

About the author

Yvonne Ou, MD

University of California, San Francisco, UCSF Medical Center

Yvonne Ou, MD, is a board certified ophthalmologist who specializes in glaucoma, including medical, laser and surgical therapies; cataract evaluation and treatment including combined cataract and glaucoma surgery; glaucoma filtering and implant surgery; and newer procedures.

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Primary Open-Angle Glaucoma: Causes, Symptoms, Treatment

Glaucoma is the second-leading cause of blindness in the world, affecting around 70 million people globally. Primary open-angle glaucoma is the most common type of glaucoma.

In the United States, around 80 percent of people with glaucoma have primary open-angle glaucoma.

Primary open-angle glaucoma is a progressive condition, which means that if it’s not treated, it gets worse over time. The good news is that it can be detected through regular eye and vision screenings. Treatment can’t restore your eyesight, but it may slow the progression of the disease and prevent further vision loss.

This article will take a look at the causes, symptoms, and treatment of primary open-angle glaucoma and whether there are steps you can take to prevent it.

Primary open-angle glaucoma is an eye condition that causes gradual blindness. To understand how the disease affects your eyes and your eyesight, it’s important to take a look at two key functions that happen in a healthy eye.

1. Vision

• Your eye is equipped with cells that act as light sensors, or photoreceptors. One type of photoreceptor is a retinal ganglion cell.
• These cells are located in the retina, the structure at the back of the eye that gathers information about what you see.
• The death of retinal ganglion cells is the underlying cause of blindness from glaucoma.

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2. Fluid balance

• Your eye is filled with a liquid called aqueous humor. Its purpose is to keep your eye plump and to supply nutrients to the cells in your eye.
• This fluid is continuously refreshed. As new aqueous humor is made, older fluid seeps out. There are two drainage pathways in your eye:
  • the trabecular meshwork (spongy tissue located near the cornea)
  • the uveoscleral outflow (a drainage route whereby aqueous humor seeps around, through, and between tissues that doesn’t involve the trabecular meshwork)

• Both of these networks sit just behind your cornea near the front of your eye. When the older fluid doesn’t drain properly, pressure builds up inside the eye.
• Too much intraocular pressure (pressure inside the eye) can damage the optic nerve and the cells that maintain your eyesight.

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Researchers have not yet pinpointed exactly what causes your eyes to stop draining properly. In some cases, the nerves that switch the draining process on and off don’t work well.

In other cases, tiny particles of pigment, blood cells, proteins, and other debris can block the trabecular meshwork drainage. Steroid therapies can also raise the pressure inside your eyes.

A 2020 research review showed that primary open-angle glaucoma occurs more frequently in:

• adults more than 40 years old
• Black people
• people with a family history of glaucoma

Some health conditions can raise your risk of developing primary open-angle glaucoma. These include:

• blood pressure that is either too low or too high
• type 2 diabetes
• glucose intolerance
• atherosclerosis
• obesity
• myopia
• sleep apnea
• migraine
• anxiety or stress
• optic disc hemorrhage
• thinned cornea
• Raynaud syndrome

Using birth control pills, alcohol, and tobacco products can also increase your risk of developing primary open-angle glaucoma.

Closed-angle glaucoma means the iris (the colored ring) in your eye meets the cornea at an angle that blocks both the trabecular meshwork and the uveoscleral drainage systems.

Closed-angle glaucoma usually causes intense pain, nausea, and blurred vision. It often comes on suddenly, and is a medical emergency.

When the trabecular meshwork is blocked but the uveoscleral drain is open, glaucoma is said to be open-angle.

When glaucoma occurs without any underlying health condition (such as cataracts or an eye injury), the disease is said to be primary.

Primary open-angle glaucoma means the disease has developed without a known cause. Most cases of glaucoma are primary open-angle glaucoma.

When another health condition causes or contributes to the development of glaucoma, the disease is called secondary glaucoma. In other words, glaucoma has developed as a result of changes caused by the other health condition.

In the early stages, primary open-angle glaucoma doesn’t usually have any noticeable symptoms.

In advanced stages, it can cause blurred vision in one or both eyes, along with a narrowed field of vision.

With primary open-angle glaucoma, vision loss starts at the outer edges of your field of vision. As the disease progresses, your field of vision shrinks. If left untreated, primary open-angle glaucoma can cause blindness.

An ophthalmologist or an optometrist can test your eyes for glaucoma as part of a routine eye exam. There are several different types of tests that your eye doctor can use to check for signs of glaucoma.

