What are the main types of glaucoma. How does glaucoma affect vision. What are the risk factors for developing glaucoma. Can glaucoma be prevented or treated effectively. What are the early warning signs of glaucoma.

The Basics of Glaucoma: A Silent Threat to Vision

Glaucoma is a complex eye disease that damages the optic nerve, potentially leading to vision loss if left untreated. Often called the “sneak thief of sight,” glaucoma can develop slowly and without noticeable symptoms in its early stages. This makes regular eye exams crucial for early detection and prevention of vision loss.

There are several types of glaucoma, but the two most common forms are:

• Primary open-angle glaucoma (POAG)
• Angle-closure glaucoma (ACG)

Understanding the differences between these types and their respective symptoms is essential for proper diagnosis and treatment.

Primary Open-Angle Glaucoma: The Most Common Form

Primary open-angle glaucoma (POAG) is the most prevalent type, affecting approximately four million Americans. Many individuals with POAG are unaware they have the condition due to its gradual onset and lack of early symptoms.

In POAG, the angle where the iris meets the cornea remains open, but the eye’s drainage canals become clogged over time. This leads to increased intraocular pressure (IOP) and subsequent damage to the optic nerve.

Symptoms of Open-Angle Glaucoma

POAG typically progresses without early warning signs. Vision loss often begins with the peripheral or side vision, while central vision remains sharp until later stages of the disease. By the time a patient notices vision changes, significant damage may have already occurred.

Are there any early symptoms of open-angle glaucoma? Unfortunately, there are usually no noticeable symptoms in the early stages of POAG. This is why regular eye exams are crucial for early detection and prevention of vision loss.

Angle-Closure Glaucoma: A Medical Emergency

Angle-closure glaucoma (ACG), also known as narrow-angle glaucoma, is less common but can be more severe than POAG. In ACG, the angle between the iris and cornea is closed or narrowed in many areas, causing a rapid increase in eye pressure.

Symptoms of Acute Angle-Closure Glaucoma

Unlike POAG, acute angle-closure glaucoma can present with sudden and severe symptoms. These may include:

• Hazy or blurred vision
• Appearance of rainbow-colored circles around bright lights
• Severe eye and head pain
• Nausea or vomiting (accompanying severe eye pain)
• Sudden vision loss

Is acute angle-closure glaucoma a medical emergency? Yes, it is. If you experience any of these symptoms, seek immediate care from an ophthalmologist to prevent permanent vision loss.

Risk Factors for Developing Glaucoma

While anyone can develop glaucoma, certain factors increase your risk. These include:

• Family history of glaucoma (parents or siblings)
• African-American or Latino ethnicity
• Age (risk increases with age)
• Diabetes
• Cardiovascular disease

How can you determine if you’re at high risk for glaucoma? Consult with an eye care professional who can assess your individual risk factors and recommend appropriate screening intervals.

Diagnosing Glaucoma: The Importance of Regular Eye Exams

Regular comprehensive eye exams are crucial for early glaucoma detection and prevention of vision loss. During these exams, your ophthalmologist will perform several tests to assess your eye health and detect any signs of glaucoma.

Common Glaucoma Tests

1. Tonometry: Measures intraocular pressure
2. Ophthalmoscopy: Examines the optic nerve
3. Visual field test: Checks for areas of vision loss
4. Gonioscopy: Inspects the drainage angle of the eye
5. Pachymetry: Measures corneal thickness

How often should you have your eyes checked for glaucoma? The American Academy of Ophthalmology recommends comprehensive eye exams every 1-2 years for adults over 40, and more frequently for those at higher risk.

Treatment Options for Glaucoma

While vision loss from glaucoma is not reversible, early detection and treatment can help slow or prevent further damage. Treatment options vary depending on the type and severity of glaucoma but generally aim to lower intraocular pressure.

Common Glaucoma Treatments

• Prescription eye drops
• Oral medications
• Laser therapy
• Surgery (e.g., trabeculectomy, drainage implants)

Can glaucoma be cured? While there is no cure for glaucoma, proper treatment and regular monitoring can help manage the condition and prevent further vision loss in most cases.

Living with Glaucoma: Lifestyle Changes and Management

If you’ve been diagnosed with glaucoma, there are several steps you can take to manage your condition and maintain your quality of life:

1. Adhere to your prescribed treatment plan
2. Attend regular follow-up appointments with your eye doctor
3. Maintain a healthy lifestyle (e.g., exercise, balanced diet)
4. Protect your eyes from injury
5. Consider assistive devices for low vision if needed

How can you adapt your daily routine to manage glaucoma? Work closely with your eye care team to develop a personalized management plan that addresses your specific needs and lifestyle.

