What are the main types of glaucoma. How does glaucoma affect vision. What are the early warning signs of glaucoma. Can glaucoma be prevented or treated. Who is at highest risk for developing glaucoma.

What is Glaucoma and How Does it Affect the Eyes

Glaucoma is a progressive eye disease that damages the optic nerve, potentially leading to vision loss and blindness if left untreated. It typically occurs when fluid builds up in the front part of the eye, increasing intraocular pressure and causing damage to the optic nerve over time.

The optic nerve contains over a million tiny nerve fibers that transmit visual information from the eye to the brain. As glaucoma progresses, these nerve fibers gradually die off, resulting in the development of blind spots in peripheral (side) vision. Many people do not notice these blind spots until significant optic nerve damage has already occurred.

How does glaucoma impact vision?

Glaucoma usually affects peripheral vision first, causing a gradual narrowing of the visual field. Central vision is typically preserved until late stages of the disease. As more optic nerve fibers die, blind spots expand and can eventually lead to tunnel vision or total blindness if the condition is not treated.

• Early stages: Minimal vision changes, often unnoticeable
• Middle stages: Expanding blind spots in peripheral vision
• Late stages: Severe visual field loss, potential blindness

Main Types of Glaucoma: Open-Angle vs. Angle-Closure

There are two primary categories of glaucoma, each with distinct characteristics and progression patterns:

Primary Open-Angle Glaucoma

Primary open-angle glaucoma is the most common form, developing gradually over time. In this type, the eye’s drainage system becomes less efficient at removing aqueous humor, leading to a slow buildup of pressure within the eye. This form of glaucoma often progresses without noticeable symptoms in its early stages.

Angle-Closure Glaucoma

Angle-closure glaucoma, also known as closed-angle or narrow-angle glaucoma, occurs when the iris blocks the eye’s drainage angle. This can happen suddenly (acute) or develop slowly over time (chronic). Acute angle-closure glaucoma is a medical emergency requiring immediate treatment to prevent vision loss.

Recognizing the Signs and Symptoms of Glaucoma

The symptoms of glaucoma can vary depending on the type and stage of the disease. Early detection is crucial for preventing vision loss, making regular eye exams essential.

Open-Angle Glaucoma Symptoms

Open-angle glaucoma typically develops without early warning signs, earning it the nickname “the silent thief of sight.” As the disease progresses, the following symptoms may appear:

• Gradual loss of peripheral vision, often in both eyes
• Tunnel vision in advanced stages
• Difficulty adapting to dim lighting

Angle-Closure Glaucoma Symptoms

Acute angle-closure glaucoma can present with sudden and severe symptoms, including:

• Intense eye pain
• Headache
• Nausea and vomiting
• Blurred vision
• Halos around lights
• Red eyes

Chronic angle-closure glaucoma may develop more slowly, with symptoms similar to open-angle glaucoma.

Risk Factors and Causes of Glaucoma

While the exact cause of glaucoma is not fully understood, several risk factors have been identified:

• Elevated intraocular pressure
• Age (especially over 60)
• Family history of glaucoma
• Ethnicity (higher risk in African Americans, Hispanics, and Asians)
• Certain medical conditions (e.g., diabetes, high blood pressure)
• Long-term use of corticosteroid medications
• Eye injuries or previous eye surgeries
• Thin corneas

Is high eye pressure always a sign of glaucoma?

Not necessarily. While elevated intraocular pressure is a significant risk factor for glaucoma, some individuals may develop the disease despite having normal eye pressure. This condition is known as normal-tension glaucoma. Conversely, some people with high eye pressure (ocular hypertension) may never develop glaucoma.

Diagnosis and Testing for Glaucoma

Early detection of glaucoma is crucial for preserving vision. Comprehensive eye exams typically include several tests to assess the risk and presence of glaucoma:

• Tonometry: Measures intraocular pressure
• Ophthalmoscopy: Examines the optic nerve for damage
• Visual field test: Checks for areas of vision loss
• Gonioscopy: Inspects the drainage angle of the eye
• Pachymetry: Measures corneal thickness
• Optical Coherence Tomography (OCT): Provides detailed images of the optic nerve and retina

How often should glaucoma screening be performed?

The frequency of glaucoma screening depends on age and risk factors. Generally, it is recommended that:

• Adults under 40: Every 2-4 years
• Adults 40-54: Every 1-3 years
• Adults 55-64: Every 1-2 years
• Adults 65 and older: Annually

Those with high-risk factors may need more frequent screenings.

Treatment Options for Glaucoma

While there is no cure for glaucoma, various treatment options can help slow its progression and preserve vision. The primary goal of treatment is to lower intraocular pressure.

Medications

Eye drops are often the first line of treatment for glaucoma. They work by either reducing the production of aqueous humor or increasing its outflow. Common types include:

• Prostaglandin analogs
• Beta blockers
• Alpha-adrenergic agonists
• Carbonic anhydrase inhibitors
• Rho kinase inhibitors

Laser Therapy

Various laser procedures can be used to improve drainage or reduce fluid production in the eye:

• Laser trabeculoplasty (for open-angle glaucoma)
• Laser iridotomy (for angle-closure glaucoma)
• Cyclophotocoagulation (reduces fluid production)

Surgery

When medications and laser treatments are insufficient, surgery may be necessary:

• Trabeculectomy: Creates a new drainage channel
• Drainage implant surgery: Inserts a small tube to help drain fluid
• Minimally invasive glaucoma surgery (MIGS): Various procedures to improve drainage with fewer risks than traditional surgery

Living with Glaucoma: Management and Lifestyle Considerations

Managing glaucoma requires ongoing care and attention to maintain eye health and preserve vision. Here are some key considerations for those living with glaucoma:

Medication Adherence

Consistently using prescribed eye drops is crucial for controlling intraocular pressure. Some tips for proper medication use include:

• Setting reminders for dosing schedules
• Using pillboxes or smartphone apps to track medications
• Learning proper eye drop application techniques
• Informing your doctor of any side effects or difficulties with medications

Regular Follow-up Appointments

Attending scheduled check-ups with your ophthalmologist is essential for monitoring disease progression and adjusting treatment as needed. The frequency of these appointments may vary depending on the severity of your condition and how well it is controlled.

Lifestyle Modifications

Certain lifestyle changes may help support overall eye health and potentially slow glaucoma progression:

• Maintaining a healthy diet rich in antioxidants and omega-3 fatty acids
• Exercising regularly (with your doctor’s approval)
• Avoiding smoking
• Protecting eyes from UV radiation with sunglasses
• Managing related health conditions like diabetes and hypertension

Can exercise impact glaucoma?

Moderate exercise may help lower intraocular pressure and improve blood flow to the optic nerve. However, certain high-intensity activities or exercises that involve inverting the head may temporarily increase eye pressure. It’s important to consult with your ophthalmologist about which exercises are safe and beneficial for your specific situation.

Preventing Glaucoma: Strategies for Reducing Risk

While not all cases of glaucoma can be prevented, there are steps you can take to reduce your risk or delay onset:

Regular Eye Exams

Routine comprehensive eye exams are the most effective way to detect glaucoma early. Early detection and treatment can significantly reduce the risk of vision loss.

Know Your Family History

If you have a family history of glaucoma, inform your eye doctor and consider more frequent screenings.

Protect Your Eyes

Wear protective eyewear during sports or activities that pose a risk of eye injury, as eye trauma can increase glaucoma risk.

Manage Chronic Health Conditions

Controlling conditions like diabetes and hypertension may help reduce your risk of developing glaucoma.

Can a healthy diet help prevent glaucoma?

While diet alone cannot prevent glaucoma, certain nutrients may support eye health and potentially reduce risk. Foods rich in vitamins A, C, and E, as well as omega-3 fatty acids and zinc, are beneficial for overall eye health. Some studies suggest that a diet high in leafy green vegetables may be particularly helpful in reducing glaucoma risk.

Emerging Research and Future Treatments for Glaucoma

The field of glaucoma research is continuously evolving, with scientists exploring new treatment options and working towards a better understanding of the disease. Some promising areas of research include:

Neuroprotection

Researchers are investigating ways to protect and potentially regenerate damaged optic nerve fibers. This approach could help preserve vision even in cases where intraocular pressure is well-controlled.

Gene Therapy

Genetic research is uncovering the role of specific genes in glaucoma development. This could lead to new targeted therapies or even ways to prevent the disease in high-risk individuals.

Stem Cell Therapy

Scientists are exploring the potential of stem cells to regenerate damaged tissue in the eye, including the trabecular meshwork and optic nerve.

Advanced Imaging Technologies

New imaging techniques are being developed to detect glaucoma earlier and monitor its progression more accurately. These may allow for more personalized treatment approaches.

What is the most promising new treatment for glaucoma?

While many exciting developments are underway, sustained-release drug delivery systems show particular promise. These implants or injections could provide long-lasting medication release, improving treatment adherence and effectiveness. Some of these systems are already in clinical trials and may become available in the coming years.

In conclusion, glaucoma remains a complex and challenging eye disease, but ongoing research and advancements in treatment offer hope for improved outcomes. Early detection through regular eye exams, combined with proper management and lifestyle considerations, can significantly reduce the risk of vision loss from glaucoma. As our understanding of the disease continues to grow, new and more effective treatments may emerge, potentially transforming the landscape of glaucoma care in the future.

What Is Glaucoma? Symptoms, Causes, Diagnosis, Treatment

Glaucoma is a disease that damages your eye’s optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve.

In this article:

Video: What Is Glaucoma?

Glaucoma is a leading cause of blindness for people over 60 years old. But blindness from glaucoma can often be prevented with early treatment.

What Is the Main Cause of Glaucoma?

Your eye constantly makes aqueous humor. As new aqueous flows into your eye, the same amount should drain out. The fluid drains out through an area called the drainage angle. This process keeps pressure in the eye (called intraocular pressure or IOP) stable. But if the drainage angle is not working properly, fluid builds up. Pressure inside the eye rises, damaging the optic nerve.

The optic nerve is made of more than a million tiny nerve fibers. It is like an electric cable made up of many small wires. As these nerve fibers die, you will develop blind spots in your vision. You may not notice these blind spots until most of your optic nerve fibers have died. If all of the fibers die, you will become blind.

How Do You Get Glaucoma?

There are two major types of glaucoma.

Primary open-angle glaucoma

This is the most common type of glaucoma. It happens gradually, where the eye does not drain fluid as well as it should (like a clogged drain). As a result, eye pressure builds and starts to damage the optic nerve. This type of glaucoma is painless and causes no vision changes at first.

Some people can have optic nerves that are sensitive to normal eye pressure. This means their risk of getting glaucoma is higher than normal. Regular eye exams are important to find early signs of damage to their optic nerve.