• Tonometry. This test measures the pressure inside your eye. After numbing your eye with eye drops, your doctor will use a small device called a tonometer to measure the inner pressure of your eyes.
• Ophthalmoscopy. Your doctor or a technician will give you eye drops to dilate your pupil — this is the opening at the front of your eye that lets in light. Once your eye is dilated, your eye doctor will use a device with a light on the end to examine your optic nerve.
• Visual field test. This test involves covering one eye at a time and then looking straight ahead while lights flash in your peripheral vision. The purpose of this test is to determine whether you have any loss to your peripheral vision.
• Pachymetry. With this quick, painless test, your doctor will gently place a probe on the front of your eye to measure the thickness of your cornea. This test is done because corneal thickness can, in some instances, influence eye pressure readings.
• Gonioscopy. After numbing your eye with drops, your doctor will place a hand-held contact lens on your eye to determine whether the angle where the iris meets the cornea is open or closed.

The goal of primary open-angle glaucoma treatment is to lower the pressure in your eye to prevent any further damage or vision loss. Treatments vary according to how advanced your glaucoma is and what’s possibly causing the problem.

Medication

The National Eye Institute says that the first-line treatment for primary open-angle glaucoma is usually prescription eye drops. One of the most common types of eye drops to help treat this condition are prostaglandins.

Prostaglandins are fatty acids that can help improve drainage inside your eye. These drops are taken before bed every night. Some of the most commonly prescribed prostaglandins for primary open-angle glaucoma include:

• Xalatan (latanoprost)
• Travatan Z (travoprost)
• Zioptan (tafluprost)
• Lumigan (bimatoprost)

Some other types of eye drops can help lower the amount of fluid your eye produces. These medications include:

• beta-blockers
• alpha-adrenergic agonists
• carbonic anhydrase inhibitors

Glaucoma eye drops are usually safe for most people. However, there’s a small possibility of side effects such as:

• changes to the color of your iris
• stinging and redness in your eye
• blurry vision
• dry mouth

Laser treatment

If eye drop medications don’t lower your eye pressure enough, your eye doctor may recommend a type of laser procedure called selective laser trabeculoplasty (SLT). Some new research has shown that SLT may be as effective as eye drops in early glaucoma.

This in-office procedure only takes a few minutes and involves your eye doctor aiming a laser at the drainage tissue in your eye.

The laser energy causes a chemical change in the eye tissue that can result in better drainage of fluid inside your eye. This, in turn, may help lower the pressure inside your eye by 20 to 30 percent, according to the Glaucoma Research Foundation. This procedure is successful in around 80 percent of cases, and the effects typically last between 3 to 5 years.

Your eye will be numbed during the laser treatment, but there can be some tenderness, redness, or dryness afterward. Your doctor may prescribe some eye drops to help your eye heal.

Surgery

Several types of surgery can be done to encourage better drainage. This includes:

• minimally invasive glaucoma surgery, which involves a surgeon using microscopic tubes to drain fluid from the eye
• trabeculectomy, in which the surgeon opens a tiny hole in the surface of your eye to allow fluid to escape
• glaucoma implant surgery, where surgeons place a small tube called a shunt into your eye to help fluid drain properly

Some people of certain ages, races, or family histories develop primary open-angle glaucoma more frequently, which can result in the eye changes that cause glaucoma. If you’re concerned about developing this condition, your doctor can work with you to help you manage your overall eye health as much as possible.

If you have a health condition that raises your risk of developing primary open-angle glaucoma, it’s important to manage that condition well. And if you smoke, use alcohol, or take birth control pills, you may want to talk with a healthcare professional about ways to reduce the risk of glaucoma.

The most important preventative step you can take is to have regular eye exams. Because symptoms do not appear until later in the course of this disease, it’s important to detect glaucoma early to prevent vision loss.

Primary open-angle glaucoma is a progressive condition that can cause permanent vision loss, and even blindness, if left untreated. It happens when retinal ganglion cells are damaged, causing the gradual loss of peripheral, and then central vision.

Primary open-angle glaucoma is caused by too much pressure within the eye. When fluid does not drain properly, the excess pressure can harm the optic nerve.

Primary open-angle glaucoma does not cause vision loss or other symptoms until later stages. For that reason, it’s important to have regular eye exams. Your eye doctor can test the pressure in your eye and evaluate your field of vision to detect glaucoma in its earliest stage, before it affects your vision.