Angle-closure glaucoma (also called “closed-angle glaucoma” or “narrow-angle glaucoma”)

This type happens when someone’s iris is very close to the drainage angle in their eye. The iris can end up blocking the drainage angle. You can think of it like a piece of paper sliding over a sink drain. When the drainage angle gets completely blocked, eye pressure rises very quickly. This is called an acute attack. It is a true eye emergency, and you should call your ophthalmologist right away or you might go blind.

Here are the signs of an acute angle-closure glaucoma attack:

• Your vision is suddenly blurry
• You have severe eye pain
• You have a headache
• You feel sick to your stomach (nausea)
• You throw up (vomit)
• You see rainbow-colored rings or halos around lights

Many people with angle-closure glaucoma develop it slowly. This is called chronic angle-closure glaucoma. There are no symptoms at first, so they don’t know they have it until the damage is severe or they have an attack.

Angle-closure glaucoma can cause blindness if not treated right away.

Video: What Is Angle-Closure Glaucoma?

What Happens If You Have Glaucoma?

Open-angle glaucoma symptoms

With open-angle glaucoma, there are no warning signs or obvious symptoms in the early stages. As the disease progresses, blind spots develop in your peripheral (side) vision.

Most people with open-angle glaucoma do not notice any change in their vision until the damage is quite severe. This is why glaucoma is called the “silent thief of sight.” Having regular eye exams can help your ophthalmologist find this disease before you lose vision. Your ophthalmologist can tell you how often you should be examined.

Angle-closure glaucoma symptoms

People at risk for angle-closure glaucoma usually show no symptoms before an attack. Some early symptoms of an attack may include blurred vision, halos, mild headaches or eye pain. People with these symptoms should be checked by their ophthalmologist as soon as possible. An attack of angle-closure glaucoma includes the following:

• severe pain in the eye or forehead
• redness of the eye
• decreased vision or blurred vision
• seeing rainbows or halos
• headache
• nausea
• vomiting

Normal tension glaucoma symptoms

People with “normal tension glaucoma” have eye pressure that is within normal ranges, but show signs of glaucoma, such as blind spots in their field of vision and optic nerve damage.

Do glaucoma suspects have symptoms?

Some people have no signs of damage but have higher than normal eye pressure (called ocular hypertension). These patients are considered “glaucoma suspects” and have a higher risk of eventually developing glaucoma. Some people are considered glaucoma suspects even if their eye pressure is normal. For example, their ophthalmologist may notice something different about their optic nerve. Most glaucoma suspects have no symptoms. That is why you need to be carefully monitored by your ophthalmologist if you are a glaucoma suspect. An ophthalmologist can check for any changes over time and begin treatment if needed.

Pigment dispersion syndrome and pigmentary glaucoma symptoms

Pigment dispersion syndrome (PDS) happens when the pigment rubs off the back of your iris. This pigment can raise eye pressure and
lead to pigmentary glaucoma. Some people with PDS or pigmentary glaucoma may see halos or have blurry vision after activities like jogging or playing basketball

See your ophthalmologist if you have these or other symptoms.

Who Is At Risk for Glaucoma?

Some people have a higher than normal risk of getting glaucoma. This includes people who:

• are over age 40
• have family members with glaucoma
• are of African, Hispanic, or Asian heritage
• have high eye pressure
• are farsighted or nearsighted
• have had an eye injury
• use long-term steroid medications
• have corneas that are thin in the center
• have thinning of the optic nerve
• have diabetes, migraines, high blood pressure, poor blood circulation or other health problems affecting the whole body

Talk with an ophthalmologist about your risk for getting glaucoma. People with more than one of these risk factors have an even higher risk of glaucoma.

Glaucoma Diagnosis

The only sure way to diagnose glaucoma is with a complete eye exam. A glaucoma screening that only checks eye pressure is not enough to find glaucoma.

During a glaucoma exam, your ophthalmologist will:

• measure your eye pressure
• inspect your eye’s drainage angle
• examine your optic nerve for damage
• test your peripheral (side) vision
• take a picture or computer measurement of your optic nerve
• measure the thickness of your cornea

Glaucoma is a silent thief of sight

Glaucoma has no symptoms in its early stages. In fact, half the people with glaucoma do not know they have it! Having regular eye exams can help your ophthalmologist find this disease before you lose vision. Your ophthalmologist can tell you how often you should be examined.

Can Glaucoma Be Stopped? 

Glaucoma damage is permanent—it cannot be reversed. But medicine and surgery help to stop further damage. To treat glaucoma, your ophthalmologist may use one or more of the following treatments.

Video: How to Insert Eyedrops

Medication

Glaucoma is usually controlled with eyedrop medicine. Used every day, these eye drops lower eye pressure. Some do this by reducing the amount of aqueous fluid the eye makes. Others reduce pressure by helping fluid flow better through the drainage angle.

Glaucoma medications can help you keep your vision, but they may also produce side effects. Some eye drops may cause:

• a stinging or itching sensation
• red eyes or red skin around the eyes
• changes in your pulse and heartbeat
• changes in your energy level
• changes in breathing (especially if you have asthma or breathing problems)
• dry mouth
• blurred vision
• eyelash growth
• changes in your eye color, the skin around your eyes or eyelid appearance

All medications can have side effects. Some drugs can cause problems when taken with other medications. It is important to give your doctor a list of every medicine you take regularly. Be sure to talk with your ophthalmologist if you think you may have side effects from glaucoma medicine.

Never change or stop taking your glaucoma medications without talking to your ophthalmologist. If you are about to run out of your medication, ask your ophthalmologist if you should have your prescription refilled.

Laser surgery

There are two main types of laser surgery to treat glaucoma. They help aqueous drain from the eye. These procedures are usually done in the ophthalmologist’s office or an outpatient surgery center.

• Trabeculoplasty. This surgery is for people who have open-angle glaucoma and can be used instead of or in addition to medications. The eye surgeon uses a laser to make the drainage angle work better. That way fluid flows out properly and eye pressure is reduced.
• Iridotomy. This is for people who have angle-closure glaucoma. The ophthalmologist uses a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.

Video: What Happens During Laser Iridotomy Surgery?

Operating room surgery

Some glaucoma surgery is done in an operating room. It creates a new drainage channel for the aqueous humor to leave the eye.

• Trabeculectomy. This is where your eye surgeon creates a tiny flap in the sclera. He or she will also create a bubble (like a pocket) in the conjunctiva called a filtration bleb. It is usually hidden under the upper eyelid and cannot be seen. Aqueous humor will be able to drain out of the eye through the flap and into the bleb. In the bleb, the fluid is absorbed by tissue around your eye, lowering eye pressure.

In trabeculectomy, a flap is first created in the sclera (the white part of the eye). Then a small opening is made into the eye to release fluid from the eye.

• Glaucoma drainage devices. Your ophthalmologist may implant a tiny drainage tube in your eye. The glaucoma drainage implant sends the fluid to a collection area (called a reservoir). Your eye surgeon creates this reservoir beneath the conjunctiva. The fluid is then absorbed into nearby blood vessels.
• Cataract surgery. For some people with narrow angles, removing the eye’s natural lens can lower eye pressure. With narrow angles, the iris and the cornea are too close together. This can cover (block) the eye’s drainage channel. Removing the eye’s lens with cataract surgery creates more space for fluid to leave the eye. This can lower eye pressure.

Your Role in Glaucoma Treatment

Treating glaucoma successfully is a team effort between you and your doctor. Your ophthalmologist will prescribe your glaucoma treatment. It is up to you to follow your doctor’s instructions and use your eye drops.

Once you are taking medications for glaucoma, your ophthalmologist will want to see you regularly. You can expect to visit your ophthalmologist about every 3–6 months. However, this can vary depending on your treatment needs.

If you have any questions about your eyes or your treatment, talk to your ophthalmologist.

Narrow-angle glaucoma: Causes, symptoms and treatment

By Autumn Sprabary; reviewed by Gary Heiting, OD

Narrow-angle glaucoma is a type of glaucoma that occurs when the structure inside the eye that allows fluid to drain normally from the eye (called the drainage angle) becomes restricted.

Narrow drainage angles in the eye increases the risk of the drainage angle becoming blocked, resulting in a significant increase in eye pressure and risk of vision loss. If this occurs, narrow-angle glaucoma is usually called angle-closure glaucoma.

Closure of the drainage angle can occur gradually, partially and intermittently with few symptoms (chronic angle-closure glaucoma) or suddenly and severely with painful symptoms (acute angle-closure glaucoma). Acute angle-closure glaucoma is a medical emergency and requires immediate attention.

Causes of narrow-angle glaucoma

Generally, narrow-angle glaucoma is caused by the iris (the colored part of the eye that surrounds the pupil) being bowed forward, restricting the space between the clear cornea and the iris where the drainage angle of the eye is located.

Conditions associated with narrow-angle glaucoma include:

• Iris plateau — In this condition, the ciliary body (the structure behind the iris that produces the aqueous fluid in the eye) is positioned too far forward in the eye. This displaces the peripheral iris forward, causing the drainage angle to be narrower than normal and at greater risk for obstruction by the front surface of the peripheral iris.

• Hyperopia — People who are highly farsighted are more likely to have eyes with shallow anterior chambers (the space in the front of the eye, between the cornea and iris) and narrow angles, increasing their risk for angle-closure glaucoma.

• Tumors and other causes — A tumor behind the iris, swelling associated with inflammation of the ciliary body (intermediate uveitis) and alteration of the shape of the eye after surgery for a detached retina also can cause angle-closure glaucoma.

Narrow-angle glaucoma symptoms

While narrow-angle glaucoma is uncommon, when it occurs, it can cause much more rapid and severe increases in eye pressure and vision loss than the much more common form of glaucoma called primary open-angle glaucoma. This is especially true if the drainage angle closes suddenly, as it does in the acute angle-closure form of narrow angle glaucoma.

Therefore, it’s critical to be aware of the signs and symptoms of this particularly dangerous type of narrow-angle glaucoma.

The Glaucoma Research Foundation lists these signs and symptoms of the acute angle-closure variety of narrow-angle glaucoma:

Other symptoms include abnormally dilated pupils, red eyes, nausea and vomiting.

The duration for which you experience these symptoms varies. However, regardless of how long symptoms persist, each angle-closure episode potentially results in partial loss of your peripheral vision.

For this reason, acute angle-closure glaucoma is considered a medical emergency. If the high eye pressure is not reduced within hours, it can cause permanent vision loss. Anyone who experiences these symptoms should immediately contact an ophthalmologist or go to a hospital emergency room.