Open-angle glaucoma. What is Open Angle Glaucoma?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Open-angle glaucoma is a chronic eye disease with a tendency to progress, characterized by increased intraocular pressure and damage to the optic nerve. Clinical symptoms are represented by a decrease in visual acuity and accommodation, painful sensations. The main diagnostic measures are tonometry, gonioscopy, optical coherence tomography, perimetry and ophthalmoscopy. The components of the complex treatment of open-angle glaucoma are laser surgery methods, surgical interventions (sinus trabeculectomy, sclerectomy) and conservative therapy.

• Causes of open-angle glaucoma
• Symptoms of open-angle glaucoma
• Diagnosis of open-angle glaucoma
• Treatment of open-angle glaucoma
• Prognosis and prevention of open-angle glaucoma
• Prices for treatment

General

Primary open-angle glaucoma (POAG) is considered as a disabling disease, including intermittent or regular increase in intraocular pressure (IOP) above individually tolerated values, damage to the integrity of the optic nerve head and retinal ganglion cells, and decreased vision. In open-angle glaucoma, in contrast to angle-closure glaucoma, IOP rises when the angle of the anterior chamber of the eye is open. According to the World Health Organization (WHO), more than 70 million patients with open-angle glaucoma are registered in the world. To date, the disease is in second place among the causes of vision loss. Pathology is most common in people after 60 years (3-4%). After the age of 45, POAG is diagnosed in 2% of the population. There are rare cases of the development of this pathology in persons under 18 years of age.

Open angle glaucoma

Causes of open-angle glaucoma

Open-angle glaucoma refers to a number of diseases that have a genetic predisposition with polygenic transmission mechanisms. This pathology has many prerequisites, but the triggering etiological factor of POAG has not been established. Functional blockade of the scleral sinus plays a key role in the development of open-angle glaucoma. Such features of the anatomy of the eyeball lead to POAG, such as a low degree of differentiation or pathology of attachment of the scleral spur and ciliary muscle, a decrease in the angle of inclination of the Schlemm’s canal. These changes progress with the age of the patient.

It was found that prolonged use of glucocorticoids, reducing the permeability of the trabecular network, inhibits the outflow of aqueous humor. The consequence is damage to the optic nerve head under the influence of high IOP. An important link in the pathogenesis of POAG is a violation of the mechanisms of regulation of blood circulation in the region of the optic nerve head. The tendency to develop POAG increases in patients with atherosclerosis, hypertension, diabetes mellitus, myopia, as well as pathological conditions accompanied by metabolic disorders.

Symptoms of open-angle glaucoma

From a clinical point of view, there are such forms of open-angle glaucoma as simple primary open-angle glaucoma, pseudoexfoliative open-angle glaucoma, pigmentary glaucoma and normal pressure glaucoma.

Simple primary open-angle glaucoma affects both eyes. In the early stages of development, the pathology is characterized by an asymptomatic course. Further, such subjective symptoms as rainbow circles join when fixing the gaze on direct rays of light, reduced accommodation, fog and flickering before the eyes. When the tolerable values ​​of IOP are exceeded, patients complain of headache radiating to the eyes and superciliary arches.

Pseudoexfoliative form of open-angle glaucoma is typical for patients who have a history of exfoliative syndrome. With this pathology, a thin layer of amyloid-like substance is deposited in the region of the structures of the anterior pole of the eyeball. Pseudoexfoliative glaucoma causes eye damage to varying degrees. The pathognomonic symptoms of the disease are a change in the contour of the pupil, depigmentation of the central part of the iris, phacodonesis (trembling of the lens during eye movements). Characterized by higher values ​​of IOP than in other forms of the disease, and the progression of the course.

Pigmentary glaucoma develops as a result of the introduction of the pigment of the iris into the zone of the corneal-scleral septum by a fluid current. Violation of the circulation of aqueous humor is a prerequisite for an increase in pressure.

Normal pressure glaucoma occurs after 35 years of age. Both eyes are affected to varying degrees. The classical clinic of glaucoma develops with normal IOP values ​​and an open angle of the anterior chamber. The trigger is arterial hypertension against the background of spasm of large vessels.

Diagnosis of open-angle glaucoma

The measurement of intraocular pressure plays a key role in the diagnosis of the disease using methods such as tonometry, elastotonometry and daily tonometry, which allows you to record changes in IOP throughout the day. It is also necessary to examine the structures of the fundus, the field of view and the angle of the anterior chamber of the eye.

The gonioscopy method allows visualizing the open angle of the anterior chamber of the eye, of medium width, increased pigmentation, increased density and the development of sclerotic changes in the area of ​​the corneal-scleral trabecula. The perimetry method determines the narrowing of the visual fields. The reason is the appearance of paracentral scotomas, Björum’s scotomas and an increase in the diameter of the blind spot. The narrowing develops from the nasal half and at the terminal stages of the disease there is complete blindness.

During ophthalmoscopy, pallor and expansion of the boundaries of the vascular funnel of the optic nerve head are observed. The progression of the pathology leads to atrophy of the second pair of cranial nerves and vascular plexuses of the eyeball, followed by the development of the ring of prepapillary atrophy. A more detailed assessment of the degree of the pathological process in the area of ​​these structures can be done using optical coherence tomography and laser scanning ophthalmoscopy. The differential diagnosis of POAG should be made with senile cataract.

Treatment of open-angle glaucoma

The first step in the etiotropic treatment of open-angle glaucoma is antihypertensive therapy. To do this, prescribe drugs to improve the outflow of intraocular fluid of the prostaglandin group (latanoprost, travoprost) and M-cholinomimetics (pilocarpine hydrochloride). In order to reduce the production of intraocular fluid, the appointment of adrenergic blockers (timolol, proxodolol), carbonic anhydrase inhibitors (diacarb), alpha-2-agonists (brimonidine) is effective. Osmotic diuretics (mannitol) help reduce IOP. As neuroprotective therapy, vitamin preparations and flavonoids (alpha-tocopherol, gamma-aminobutyric acid), calcium channel blockers (nifedipine) and non-enzymatic antioxidants (ethylmethylhydroxypyridine succinate) are used.

Laser treatments have limited indications for open-angle glaucoma. Laser iridectomy is indicated in the presence of a narrow corneal-scleral angle. Laser trabeculoplasty is used only with low efficiency of conservative therapy. Surgical intervention for open-angle glaucoma consists of sinustrabeculectomy, which is one of the non-penetrating filtering operations.

During the first 10 days after surgery, you should stop eating salty and pickled foods, as well as alcoholic beverages. Patients should avoid getting water into the surgical area, do not rub the eyes. During this period, it is recommended to sleep on the side opposite to the surgical wound and limit physical activity. At the end of the rehabilitation period, it is necessary to undergo an examination by an ophthalmologist 2 times a year.

Prognosis and prevention of open-angle glaucoma

Modern methods of ophthalmology cannot provide a complete recovery of patients with glaucoma, but treatment is necessary, because this pathology is characterized by a progressive course and in the terminal stages of the disease leads to irreversible loss of vision. The prognosis for glaucoma in the early stages is favorable for life and performance. The basis for establishing a disability group is a sharp decrease in visual acuity.

Prevention of POAG is reduced to regular examination by an ophthalmologist of patients over 40 years of age, as well as all persons at risk. All patients with an established diagnosis of glaucoma should be registered at the dispensary and visit an ophthalmologist once every 2-3 months.

You can share your medical history, what helped you in the treatment of open-angle glaucoma.

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IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Open-angle glaucoma – what is it, causes, symptoms and treatment | Blog

Eye diseases are one of the most common pathologies in modern medicine. Recently, the number of patients diagnosed with glaucoma has increased significantly. In this material, we will consider open-angle glaucoma in detail. First, let’s define what is open-angle glaucoma?

Open-angle glaucoma (h50. 1 according to ICD-10) is a progressive chronic eye disease characterized by increased intraocular pressure (IOP), leading to damage to the optic nerve, which, in turn, is fraught with disability or even blindness.

Types of disease

The classification of open-angle glaucoma includes several concepts: primary and secondary open-angle glaucoma.

Primary open-angle glaucoma is a regular or intermittent increase in pressure within the eye when the anterior chamber angle is open. At the same time, such pressure values ​​\u200b\u200bare significantly higher than those that a person is able to individually endure. Moreover, the progress of the disease leads to pathological disorders in the structure of retinal ganglion cells and the optic nerve head. All these pathological changes lead to a significant deterioration in the quality of vision and ultimately become the cause of complete blindness of the patient.