SEE RELATED: Glaucoma and headaches

Risk factors for narrow-angle glaucoma

There are certain characteristics that put an individual at higher risk for narrow-angle glaucoma. These risks include:

• Hyperopia — People who are farsighted are more likely to have eyes with shallow anterior chambers and narrow angles, increasing their risk for narrow-angle glaucoma.

• Age — As you grow older, the anterior chamber tends to become increasingly shallow, and the drainage angle may narrow as you age.

• Race — Anatomically, individuals who are Asian, as well as Inuit and other northern indigenous people, have narrower anterior chamber drainage angles. This results in a higher incidence of narrow-angle glaucoma in these populations.

• Sex — When studied in Caucasians, narrow-angle glaucoma occurs three times more frequently in women than in men. Among African Americans, men and women appear to be affected equally.

Narrow-angle glaucoma treatments

The best way to treat narrow-angle glaucoma is to keep your eye pressure at a safe, stable level. Some ways to achieve this include:

• Surgery — If signs of narrow-angle glaucoma are detected during an eye exam, your eye doctor may suggest glaucoma surgery to reduce your risk of angle-closure attacks.

Procedures called iridotomy and iridectomy are typically performed on narrow-angle glaucoma patients.

During an iridotomy, surgeons use a laser to create a small hole in the peripheral iris to increase fluid drainage and decrease the risk of angle closure. An iridectomy involves removing a small piece of the iris to make better fluid flow in the eyes possible.

Awareness of narrow-angle glaucoma’s potential sudden onset and severe risk can easily cause unrest, but don’t worry. The disease is easily detectable in a comprehensive eye exam and is treatable by a variety of surgical and non surgical options.

Knowledge is the first step in prevention. If you fall under “at-risk” and it’s been a while since your last eye exam, it’s time to see your eye doctor. At the very least, you gain peace of mind. At most, you save your vision.

SEE RELATED: Natural remedies for glaucoma

Page published in July 2020

Page updated in November 2021

Chronic Angle Closure Glaucoma | Ophthalmology

Overview and Facts about Chronic Angle Closure Glaucoma

Even though it can be prevented, glaucoma conditions are one of the leading causes of blindness in people over 60 years old. Chronic angle closure glaucoma develops slowly over time as the iris, or colored part of the eye, blocks the eye’s drainage angle.

Once it becomes fully blocked, the pressure in your eye increases, leading to a range of symptoms and, sometimes, permanent eye damage.

In some cases, no symptoms are noticed until a sudden blockage occurs, causing an attack. Approximately 30% of people with chronic angle closure glaucoma experience one of these attacks.

Signs and Symptoms of Chronic Angle Closure Glaucoma

Due to the slow onset of chronic angle closure glaucoma, you may not notice symptoms until they become severe. Common symptoms of the glaucoma condition include:

• Blurry vision
• Severe eye pain
• Headache
• Nausea
• Vomiting
• Colored rings or halos around lights

Causes and Risk Factors of Chronic Angle Closure Glaucoma

The underlying cause of chronic angle closure glaucoma is currently undetermined. Most likely, it can be caused by the following:

• Your iris becoming thicker than normal
• A plateau iris that blocks fluid due to a roll on its side
• An overly large lens that keeps fluid from moving through the eye

Certain people have a higher risk of developing chronic angle closure glaucoma than others. If you have a small eye or an unusually large lens, you may have a higher risk for this glaucoma condition. Other risk factors include those who are:

• Women
• Over 50
• Asian or Inuit
• Farsighted
• Related to someone with chronic angle closure glaucoma

Tests and Diagnosis of Chronic Angle Closure Glaucoma

If your doctor thinks you may have chronic angle closure glaucoma, a complete eye exam is necessary, not just the common glaucoma screening. A complete eye exam includes:

• Measuring eye pressure
• Looking at the drainage angle
• Examining the optic nerve
• Testing peripheral vision

Treatment and Care for Chronic Angle Closure Glaucoma

Once chronic angle closure glaucoma damages your eye, it cannot be reversed, but your doctor can prevent further damage with a combination of medication and surgery. They may prescribe daily eye drops to help keep eye pressure down.

There are several types of these eye drops available, including some that make the eye create less fluid and some that help the fluid drain more efficiently. Your doctor can determine which is best for you.

Most cases of chronic angle closure glaucoma require some level of surgery. In some cases, your doctor uses laser surgery to either create a tiny hole in the iris or to shift the iris away from the drainage angle. Both procedures allow the fluid to drain better from your eye.

Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)

Aetiology

Primary angle closure (PAC) is defined as appositional or synechial closure of the anterior chamber angle which can lead to aqueous outflow obstruction and raised IOP, in the absence of glaucomatous optic neuropathy. PAC is generally bilateral

Optic nerve damage resulting from PAC is described as primary angle closure glaucoma (PACG). The pooled prevalence of PACG among Caucasians of European ancestry aged 40 and over is 0.4%

PACG is caused by a variety of mechanisms although pupil block, in which aqueous is impeded on its passage between the lens and posterior surface of the iris, is considered to be a key element in its pathogenesis

Patients with angle closure disease may be categorized as follows:

(ITC = irido-trabecular contact, PAS = peripheral anterior synechiae) 

Acute angle closure (AAC) crisis: typically PAC and PACG develop chronically without symptoms, however an acute rise in IOP (unilateral in 90% of cases) can present as a clinical emergency

Predisposing factors

Anatomical

Associated with:

• sex (F:M ratio 3:1)
• ethnicity (e. g. Chinese, Vietnamese, Inuit). PACG is recognized as a leading cause of blindness in East Asia
• family history
• short axial length (hypermetropia)
• shallow AC (F>M)
• increasing age (AC becomes shallower as lens thickness increases)
• small corneal diameter

Iatrogenic (secondary angle closure)

• Drug induced (topical and systemic, see Evidence Base)

Adrenergic agents e.g. phenylephrine

Drugs with anticholinergic effects e.g. tricyclic antidepressants

Drugs that may cause ciliary body oedema, e.g. topiramate, sulphonamides

Angle closure may follow a number of surgical procedures, for example vitreo-retinal surgery with intraocular gas, especially in aphakic eyes

Symptoms primary angle closure

Patients with PAC can be asymptomatic or mildly symptomatic (ocular discomfort, headache). AAC is associated with sudden onset of symptoms and signs:

• rapid progressive impairment of vision of one or both eyes
• ocular and periocular pain which can be severe
• nausea and vomiting
• ocular redness

50% of patients with an acute angle closure attack give history of previous intermittent attacks, e.g. episodes of blurring of vision lasting 1- 2 hours, associated with haloes around lights, eye ache or frontal headache

Signs of primary angle closure

In a PAC suspect the eye may appear normal (with the exception of a narrow angle, as judged by the van Herick technique or by gonioscopy)

In cases with a narrow van Herick angle (≤ 25% [Grade 1 or 2]) with a normal anterior chamber depth, plateau iris should be suspected

In AAC the following signs may be present:

• limbal and conjunctival vessels dilated, producing ciliary flush
• pupil fixed, semi-dilated, vertically elliptical, iris whorling
• corneal oedema
• shallow AC with peripheral irido-corneal contact (if angle can be visualised)
• high intraocular pressure (40-80mmHg)
• AC flare and cells
• optic disc oedematous and hyperaemic
• grey/white anterior sub-capsular lenticular opacities (Glaukomflecken): diagnostic of previous attacks

Differential diagnosis

Neovascular glaucoma

Phakolytic glaucoma

Phakomorphic glaucoma

Acute anterior uveitis

Uveitis with raised IOP

Malignant glaucoma (cilio-lenticular block or aqueous misdirection glaucoma)

Management by optometrist

Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere

GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above

Non-pharmacological

Potentially occludable angle as judged by van Herick test

NICE does not provide guidance on referral for angle closure; however SIGN recommends that patients with peripheral anterior chamber width of ≤25% of the corneal thickness (van Herick Grade 1 or 2) should be referred to secondary eyecare services
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

PAC Suspect

Can only be diagnosed by gonioscopy. The decision to refer for further treatment should be based on the risk of developing PAC/PACG or AAC. If not referring for further investigation, patients with PACS require close monitoring and serial gonioscopy. Patients should be aware that they are at risk of occlusion and that certain medications could induce angle closure
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

PAC

The current clinical consensus is that patients with PAC/PACG should be treated surgically (peripheral iridotomy or cataract extraction) to relieve pupillary block together with pharmacological therapy to reduce elevated IOP
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Pharmacological

AAC

Prior to referral, commence first aid treatment with a drop of pilocarpine 2% eye drops in blue eyes and 4% eye drops in brown eyes (although this is likely to be ineffective when IOP is over 40mmHg and paradoxically pilocarpine can exacerbate angle closure by inducing anterior lens movement)
(GRADE*: Level of evidence=low, Strength of recommendation=weak)

Where the IOP is 40mmHg or higher and the patient is not vomiting, give a single dose of oral acetazolamide (Diamox) 500mg (not slow release formulation). (NB: Diamox may be hazardous in an elderly frail patient.) Then refer as an emergency to ophthalmologist. (In view of potential unwanted effects of this treatment, patient should be accompanied by a carer or relative)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

 

Management category

AAC
A2: first aid measures and emergency (same day) referral to ophthalmologist

PAC/PACG
A3: urgent (within one week) referral to ophthalmologist; no intervention

PAC Suspect
A3 (modified): routine referral to ophthalmologist; no intervention

Possible management by ophthalmologist

AAC: treatment directed to breaking the pupil block and reducing IOP

Medical

• miotics (e.g. gutt. pilocarpine 2-4%)
• systemic agents (e. g. acetazolamide, glycerol)
• topical antihypertensives (e.g. gutt. timolol, gutt. dorzolamide, gutt. brimonidine)

Urgent interventions

• anterior chamber paracentesis (occasionally used in advance of peripheral iridotomy)
• argon laser peripheral iridoplasty (occasionally used in advance of YAG laser peripheral iridotomy [LPI])
• LPI

Less urgent interventions

• cataract surgery
• clear lens extraction
• selective laser trabeculoplasty, post LPI

PAC / PACG: first line treatment options include:

• topical medical therapy
• LPI (for patients with PACG)
• early (clear) lens extraction (a recent RCT found that clear lens extraction showed greater efficacy and was more cost-effective than LPI)

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www. gradeworkinggroup.org)

Sources of evidence

American Academy of Ophthalmology Glaucoma Panel. Preferred Practice Pattern Guidelines: Primary Angle Closure. San Francisco, CA: American Academy of Ophthalmology; 2015.

Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, Scotland G, Javanbakht M, Cochrane C, Norrie J; EAGLE study group. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388(10052):1389-1397

Dabasia PL, Edgar DF, Murdoch IE, Lawrenson JG. Non-contact screening methods for the detection of narrow anterior chamber angles. Invest Ophthalmol Vis Sci. 2015;56:3929-35

Day AC, Baio G, Gazzard G, Bunce C, Azuara-Blanco A, Munoz B, Friedman DS, Foster PJ. The prevalence of primary angle closure glaucoma in European derived populations: a systematic review. Br J Ophthalmol. 2012;96(9):1162-7

Hui X, Michelessi M. Medical interventions for treating primary angle-closure glaucoma. Cochrane Database of Systematic Reviews 2015;12:CD012001

Lachkar Y, Bouassida W. Drug-induced acute angle closure glaucoma Curr Opin Ophthalmol 2007;18:129-33

Napier ML, Azuara-Blanco A. Changing patterns in treatment of angle closure glaucoma. Curr Opin Ophthalmol. 2018;29(2):130-4

Rich R. The pilocarpine paradox. Journal of Glaucoma. 1996;5:225-7

Plain language summary

Primary Angle Closure Glaucoma (PACG) is rarer in this country than Primary Open Angle Glaucoma, and in its acute form differs in that the drainage route for the fluid inside the eye is closed off, rather than gradually blocked. It affects women more often than men, is commoner in long-sighted people and people of East Asian ancestry, and becomes more likely to occur as people age. Certain drugs and eye operations can also cause the drainage angle to close.

A sudden complete closure of the drainage route (known as acute angle closure crisis), which usually affects just one eye, causes rapidly progressing impairment of vision, redness of the eye, and pain in and around the eye which may be so severe as to cause nausea and vomiting. The eye pressure may be very high, because the fluid continues to be formed within the eye but cannot drain away. Various other changes will be seen in the eye by the examining optometrist.

An acute attack of angle closure is an emergency which needs same-day referral to the ophthalmologist. There are drugs that the optometrist can use as first aid. The ophthalmologist will also prescribe drugs and may advise laser treatment to create a tiny hole in the iris (the coloured part of the eye) through which the fluid can drain.

If at a routine eye examination there are signs that there have been earlier, milder attacks of angle closure, or if it appears that a patient could develop PACG, the referral can be urgent, or may be made with less urgency.

Glaucoma (primary angle closure) (PACG)
Version 15
Date of search 15.12.17
Date of revision 19.04.18
Date of publication 09.05.18
Date for review 14.12.19
© College of Optometrists

What Are the Symptoms of Narrow Angle Glaucoma?

If you’ve been experiencing eye trouble that you believe to be episodes of Narrow Angle Glaucoma, then it can be vital to learn about the eye problem and potential treatments for it. Narrow Angle Glaucoma is an eye condition you should educate yourself about, especially if you are experiencing the symptoms. But what exactly are the symptoms of Narrow Angle Glaucoma and how can the eye problem be treated best?

Understanding Narrow Angle Glaucoma

Narrow Angle Glaucoma is a serious eye condition that happens because of changes in the iris, or part of the eye with color. When the iris comes forward, the release of fluids is stopped because of a block in the drainage angle. As a result, there may be pressure that negatively impacts regular messages to the brain of visuals seen by the eye.

Symptoms of Narrow Angle Glaucoma

Early symptoms you should notice from Narrow Angle Glaucoma include intense eye pain, headaches or migraines, fuzzy lighting or halo figures, pupil dilation, vision troubles, bloodshot eyes, and physical sickness. These symptoms may only last a couple hours or occur up until the intraocular pressure becomes minimal.

Each Narrow Angle Glaucoma episode has the power to affect your peripheral vision, meaning vision loss can happen as a result. Narrow Angle Glaucoma can be more episodic and worsen slowly, which makes the eye condition leave unanticipated damage. Angle Closure Glaucoma is extremely serious and more of an immediate emergency because the pressure on the eye needs to be reduced or vision loss will occur.

Causes and Treatment

The causes for the change in the position of the iris that create Narrow Angle Glaucoma include blockage of the pupillary channel, iris plateau, farsightedness, and possible tumors surrounding the iris. These issues are eye conditions that a leading eye care specialist will know to watch out for. This is why it is critical to get regular eye exams and schedule a checkup with an ophthalmologist when symptoms of eye conditions like Narrow Angle Glaucoma arise. Treatment for Narrow Angle Glaucoma involves reducing pressure, which can be done by oral or intravenous medication. Eye drops for glaucoma can also be helpful. Sometimes, laser and non laser glaucoma surgery may be necessary to decrease the intraocular pressure.

Making An Appointment with Ophthalmologists at FLEI

Whether you believe you are suffering from an episode of Narrow Angle Glaucoma or another eye condition that requires proper diagnosis and monitoring or treatment, Fort Lauderdale Eye Institute is the best eye care facility to turn to. With professionals who have decades of experience as eye care specialists, you can find relief and solace when being cared for. Book your appointment with an ophthalmologist today at Fort Lauderdale Eye Institute.

What are the Symptoms of Glaucoma?

The symptoms of glaucoma depend largely upon which type of glaucoma you have. There are two main types of glaucoma: open angle and closed angle. Most cases of glaucoma are open angle. About 1% are closed angle (also known as narrow angle).

Typically there are no symptoms in open angle glaucoma until late in the disease, when extensive irreversible damage has already been done.

Open angle glaucoma is a disease where fluid builds up in the eye creating pressure. The pressure in the eye causes damage to the optic nerve, which in turn causes vision loss. The eye pressure does not have to be very high – sometimes it is even normal – so generally the patient does not feel any pressure sensation or pain.

Open angle glaucoma development is usually a very slow process. It can take many years to develop. For this reason, the very slow loss of peripheral (side) vision is so gradual that it is often not noticed by patients until quite advanced. Late in the disease, patients may notice that parts of their vision are missing or that they are developing “tunnel vision” with a central clear area and loss of side vision.

The lack of symptoms until late in open angle glaucoma makes this disease very dangerous. Glaucoma is often diagnosed late and is one of the most common causes of blindness in the United States. Unfortunately, glaucoma damage is not reversible. Early detection with regular screening is the best way to prevent vision loss from this disease.

Closed Angle Glaucoma Symptoms

Most glaucoma is open angle as described above, and does not have symptoms. Closed angle glaucoma (also called narrow angle glaucoma) accounts for only 1% of all glaucoma cases, but is generally very symptomatic.

Patients experience a severe rise in eye pressure that can occur suddenly when the drain in the eye closes. These patients start out with less space near the drain of the eye, which becomes more crowded with age as the natural lens in the eye grows. Unlike the very gradual process of open angle glaucoma, closed angle can occur in hours.

Symptoms can include:

• Severe eye pain
• Blurred vision
• Halos around lights
• Redness of the eye
• Nausea and vomiting

Closed angle glaucoma is a medical emergency. It must be treated urgently with eyedrops, oral medication, and/or laser. If not treated promptly, permanent vision loss or blindness can occur. Closed angle glaucoma may occur in both eyes at once, or start in just one eye.

Regular eye exams can prevent angle closure glaucoma. A narrow angle, one that is at risk of closing off and causing closed angle glaucoma, can be detected on a screening exam. This can be treated before glaucoma occurs in order to prevent angle closure glaucoma.

How can I prevent vision loss from glaucoma?

The key to preventing vision loss from all types of glaucoma is early detection. The risk for glaucoma goes up with age. Family history of glaucoma also increases risk. We recommend screening about every 3 years in your 40s, every 2 years in your 50s, every 1.5 years in the 60’s and annually over 70, but more often if certain risk factors are present.

For more detailed information on Glaucoma and how Glaucoma is diagnosed and treated please select a topic below:

Open- vs. Closed-Angle Glaucoma: What’s the Difference?

Glaucoma is a group of eye diseases, and each type is different.

The two most common forms are open-angle glaucoma, and closed-angle glaucoma.

These two types of glaucoma in particular have several things in common:

• High eye pressure is the greatest risk factor
• They are most often characterized by damage to the optic nerve.
• People with glaucoma experience gradual vision loss, initially as a loss of peripheral vision.
• Often, symptoms are unnoticeable early on.

There are also some important differences:

• Open-angle is usually a chronic condition with few symptoms, while closed-angle is most often an acute condition with sudden symptoms.
• In open-angle, eye pressure builds gradually, but in closed-angle, it’s far more sudden.
• Open-angle glaucoma is not a medical emergency, but can cause vision issues over time; closed-angle is a medical emergency requiring immediate medical attention.

The dangers of high intraocular pressure

High eye pressure is as troublesome as high blood pressure when it comes to our health. Statistically speaking, those with high eye pressure, also known as intraocular pressure (IOP), often have other health issues, as well, including high blood pressure and diabetes.

Eye pressure can increase as a result of age, certain medications, and eye trauma. It also tends to run in families, and African Americans are at greater risk.

Left untreated, high eye pressure (which is greater than 21mmHg, or millimeters of mercury) can trigger the development of glaucoma, particularly the open-angle or closed-angle types.

Where does the term “angle” come from?

There’s an angle between the iris (the colored part of your eye) and the cornea (the transparent covering over your eye). It’s in the location of this angle where the fluid produced inside your eye (called the aqueous humor) drains from the eye into the body’s circulatory system. This aqueous humor helps maintain the right eye pressure.

A sponge-like structure inside the eye called the trabecular meshwork is important for that drainage function to work correctly. The fluid drains through the trabecular meshwork, then through a drainage canal, into collector channels and then to veins.

One of the reasons aging puts us at higher risk for high eye pressure is that as we get older, we lose the trabecular cells that help the meshwork do its important work. As a result, fluid can build up inside the eye.

What is open-angle glaucoma?

This is the most common form of glaucoma, found in 90% of people with the disease. While experts don’t know for sure what causes this type, many agree that as pressure in the eye builds, it increasingly pushes on the optic nerve, resulting over time in impaired vision.

Vision loss may be so gradual that you may not notice any symptoms of this chronic disease. This is one reason regular eye exams are so important, especially if you have one or more risk factors. Because open-angle is a chronic condition, your eye doctor will need to conduct specific diagnostic tests to measure your eye pressure and to confirm how wide open the drainage angle is between the iris and the cornea.

What is closed-angle glaucoma?

Also called angle-closure glaucoma or narrow-angle glaucoma, this type is a medical emergency requiring an immediate trip to the emergency room or your eye doctor. The aqueous humor is blocked completely from draining out of your eye, causing a sudden spike in eye pressure. When this type of glaucoma occurs, it can lead to blindness in a matter of days if left untreated.