As for the second concept, here the outflow of intraocular fluid and an increase in intraocular pressure are provoked by numerous other diseases that cause modifications in the drainage system of the eye. Such modifications adversely affect the condition of the optic nerve, worsening the general condition of vision up to its complete loss.

Stages of the disease

Like any pathology, this disease is divided into certain stages. There are four of them, and each of them characterizes the severity of the impact of the disease on the human eye system.

1. Grade 4 open-angle glaucoma refers to complete loss of vision in one or both eyes. Quite rarely there are cases of preservation of light perception and areas of visibility in the temporal sector.
2. Stage 3 open-angle glaucoma – there is a significant defect in vision. This stage is characterized by a concentric decrease in the visual field in one or more segments. As a result, patients are able to perceive the world around them only with the help of the so-called “tube” vision, that is, the visual process seems to take place through a narrow tube.
3. Open-angle glaucoma of the 2nd degree – there is a noticeable narrowing of the visual field on the nasal side. As a result of ocular hypertension, the patient feels severe, pressing and dull pain in the eyeball. In this case, the overall visual acuity is significantly reduced.
4. Open-angle glaucoma of the 1st degree – at a mild stage, the symptoms of the disease are not expressed in any way. In the case of diagnosis, the patient has a slight modification of the visual field, an increased IOP value and excavation (depression formation) in the center of the optic disc.

It is important to note that the sooner you seek qualified help from ophthalmologists, the more likely you are to save your eyesight. GlazCo Eye Hospital has highly qualified specialists capable of performing high-quality diagnostics of any eye pathologies. Our staff also has surgeons with many years of experience who are able to perform safe and effective glaucoma surgery.

Causes

Causes of open-angle glaucoma to a greater extent lie in predisposition at the genetic level. Despite the existence of many prerequisites for the onset of the disease, the cause of the pathological process has not yet been established by modern medicine.

A key role in the development of open-angle glaucoma is assigned to such a phenomenon as functional blockade of the scleral sinus. It can be caused by the following anatomical features of the eye: a low angle of inclination of the Schlemm’s canal, pathology of attachment of the ciliary muscle or scleral spur, etc. With age, the severity of these changes progresses, which is the cause of the disease.

Patients with diabetes mellitus, atherosclerosis, high degrees of myopia, hypertension and chronic diseases associated with metabolic disorders are more prone to developing an open-angle pathology.

Signs of the disease

At an early stage, the pathology does not manifest itself in any way. However, over time, patients may experience the following symptoms of open-angle glaucoma:

• redness and pain in the eyes;
• headaches;
• iridescent halos appear when looking at bright light;
• a noticeable drop in the level of vision at night;
• discomfort in the eyes;
• increased lacrimation;
• the appearance of so-called “grids” before the eyes;
• feeling of pain in the area of ​​the superciliary arches.

Diagnosis

The main method for diagnosing open-angle glaucoma is to measure intraocular pressure. In modern medicine, there are several methods for performing this procedure.

1. Biomicroscopy. In the process, the angle of the anterior chamber, the area of ​​the fundus and the field of view are examined.
2. Perimetry. This method is not only necessary to determine the narrowing of the visual fields, but also helps to identify the causes of the condition – Björum’s scotomas and paracentral scotomas.
3. Optical coherence tomography (OCT). The purpose of this procedure helps to find the details of the pathological process in the involved structures.
4. Elastotonometry, conventional or daily tonometry. The latter method allows the doctor to know changes in intraocular pressure during the day.
5. Differential diagnosis. This procedure is performed when the patient has a cataract due to age.
6. Gonioscopy. This method helps to visualize the degree of openness of the anterior chamber angle. It is also indispensable, if necessary, to identify the development of sclerotic changes in the corneal-scleral trabeculae, its increased density, as well as increased pigmentation.
7. Ophthalmoscopic examination. Allows the doctor to identify the expansion of the boundaries of the vascular funnel of the optic nerve head, as well as its pallor.

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Treatment

The treatment of open-angle glaucoma involves several stages.

In the case of the initial form of the disease , medical treatment of primary open-angle glaucoma is prescribed. The patient receives a prescription containing eye drops that will improve the outflow of intraocular fluid. Your doctor may also prescribe antioxidants, diuretics, calcium channel blockers, flavonoids, and essential vitamins.

The laser treatment for open-angle glaucoma is used when a patient has a narrow corneal-scleral angle. In this case, a laser iridectomy is prescribed. With insufficient effect from conservative therapy, selective laser trabeculoplasty can also be prescribed.