Sometimes angle-closure glaucoma does occur more gradually and without symptoms, but most often it’s acute angle-closure glaucoma that should be treated right away. These symptoms include:

• Severe and throbbing eye pain
• Red eyes
• Blurred vision
• Headache
• Nausea and vomiting

Are you at risk of glaucoma? Regular eye exams are important for everyone, and especially for those who are at risk of developing certain eye diseases. Protect your vision by scheduling an eye exam today.

90,000 causes, symptoms, diagnosis and treatment of glaucoma

The term glaucoma means an extensive group of diseases that are characterized by:

• increased intraocular pressure (IOP)
• damage to the optic nerve head, as well as retinal ganglion cells
• narrowing of the field of view

Glaucoma can occur regardless of age, but is most common in the elderly or senile . .

Glaukoma is considered one of the main causes of irreversible blindness in the world according to the World Health Organization (WHO).

Intraocular fluid and ways of its outflow

Intraocular fluid (hereinafter IVF) plays a huge role in maintaining the level of intraocular pressure. It is one of the sources of nutrition for intraocular structures (lens, cornea, trabecular apparatus, vitreous body).

Produced by the IHF by the processes of the ciliary body located behind the iris, and collects in the posterior chamber of the eye. Further, most of the fluid, washing the lens, flows through the pupil, enters the anterior chamber and passes through the ocular drainage system (trabecula and Schlemm’s canal), which is located in the corner of the anterior gully chamber.From the drainage system of the eye, the VHF enters the excretory collectors (graduates), and then into the superficial veins of the sclera.

In this way, about 85% of the intraocular fluid flows out, but there is another outflow path, which flows out about 15%.

VHF can leave the eye, seeping through the stroma of the ciliary body and sclera into the veins of the choroid and sclera. This outflow pathway is called uveoscleral.

There is a certain balance between the production of VHF and its outflow.When this balance is disturbed, the level of intraocular pressure changes, which is a prerequisite for the development of glaucoma.

Causes and mechanisms of development of glaucoma

Glaucoma is a multifactorial disease, the development of which requires a number of reasons (risk factors):

• heredity
• individual anatomical features or abnormal structure of the eye
• pathology of the cardiovascular, nervous and endocrine systems.

Various combinations of these risk factors trigger the mechanism of glaucoma development , which can be represented as stages:

• increased production of intraocular fluid and / or deterioration of its outflow from the cavity of the eyeball;
• increase in intraocular pressure (IOP) above the tolerant (tolerated) for the optic nerve;
• ischemia (impaired blood supply) and hypoxia (lack of oxygen) of the optic nerve head;
• development of glaucomatous optic neuropathy followed by
• atrophy (death) of the optic nerve.

Forms of glaucoma

The following main types (forms) of glaucoma are distinguished:

• congenital glaucoma:
• primary early congenital glaucoma,
• infantile congenital glaucoma,
• juvenile glaucoma,
• combined congenital glaucoma
• primary adult glaucoma:
• primary open-angle glaucoma (POAG)

  multifactorial disease associated with involutional and age-related changes in the eye)

• primary angle-closure glaucoma (PZUG)

  (the main cause of the disease is the closure of the corner of the anterior chamber, where the drainage system of the eye is located, by the root of the iris)

• secondary glaucoma in adults:

  (a consequence of other ocular or somatic diseases, in which the involvement of structures involved in the production or outflow of OHF occurs)

Glaucoma symptoms

Mostly glaucoma is asymptomatic, and the patient notes a decrease in vision, when already 50% of the optic nerve fibers are damaged irreversibly.

Nonspecific symptoms of glaucoma are:

• blurred vision
• pain
• thread
• a feeling of heaviness in the eyes
• narrowing of the field of view
• blurred vision at night
• “rainbow circles” before the eyes when looking at a light source

These symptoms are called nonspecific because they can be characteristic of other ophthalmic diseases.
In case of angle-closure glaucoma and the occurrence of an acute attack, the symptoms are pronounced: sharp pain in the eye, headache, redness of the eye, nausea, vomiting.

But if any of the above symptoms appear, you should immediately consult a doctor.

Diagnostics of glaucoma

To diagnose glaucoma and determine the method of treating glaucoma, it is necessary to conduct a thorough diagnostic examination, which should include:

• visometry (determination of visual acuity)
• refractometry (determination of the optical power of the eye – refraction)
• perimetry (definition of peripheral vision)
• tonometry (determination of intraocular pressure)
• biometrics (determination of anterior chamber depth, lens thickness, eye length)
• biomicroscopy (examination of tissues and media of the eye using a slit lamp)
• gonioscopy (study of the structure of the anterior chamber angle)
• ophthalmoscopy (fundus examination with assessment of the state of the optic nerve and retina)

Glaucoma Treatment

Conservative treatment of glaucoma includes drugs that reduce the production of intraocular fluid and / or improve its outflow, hemodynamic (improving blood supply) and neuroprotective (protecting nerve fibers) drugs.

These drugs are prescribed only after a diagnostic examination by an ophthalmologist.

In case of insufficient effectiveness of conservative therapy (increased IOP, narrowing of the visual field, progression of optic neuropathy), surgical treatment is indicated.

Surgical treatment of glaucoma is aimed at eliminating intraocular blocks (obstacles) in the path of intraocular fluid movement or at creating a new outflow pathway.

There are many types of operations for glaucoma, but the most successful are:

non-penetrating deep sclerectomy

– with drainage of the anterior chamber angle

– without drainage of the anterior chamber angle

After the incision of the conjunctiva and the formation of superficial and deep scleral flaps, the outer wall of the Schlemm’s canal is removed, thus increasing the outflow of intraocular fluid through the drainage system of the eye.Sometimes in the area of ​​excision of the outer wall of the Schlemm’s canal, a drain is implanted to enhance the effectiveness of the operation.

Benefits of this operation:

• painlessness
• local drip anesthesia
• atrauma
• is carried out without penetration into the eye cavity, which avoids a number of complications (a sharp decrease in IOP, bleeding, detachment of the choroid, etc.)

Non-penetrating deep sclerectomy is a highly effective method of surgical treatment of open-angle glaucoma.

Penetrating deep sclerectomy

– with drainage of the anterior chamber angle

– without drainage of the anterior chamber angle

– with valve implantation

After the incision of the conjunctiva and the formation of the superficial scleral flap, the deep layers of the sclera are excised, then the anterior chamber is opened and part of the iris is excised, which allows the intraocular fluid to circulate freely in the anterior and posterior chambers of the eye. To enhance the efficiency of the outflow of high fluid from the eye, a drain or a valve is implanted in the area of ​​the operation.

Penetrating deep sclerectomy is a more traumatic operation, but its effectiveness is indisputable in the form of angle-closure glaucoma and with the ineffectiveness of a previously performed non-penetrating operation.

It is worth remembering that timely diagnosis and the appointment of adequate conservative or surgical treatment allows you to maintain high vision in patients with glaucoma for a long period.

In our ophthalmology department, all the necessary preoperative examinations for the treatment of glaucoma are performed, and the department’s specialists own the entire arsenal of surgical interventions.

Phone for making an appointment: 8 (499) 968-69-12 or 8 (926) 465-16-76

Angle-closure glaucoma

Glaucoma is a large group of diseases characterized by a periodic or constant increase in IOP, optic nerve atrophy and specific visual impairment. This disease is chronic, and, therefore, it will not be possible to get rid of it once and for all. In turn, the death of the optic nerve means irreversible loss of vision.However, early detection and treatment can slow down or even stop the progression of the disease.

According to the Ministry of Health of the Russian Federation, 1.182 million patients with glaucoma were registered in 2015.

The reasons for the development of glaucoma.

A liquid substance called aqueous humor is constantly produced in the eye. Watery moisture is secreted by the ciliary body into the posterior chamber – a small space between the lens and the iris.Then it exits through the opening of the pupil into the anterior chamber – the space between the cornea and the iris – and fills it. In the corner of the anterior chamber, where the cornea and iris converge, there is a complex drainage system of the eye, through which aqueous humor leaves the eye and goes into the bloodstream.

It is the balance between production and the outflow of aqueous humor that determines intraocular pressure (IOP). In most people, IOP is in the range of 16-25 millimeters of mercury.Some eyes can handle higher pressures though. Therefore, the norm is always individual: what is high for one may turn out to be normal for another.

Currently, there are a large number of theories trying to explain the occurrence of glaucoma. The main ones are:

• Heredity

The most frequent occurrence of the disease in people whose parents suffered from glaucoma was noted.

• Anatomical features of the structure of the eyeball

One of these features is the change in the angle of the anterior chamber of the eye, which is formed by the root of the iris and cornea. When the angle is closed, the angle is significantly narrowed, which makes it difficult for the outflow of intraocular fluid from the eye into the vasculature along the Schlemm’s canal, which causes hypertension.

• Concomitant diseases of the body, etc.

Types of glaucoma.

According to the time of the onset of the disease, the following types of glaucoma are distinguished:

Revealed before the age of 3 years.

Almost always, childhood glaucoma leads to absolute blindness to adulthood.

A rare form, manifests itself in childhood, from 3 to 10 years.

Also a rare form of the disease, found in young people from 11 to 35 years old.

• Adult glaucoma

The main form of the disease occurs in people over 35 years old.

By origin, glaucoma is:

• Primary (open-angle, closed-angle)
• Secondary (inflammatory, phacogenic, post-traumatic, vascular, etc.)

Signs (symptoms of glaucoma)

Glaucoma is an insidious disease because it rarely causes complaints. Detection and prevention is often only possible through regular check-ups with an ophthalmologist.And such forms of glaucoma as angle-closure and congenital glaucoma cause symptoms.

Acute attack of angle-closure glaucoma:

• Extreme pain in the eye
• Sharp deterioration of vision
• Headache (often half of the head hurts from the side of the sore eye)
• Nausea and vomiting
• Glare and photophobia

Congenital glaucoma:

• Lacrimation
• Photophobia
• Increase in the size of the cornea and the whole eye

Glaucoma stages:

• Stage I, or initial

The boundaries of the visual fields are most often not changed, the excavation of the optic nerve head is insignificant.

• Stage II, or advanced

Pronounced narrowing of the visual fields in the upper nasal and lower nasal segments by 10-15 ° is already noted, scotomas (areas of visual field loss) appear in the central sections.

• Stage III, or distant

The narrowing of the visual fields reaches 30-40 ° (or 15 ° from the fixation point – the center), atrophy of the optic nerve head is greatly expanded.

• Stage IV, or terminal glaucoma

Visual acuity is most often absent or very close to zero, that is, a person distinguishes between day and night.The fields of view are narrowed to a point or not defined.

Glaucoma diagnostics.

Due to the fact that glaucoma in most cases does not manifest itself in any way, persons over 40 years of age must be shown to an ophthalmologist once a year with the obligatory measurement of intraocular pressure. Those who are suspected of having glaucoma by a doctor may need more testing.

The optic disc becomes gray with glaucoma and a characteristic depression (excavation) appears in its center.The further advanced the glaucoma, the wider the excavation. The width of the excavation is quantified by taking its width as a ratio to the width of the disc. For example, an E / D (excavation / disc) of 0.5 indicates less advanced glaucoma than an E / D of 0.9.

To diagnose glaucoma, our clinic uses the following research methods:

• Visometry – determination of visual acuity
• Tonometry – determination of intraocular pressure, both by the contact method (according to Maklakov) and non-contact (using a stream of air on a special apparatus)
• Tonography – determination of hydrodynamics of the eye
• Perimetry – a type of examination of the visual fields, which allows you to identify changes in the fields: their narrowing or loss of parts
• Gonioscopy is a special research method that allows you to assess the angle of the anterior chamber, for this, a gonioscopic lens is used
• Biomicroscopy is a general examination method that makes it possible to assess the degree of glaucomatous excavation of the optic nerve head, as well as other changes in the iris, fundus, blood vessels, lens
• Electrophysiological examination of the optic nerve – a method of examination to determine the degree of functioning of the optic nerve
• Ultrasound – a research method for visualizing the structures of the eyeball
• Optical coherence tomography (OCT) is an examination method that allows you to assess, on a microscopic scale, changes in the optic nerve head and macular region

Glaucoma treatment.

Conservative treatment of glaucoma consists in the use of antihypertensive eye drops to reduce intraocular pressure and stabilize the glaucoma process. The choice and selection of the drug is carried out by a doctor – an ophthalmologist. This method of treatment requires constant instillation of antihypertensive drops and, if ineffective, requires a change in the drug or a decision on the surgical treatment of glaucoma.

Surgical treatment of glaucoma is aimed at improving and / or creating pathways for the outflow of intraocular fluid, resulting in a decrease in intraocular pressure.There are laser and surgical surgical methods for treating glaucoma.

The opinion about the sufficiency of one operation for glaucoma is deeply mistaken. Glaucoma cannot be cured by surgery. The disease remains for life, the operation only reduces the pressure. The decrease in pressure after surgery is never permanent. Typically, intraocular pressure becomes high again after a few years. Hence the conclusion: After the operation, you need to continue to periodically observe the doctor and measure the intraocular pressure!

Laser operations.

• Laser peripheral iridectomy

• Selective laser trabeculoplasty

• YAG – laser activation of the trabecula

• Laser Descemetogonyopuncture

• Transscleral diode-laser cyclocoagulation

Surgical operations.

• Microinvasive non-penetrating deep sclerectomy (MNGSE)

• Deep sclerectomy (GSE)

• Implantation valve Ahmed

• Endoscopic cyclophotocoagulation of ciliary processes

Glaucoma

Glaucoma is a disease caused by damage to the optic nerve .Most often this is associated with a increase in intraocular pressure .

Increased pressure inside the eye damages the optic nerve, which is responsible for transmitting images to the brain. Without proper treatment, glaucoma can cause complete blindness, which develops within a couple of years after damage to the optic nerve.

Glaucoma is inherited and may not appear until old age.

Glaukoma is usually called “the hijacker of vision”, because the loss of vision occurs gradually and over a long period of time.Glaucoma is the second leading cause of vision loss worldwide.

To date, it has been diagnosed in more than 67 million people.

• Types of glaucoma
• Symptoms and risk factors for glaucoma
• Diagnostics of glaucoma
• Glaucoma treatment and prognosis
• Research in the treatment of glaucoma

Types of glaucoma

There are two main types of glaucoma :

1. Open-angle glaucoma (wide-angle glaucoma, open-angle glaucoma) is the most common type of glaucoma.The cause of nerve damage is a violation of the circulation of intraocular fluid, which, for some reason, does not leave the eye, causing an increase in intraocular pressure, which, in turn, damages the optic nerve. Some doctors distinguish another subtype of open-angle glaucoma – normal pressure glaucoma, which develops in conditions of normal intraocular pressure.
2. Angle-closure glaucoma (acute-angle glaucoma, closed-angle glaucoma) is caused by the structural features of the anterior segment of the eye, namely, the large size of the lens, due to which the iris blocks the outflow of intraocular fluid.The result is increased pressure within the eye and damage to the optic nerve. The angle-closure form is diagnosed in 15-40% of patients with glaucoma. More common in people of the Mongoloid race and women.

Sometimes ophthalmologists distinguish into a separate type the so-called childhood glaucoma (congenital or developing). Childhood glaucoma occurs in infants, children, and adolescents. As a rule, it is the result of abnormalities in the development of the eye, due to which the intraocular pressure increases.The development of childhood glaucoma is indicated by large eyes, intolerance to bright light, uncontrolled blinking, red wet eyes, constant rubbing of the eyes.

Symptoms and risk factors for glaucoma

Signs and symptoms of glaucoma depend on the stage of development of the disease and its type.

Symptoms of open-angle glaucoma:

• narrowing of peripheral (lateral) vision – the appearance of the so-called tunnel vision , when a person sees only what is directly in front of him.Loss of vision can develop over the years, so the disease is difficult to notice at the initial stage, when the symptoms do not interfere with leading a normal life;
• general visual impairment.

The symptoms of angle-closure glaucoma are different from those of open-angle glaucoma. With a narrow-angle shape, nerve damage can occur at the time of the expansion of the iris. Typically, this happens when a person is looking at something in dim light or darkness – the pupil dilates and the iris blocks the outflow of intraocular fluid, causing nerve damage.

The symptoms of angle-closure glaucoma include:

• sudden eye pain;
• redness;
• blurred vision;
• the appearance of glowing circles around objects;
• nausea and vomiting.

When these symptoms appear, see a doctor immediately , as angle-closure glaucoma can cause rapid and irreversible loss of vision.

There are certain factors, the presence of which increases the risk of developing glaucoma.

Glaucoma risk factors:

• old age – people over 60 have a higher risk of developing this disease;
• ethnicity also plays an important role. Glaucoma is more common among African Americans and Asians;
• gender – glaucoma often affects women;
• a history of certain diseases and conditions – diabetes and hypothyroidism;
• eye injuries – Severe eye injuries contribute to the development of glaucoma.These include retinal detachment, inflammation and swelling;
• Ophthalmic surgery is another risk factor, the presence of which increases the risk of damage to the optic nerve;
• myopia – people suffering from myopia are at risk, susceptible to diseases such as glaucoma;
• Taking corticosteroids increases the risk of damage to the optic nerve.

For the timely detection of damage to the optic nerve, which in the initial stages may develop asymptomatically, you should be examined by an ophthalmologist at least once a year.

Diagnostics of glaucoma

Glaucoma can be detected during a routine examination by an ophthalmologist, and very often even before the patient begins to notice the first symptoms.

Your doctor may suggest that you have some quick and painless tests to confirm your diagnosis.

1. Ocular tonometry – measures intraocular pressure.
2. Gonioscopy – a method of visual examination of the anterior chamber of the eye using goniolins.Allows you to estimate the angle between the cornea and the iris of the eye.
3. Perimetry or visual field test – allows you to detect a narrowing of peripheral vision, indicating the development of open-angle glaucoma.
4. Evaluation of the optic nerve or ophthalmoscopy – allows you to identify lesions of the optic nerve. The study is carried out after using eye drops that dilate the pupil.
5. Optical coherence tomography – a method of non-invasive examination of the eye, allowing to detect damage to the retina and / or optic nerve.

Glaucoma treatment and prognosis

Glaucoma is considered an incurable disease , but the right treatment can slow down the development of its symptoms. There are several approaches to glaucoma treatment :

• eye drops. The least invasive treatment for glaucoma to prevent negative symptoms in patients with recent or minor damage to the optic nerve. Eye drops can reduce the formation of fluid in the eye or increase its outflow.It should be remembered that such drops have many side effects.
• laser surgery – allows you to enhance the outflow of fluid from the eye in people with open-angle glaucoma, and also eliminates fluid blockage in closed-angle glaucoma. Laser surgery offers several methods for solving this problem – trabeculoplasty (unblocking the drainage zone), iridectomy (the doctor makes a hole in the iris to create another path for the outflow of intraocular fluid), cyclophotocoagulation (areas of the middle layer are treated, which reduces the production of fluid).
• microsurgery – offers the creation of a channel for the outflow of intraocular fluid. In some cases, the doctor will decide to have a drainage tube implanted. May cause temporary or permanent loss of vision.

As a rule, glaucoma treatment begins with the least invasive method – eye drops. However, with age, symptoms of the disease may worsen. In this case, the doctor decides on the operation. It should be noted that pediatric glaucoma is treated exclusively by surgical methods, since its cause, as a rule, is the improper development of the drainage system of the eye, which is responsible for the outflow of fluid.

The prognosis for people with glaucoma depends on the cause of the damage to the optic nerve, and the complexity of the symptoms with which they consulted a doctor. The earlier glaucoma was diagnosed, the longer modern medicine can hold back its development. According to statistics, most people who follow a treatment plan do not completely lose their vision.

90,000 Glaucoma – causes, symptoms, treatment

What is glaucoma

Glaucoma is an extensive group of eye diseases characterized by constant or periodic increased intraocular pressure, atrophy of the optic nerve, followed by the development of typical visual field defects and decreased visual acuity.This disease occupies a leading place among the causes of irreparable blindness. Vision in glaucoma decreases smoothly, and therefore changes in visual functions are most often noticed by the patient already in the advanced stage of the disease.

In this case, vision decreases, up to the onset of blindness, which is irreversible, since the optic nerve dies. It is no longer possible to restore sight to a patient who has become blind for this reason!

Early diagnosis and treatment of this ailment can compensate for the course of glaucoma, prevent damage to the optic nerve and associated loss of vision.Therefore, it is very important to be regularly examined by competent specialists.

Primary open-angle glaucoma usually develops as a result of progressive disturbance of the outflow of intraocular pressure. As a rule, the cause is age-related changes in the angle of the anterior chamber of the eye. IOP can also rise due to too active synthesis of aqueous humor, which is observed in people with myopia.

Angle-closure glaucoma occurs due to a sharp overlap of the anterior chamber angle by the iris root.What happens most often in people with hyperopia. Their eyeball is small, the anterior chamber is small, and the lens is large. These anatomical features contribute to the development of the disease.

The following factors can provoke an attack of angle-closure glaucoma:

• drinking a lot of liquid at one time;
• prolonged stay in a dark room;
• Frequent work with head tilted;
• Instillation in the eye of mydriatics – drugs that dilate the pupil.

It should be noted that at an appointment with an ophthalmologist, drops are often given to a person to help dilate the pupil and see the fundus well. In people with increased intraocular pressure, these drugs can cause an attack of angle-closure glaucoma. That is why it is necessary to measure IOP before using mydriatics.

Causes of glaucoma development

Glaucoma can occur at any age; it mainly affects people over the age of 40.But this ailment can also affect young people (adolescent glaucoma) and even newborns (congenital glaucoma), since most often it develops in those people whose parents also suffered from this ailment. Glaucoma can be an occupational disease, develop as a result of age-related changes, trauma, or concomitant diseases.

Risk factors include:

• age over 50;
• burdened heredity – the presence of glaucoma in close relatives;
• injuries, eye contusions;
• chronic ophthalmic diseases such as cataracts, high myopia, iridocyclitis, chorioretinitis;
• presence of hypertension, hypotension, diabetes mellitus, obesity;
• sclerotic changes in blood vessels or deposition of atherosclerotic plaques in them;
• cervical osteochondrosis, leading to a violation of the innervation of the eyeballs.

Glaucoma symptoms

Glaucoma is most often asymptomatic, abnormalities are often detected by chance, during an examination or visit to an ophthalmologist for any other reason.

Over time, a person begins to orientate himself much worse in space due to a narrowing of the field of vision. In the later stages of the disease, it may seem to him that he is looking at the world around him as through a telescope. Twilight vision is also severely affected.The patient practically loses the ability to see something in the dark.

With angle-closure glaucoma, a person develops severe pain in the eye, which soon spreads to the entire half of the head. The patient’s body temperature rises, chills, nausea and even vomiting appear. On palpation, the eye is very hard, resembling a stone. All symptoms appear sharply and develop rapidly.

Some non-specific symptoms may indicate the presence of the disease:

• mild pain, a feeling of heaviness in the eyes;
• rapid visual fatigue;
• deterioration of visual acuity at dusk;
• double vision;
• The appearance of rainbow circles when looking at light;
• sensation of increased moisture in the eyes.

Stages of glaucoma

According to the severity of the process, there are 4 stages of glaucoma:

• I initial stage – the early stage is characterized by periodic surges in intraocular pressure, causing a sharp dilation of the pupils, headaches.
• Stage II of advanced glaucoma — advanced glaucoma is manifested by a significant narrowing of the visual field from the nasal side or the formation of a large arcuate scotoma. Increased intraocular pressure provokes pain in the affected eye; sometimes an increase in the eyeball is visible even visually.Visual acuity drops. At this stage, most often it is impossible to do without surgery.
• Stage III of advanced glaucoma – at this stage, glaucoma is accompanied by concentric narrowing of the visual field and complete loss of its large areas, that is, a significant increase in the blind spot. A sharply increased intraocular pressure leads to other pathologies: retinal detachment, clouding of the lens, the formation of hemorrhages. Drug therapy and diet in the third stage of glaucoma are only an auxiliary means, the main method of treatment in this case is surgery.
• IV terminal stage of glaucoma — complete loss of central vision and complete loss of object vision. With terminal glaucoma, there is a serious increase in intraocular pressure, it is accompanied by severe headaches and eye pains, an increase and clouding of the eyeball – buphthalmos or bull’s eye.

Depending on age, glaucoma is isolated congenital (in children under 3 years old), infantile (in children from 3 to 10 years old), juvenile (in people aged 11 to 35 years old) and adult glaucoma (in people over 35).All forms are acquired, except congenital.

Glaucoma treatment

Is glaucoma treated

If there is a suspicion that a person has glaucoma, then it is possible to determine the stage of development of the disease during an examination by a specialist. How to cure the patient, the doctor will decide on the basis of the diagnostic data received. At the initial stage of the development of the disease, it is possible to treat glaucoma without surgery, the so-called conservative method.The therapy is carried out with the help of special eye drops, which lower the pressure inside the eye, improve the outflow of fluid passing through the organ, or reduce its secretion.

The positive effect of such treatment is possible with an open-angle type of ailment, when there are still no changes in the structure of the eyes. If a patient is diagnosed with angle-closure glaucoma, then medications are practically useless. And to eliminate the problems, surgical methods of treatment are already being used. With their help, angle-closure glaucoma is curable both at the initial stage of the disease and at later stages.

Glaucoma surgery

Surgical intervention is indicated for open-angle glaucoma, poorly responsive to the use of prescribed drugs. In an acute attack of angle-closure glaucoma, surgery is necessary if intraocular pressure cannot be normalized with medication.

• The most modern and less traumatic operations are laser methods of glaucoma treatment:

1.Laser iridotomy is the removal of glaucoma without surgery. This type of treatment is highly effective, easily tolerated and safe. Removal of glaucoma with a laser guarantees a complete cure for the disease. Laser iridotomy is performed without opening the eyeball and is a microsurgical intervention. The risk of complications is minimal.

2. Trabeculoplasty – the surface of the diaphragm is cauterized with a laser, which increases its tension and, as a result, permeability.As a result, more fluid swells from the anterior chamber, and the pressure decreases.

• Cryodestruction: the essence is similar to the previous method, but the effect is carried out not by a laser, but by cold, and the object is not the iris, but the sclera. It is exposed to cold, applying applications at several points at once. The operation is contraindicated in terminal glaucoma, unsuccessful surgical interventions, a history of pain. Cryodestruction is not so safe and often causes complications.It is used if laser correction is contraindicated for the patient for any reason.

Prevention of glaucoma

Preventive measures can help reduce the damage that increased pressure does to the visual system, thereby preventing optic atrophy and blindness.

1. Do not overstrain – limit both physical and psycho-emotional stress.
2. Do not keep the head tilted – it is harmful for patients with glaucoma to engage in activities that require prolonged tilting of the head down.This applies to reading, drawing, drawing, knitting, embroidery and others. It is necessary to maintain a straight head position when working at a computer, watching TV.
3. Set up the right lighting – it is dangerous for people with glaucoma to work in poor lighting conditions. It is important to make it bright so as not to strain your eyes.
4. Give up bad habits, as smoking negatively affects the blood supply to the whole body. The transportation of oxygen and nutrients to all elements of the eyeball is disrupted.
5. Choose loose-fitting clothing that does not interfere with blood circulation in the neck and head.
6. Avoid eye fatigue – while working at the computer, reading and watching movies, it is important to take breaks. It is recommended to set aside 15-20 minutes of rest every hour. At this time, you need to really rest, and not change one strenuous activity for another.
7. Eat right – to prevent glaucoma, you need to include raw vegetables, fish, fruits in the diet, while reducing the amount of animal fats and sugar.
8. Consume moderate amounts of water and other drinks. Don’t drink more than one glass of any liquid at a time. As a safety net, you can check the reaction to coffee or green tea: measure the pressure before and after.
9. Fully rest, get enough sleep, it is advisable not to stay up late, to walk in the fresh air in the evening. You should sleep on comfortable pillows. After waking up, it is recommended to do a warm-up without getting out of bed.
10. Do not give up medication.
11. Avoid sudden changes in lighting – changing the intensity of lighting is a strong strain on the eyes, so before going, for example, in a movie theater, you need to use drops that prevent pupil dilation.
12. Constantly monitor your condition. Even with stable intraocular pressure, you need to see a doctor at least four times a year.

These measures will help to avoid not only glaucoma, but also other diseases of the visual system. Prevention is recommended for everyone, since glaucoma can manifest itself even in an absolutely healthy person.At Lensmaster you can get free vision diagnostics by making an appointment through the website.

What is eye glaucoma, symptoms and treatment – Dobrobut clinic

Symptoms, treatment and prevention of glaucoma

Glaucoma is an ophthalmic disease associated with increased intraocular pressure. This condition provokes degeneration of the optic nerve, which progresses and leads to blindness. Most often, the disease develops in patients after 40 years.With early detection and qualified assistance, the pathology is treatable. Knowing the signs of angle-closure / open-angle glaucoma, you can prevent irreversible processes and avoid loss of vision.

Reasons for development

The hereditary factor is most often considered. According to statistics, if the parents were diagnosed with glaucoma, then the disease with a probability of 30-50% can be diagnosed in children. Serious head and eye injuries can also trigger high intraocular pressure.If this condition is present for a long time, optic nerve degeneration cannot be avoided.

The above reasons refer to primary glaucoma – a disease that develops on its own. Ophthalmologists refer to the causes of secondary glaucoma as diabetes mellitus and atherosclerosis.

Symptoms of glaucoma

A number of forms of the disease are asymptomatic. The patient only notes a gradual deterioration in vision and tries to solve this problem on his own – wears glasses or contact lenses.Diagnosis of primary glaucoma is possible only with preventive examinations, because, as a rule, it proceeds without pronounced symptoms. It is extremely important for a person to independently monitor their health and visual acuity. With a decrease in vision, it is necessary to contact an ophthalmologist and undergo a special examination, consisting of a study of intraocular pressure, a study of visual fields and tonography.

But most often the symptoms of glaucoma are quite intense:

• periodically occurring fogging of images – a person sees the world around him “in a haze”;
• regularly appearing halos, luminous circles around light objects or lighting fixtures;
• regular pains in the temples and in the region of the browbone.

Acute increase in intraocular pressure may also occur. In this case, the patient complains of an attack of nausea (not associated with eating), severe weakness and severe pain in the affected eye. This is an acute attack of glaucoma, a person is at risk of rapid loss of vision and the onset of blindness. Only a doctor can preserve the functionality of the organ of vision, therefore it is necessary to call the ambulance team, since hospitalization is inevitable.

Glaucoma treatment

How to treat glaucoma at different stages is decided by an ophthalmologist.First, the patient is examined, the level of intraocular pressure and general health are ascertained. If the appeal for qualified medical care was carried out in a timely manner, then drug treatment will be prescribed. Eye drops for glaucoma are drugs from the group of prostaglandins or alpha antagonists. They have the same effect on the organs of vision – they reduce intraocular pressure. In parallel with these funds, drugs are prescribed in the form of drops to improve the blood supply to the eyeball.

In most cases, drug therapy has a positive effect – intraocular pressure is normalized and stabilized, the process of optic nerve degeneration stops. Such treatment is carried out under the supervision of ophthalmologists. If no positive dynamics is noted, then surgical intervention will be prescribed. Treatment of secondary glaucoma, as a rule, is carried out with the therapy of the underlying disease that caused the ocular pathology.

Glaucoma surgery is performed on the iris – the doctor creates pressure compensation between the anterior and posterior chambers of the eyeball.This method of treatment also serves to prevent a re-increase in intraocular pressure. The operation is performed under local anesthesia and most often in outpatient settings. After manipulation, the patient should periodically undergo a preventive examination by a doctor in order to exclude a relapse of the disease.

Laser treatment of glaucoma is a new direction in ophthalmology. It is low-traumatic, the first results are noticeable 1-2 hours after the intervention, and the likelihood of complications is at zero.But ophthalmologists warn that laser correction of intraocular pressure does not give long-term and confident results. Most often, a second course of laser therapy has to be carried out after a few months.

Prevention of glaucoma

Timely diagnosis of the disease is possible only with examinations by a doctor – they should be carried out at least once a year. But there are a number of recommendations from ophthalmologists that are clear preventive measures for glaucoma:

Excessive physical and visual stress should be avoided.You should not lift weights over 10 kg (at least continuously and for a long time), stay at the computer for a long time and work with documents without interruption.
1. The diet needs to be adjusted. It is worth limiting the use of coffee, strong tea, spices and hot seasonings. It is advisable to include fresh vegetables and fruits, juices in the menu – this will saturate the body with vitamins and minerals.
2. Every day you should drink at least one and a half liters of clean water. This will ensure the elimination of toxins and toxins, and stabilize the blood flow.

Prevention of glaucoma consists in the timely treatment of diseases that can provoke problems with the optic nerve. We are talking about diabetes mellitus, vascular pathologies – you need to fulfill all the medical prescriptions of the doctor.

Glaucoma of the eye – what it is, how it manifests itself and what to do to prevent its development – these questions will be answered by a qualified doctor. And you can make an appointment with him on the pages of our website https: // www.dobrobut.com/.

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20 November 2015

Ophthalmology: treatment of glaucoma

Intraocular fluid circulates in the eye. It is formed by the processes of the ciliary body, then through the pupil enters the anterior chamber and through complex anatomical structures located in the corner of the anterior chamber of the eye (in particular, Schlemm’s canal), is removed into the veins located in the outer wall of the eye.

The production of liquid and its outflow must be balanced, and if the production exceeds the outflow, then the liquid will accumulate in the eye – intraocular pressure (IOP) rises. This is how glaucoma develops.

The optic nerve is most sensitive to increased IOP. With an increase in IOP, its fibers begin to atrophy and the patient’s field of vision narrows, gradually turning into the so-called “tube”, which subsequently also disappears – the eye becomes blind. With such a complete atrophy of the optic nerve, no ophthalmologist at the present time can help restore vision.That is why it is necessary to diagnose and start treatment on time.

Glaucoma is closed-angle and open-angle.

Angle-closure glaucoma.

It is like an acute form of glaucoma. It often develops in farsighted eyes with a short anteroposterior axis. They are small in size, but all anatomical structures should “fit” in them. The lens in them, on the contrary, is thick and can compress the root of the iris, in such a way that the angle of the anterior chamber closes, and the outflow of fluid stops – the IOP rises sharply.An acute attack of glaucoma occurs, accompanied by pain in the eye and its redness. Thus, angle-closure glaucoma makes itself felt, requiring urgent treatment.

Open-angle glaucoma.

This is a kind of “chronic” form of glaucoma. It can be completely asymptomatic, and the patient may not know about his illness for a long time. Changes are noticeable only to an ophthalmologist who uses special equipment.

Therefore, it is important after 40 years to be checked regularly for glaucoma.

Screening – diagnostics of glaucoma includes measurement of IOP and assessment of the state of the optic nerve. With glaucoma, the disc loses its pink color, gradually turning pale and acquiring a grayish tint. At the same time, under the influence of increased IOP, the inner part of the optic nerve disc bends outward – the fibers of the optic nerve are, as it were, compressed and gradually die. When examining such a disc, it seems that the vessels on the disc, coming out to the retina, are bent over the edge of the optic disc.

Such a picture is called “glaucomatous excavation” of the optic disc.A reflection of the state of the optic nerve is the visual field – the more it is narrowed, the more optic nerve fibers are atrophied.

According to the state of the optic nerve, the stage of glaucoma is determined: initial (I), developed (II), advanced (III), and terminal (IV). According to IOP numbers, these are “a” (IOP up to 26 mm Hg), “b” (IOP 27-32 mm Hg) and “c” (IOP over 33 mm Hg).

Thus, the diagnosis of glaucoma can sound like this: o / u glaucoma I in, or o / u glaucoma III c, etc.

Treatment of glaucoma.

It consists in the normalization of intraocular pressure and the treatment of glaucomatous atrophy of the optic nerve.

At the same time, the doctor’s goal is to preserve (not improve!) Those visual functions that are available at the time of visiting a doctor.

Reduction of IOP is carried out both by using various drops and by performing surgical operations.

Previously, in the initial stages of glaucoma, it was proposed exclusively to instill drops and only with negative dynamics of the process (loss of vision, narrowing of the field of vision, which, we repeat, is already irreversible), the patient was offered an operation.

Such a cautious attitude to surgical interventions was due to the fact that they were all performed earlier with opening the eyeball. However, any penetration into the eye cavity is a risk of subsequent development of cataracts, as well as eye infection.

In the 80s, new types of surgical interventions began to appear – these are operations on the drainage pathways of the eye (for example, the Schlemm’s canal), respectively, not accompanied by opening the eyeball (for example, non-penetrating deep sclerectomy – NGSE).The almost complete absence of complications (in the hands of a competent surgeon) allows such an operation to be carried out even in the initial stage of glaucoma, when there is still high vision (and, accordingly, aimed at preserving this vision).

So, it should be remembered that the earlier the treatment of glaucoma is started, the higher the chances of maintaining vision. The longer the “experience” of the disease, the worse the operations “work”.

Carrying out an operation and lowering IOP does not mean that the patient has got rid of glaucoma.

Glaucoma requires constant monitoring, even though IOP is normal.

The fact is that, once started due to high IOP, the process of glaucomatous atrophy of the optic nerve can progress steadily, even despite the normalization of IOP. Therefore, optic atrophy must be treated. As a rule, conservative treatment is carried out – these are various forms of stimulation of the optic nerve, and the use of various medications.

It should be remembered that there is glaucoma with normal and even low IOP.In this case, IOP is normal or below normal, but there is a progressive narrowing of the field of view and glaucomatous excavation.

Based on materials from the site oftalm.ru.

Glaucoma – Patient Memo

Risk group:

1. People from 40 years old
2. Diabetics, hypertension
3. Those whose direct relatives suffer from glaucoma.

For people at risk, tonometry (measurement of intraocular pressure) is recommended every 6 months.

Symptoms:

Most often, increased eye pressure is not felt in any way, sometimes there are external manifestations in the form of redness of the eyes. In case of angle-closure glaucoma, there may be an acute painful attack (it hurts in the eye, in the eyebrow arch, in the temple), vision as “in a fog”, when looking at light sources, iridescent halos. The attack often occurs in the evening.

The norm of intraocular pressure is from 9 to 22 mm Hg. Art.

What do you need to know if you are diagnosed with glaucoma?

• Do not be nervous, tune in positively and carefully follow all the prescriptions of your doctor.
• This disease is chronic, it is impossible to recover from it. Timely started treatment under the supervision of an ophthalmologist restrains the development of glaucoma and preserves the patient’s vision.
• The goal of treatment is to reduce and stabilize intraocular pressure.
• Conservative home treatment is carried out with eye drops to normalize eye pressure. It is highly likely that you will use them all your life: one drop under the lower eyelid.
• Tell the ophthalmologist what chronic diseases you suffer from, as well as what drugs you are taking as prescribed by doctors of a different specialization (cardiologist, neurologist, therapist).
• The term of application of eye drops after opening the bottle is no longer than a month.
• Eye drops can have the following side effects: a decrease in total blood pressure, sensitivity or intolerance to drugs is possible, manifested by burning sensation, redness, arrhythmia, migraine. The doctor must be informed about this, and he will select another remedy.
• Follow the drip regime exactly. In order not to miss the next dose of drops, store the bottle at home and at work.Be sure to take them with you on your trip.
• In addition to drug treatment at home, therapeutic measures are carried out within the walls of the clinic – injection courses in the treatment room, physiotherapy apparatus treatment, laser treatment with YAG and ARGON lasers. They are especially successful in stages 1-2 of glaucoma.
• If other means are ineffective, you may be offered surgical treatment. Antiglaucoma surgeries in our clinic are fast, affordable and completely safe: they are bloodless and relatively painless (they are performed without anesthesia (under intravenous anesthesia) and hospitalization, on the same day the patient does his usual business at home).The recovery period after surgery takes up to 3 days, but under the supervision of a doctor, the patient will be up to 1 month after the surgery.
• If an operation is recommended to you, do not postpone it for a long time. If, with the diagnosis of “glaucoma” at the stage when conservative treatment is no longer effective, the patient postpones the antiglaucomatous operation, then, unfortunately, without treatment, the prognosis is not comforting – complete and irreversible loss of vision!
• Work the way your age and health conditions allow.Avoid physical activity (the maximum weight that can be lifted is 10 kg), try not to be nervous.
• Do not tilt. For any activity – reading, knitting, etc. – do not tilt your head! With intense visual work, take short breaks – 10 minutes per hour.
• Watch the lighting. You can watch TV, but not in the dark and in the correct position, so that your head is neither tilted nor thrown back.
• Do not wear anything that obstructs blood circulation in the head and neck area (such as a tight tie).
• Good sleep is very important. Before going to bed, it is recommended to take evening walks and take a relaxing bath.
• Your diet must include vegetable dishes, fish, vegetables and fruits, limit fats and sugar.
• Drinking regime: Do not drink more than a glass at once. Tea is healthy. For coffee lovers: 1 cup a day doesn’t hurt, but only in the morning.
• If you smoke, you must quit!
• See your treating ophthalmologist regularly.A follow-up examination for the diagnosis of glaucoma is recommended once a quarter.

How does glaucoma occur?

With glaucoma, the outflow of fluid from the eye is impaired. Intraocular pressure begins to rise. Pressure on the optic nerve leads to a deterioration in the condition of the nerve fibers and the blood supply to the optic nerve. Vision is impaired first along the periphery (the field of view is limited), the person begins to see worse. If the pressure on the nerve is not relieved by one or another method of treatment, the nerve fibers die, which irreversibly leads to blindness.

Early detection of increased intraocular pressure is the key to maintaining vision and quality of life. It is very important to identify and start treating glaucoma at an early stage! This allows you to preserve vision for many years.

In the clinic of microsurgery “Glaz” them. Svyatoslav Fedorov successfully treat glaucoma by specialists of the highest level using the latest generation equipment.