Advancing Research and Future Treatments for Glaucoma

Ongoing research in the field of glaucoma is paving the way for new and improved treatment options. Some promising areas of study include:

• Neuroprotection strategies to preserve optic nerve function
• Gene therapy for glaucoma
• Advanced imaging techniques for earlier detection
• Novel drug delivery methods
• Stem cell therapies for optic nerve regeneration

What potential breakthroughs in glaucoma treatment are on the horizon? While it’s difficult to predict specific outcomes, researchers are working tirelessly to develop more effective and less invasive treatments for glaucoma.

Glaucoma Awareness and Education: Empowering Patients and Communities

Raising awareness about glaucoma is crucial for early detection and prevention of vision loss. Here are some ways to promote glaucoma awareness:

• Share information about glaucoma risk factors and symptoms
• Encourage regular eye exams, especially for high-risk individuals
• Support glaucoma research and advocacy organizations
• Participate in community health events focused on eye health
• Share personal experiences to help others understand the impact of glaucoma

How can you contribute to glaucoma awareness in your community? Consider volunteering with local vision health organizations or sharing educational resources on social media to help spread awareness about this important eye health issue.

The Role of Technology in Glaucoma Management

Advancements in technology are revolutionizing the way glaucoma is diagnosed, monitored, and treated. Some innovative technologies include:

• Artificial intelligence for analyzing retinal images
• Telemedicine platforms for remote glaucoma monitoring
• Smart contact lenses for continuous IOP monitoring
• Virtual reality-based visual field testing
• 3D-printed drainage devices for glaucoma surgery

How are technological advancements improving glaucoma care? These innovations are enabling earlier detection, more accurate diagnosis, and personalized treatment plans for patients with glaucoma.

Glaucoma in Special Populations: Children and Pregnancy

While glaucoma is more common in older adults, it can affect individuals of all ages. Special considerations are necessary for certain populations:

Pediatric Glaucoma

Glaucoma in children, also known as congenital or infantile glaucoma, is rare but requires prompt treatment to prevent vision loss. Symptoms may include:

• Excessive tearing
• Light sensitivity
• Enlarged eyes
• Cloudy corneas

Glaucoma During Pregnancy

Pregnancy can affect intraocular pressure and may require adjustments to glaucoma treatment. Pregnant women with glaucoma should work closely with their ophthalmologist and obstetrician to manage their condition safely.

How should glaucoma management be approached in special populations? A tailored approach considering age, overall health, and specific circumstances is essential for effective glaucoma care in these groups.

The Psychological Impact of Glaucoma: Coping and Support

Living with glaucoma can have significant psychological effects, including:

• Anxiety about potential vision loss
• Depression related to lifestyle changes
• Stress from managing a chronic condition
• Fear of losing independence

Coping strategies and support systems are crucial for maintaining mental well-being while managing glaucoma. These may include:

1. Joining support groups for individuals with glaucoma
2. Seeking counseling or therapy
3. Practicing stress-reduction techniques (e.g., meditation, yoga)
4. Staying connected with friends and family
5. Engaging in hobbies and activities that bring joy

How can patients address the emotional challenges of living with glaucoma? Open communication with healthcare providers, loved ones, and support groups can help individuals develop effective coping strategies and maintain a positive outlook.

Glaucoma and Complementary Therapies: Exploring Holistic Approaches

While conventional medical treatments remain the cornerstone of glaucoma management, some patients explore complementary therapies to support their overall eye health. These may include:

• Nutritional supplements (e.g., antioxidants, omega-3 fatty acids)
• Acupuncture
• Herbal remedies
• Mindfulness and meditation practices
• Eye exercises

It’s important to note that while some complementary therapies may offer general health benefits, they should not replace prescribed glaucoma treatments. Always consult with your eye care professional before incorporating any new therapies into your glaucoma management plan.

Can complementary therapies effectively treat glaucoma? While some complementary approaches may support overall eye health, they should be used in conjunction with, not as a replacement for, conventional glaucoma treatments prescribed by your eye care professional.

The Economic Burden of Glaucoma: Individual and Societal Impacts

Glaucoma not only affects individual patients but also has broader economic implications for society. The costs associated with glaucoma include:

• Direct medical expenses (medications, surgeries, doctor visits)
• Indirect costs (lost productivity, caregiver burden)
• Long-term care expenses for those with severe vision loss
• Research and development costs for new treatments

The economic impact of glaucoma underscores the importance of early detection and effective management to minimize both individual and societal costs.

How can the economic burden of glaucoma be addressed? Strategies may include improving access to early screening and treatment, developing more cost-effective therapies, and implementing public health initiatives to prevent vision loss from glaucoma.

Global Perspectives on Glaucoma: Challenges and Opportunities

Glaucoma is a global health concern, with prevalence and access to care varying widely across different regions. Some key global issues include:

• Disparities in access to glaucoma screening and treatment
• Variations in glaucoma prevalence among different ethnic groups
• Challenges in delivering glaucoma care in resource-limited settings
• Need for culturally appropriate education and awareness programs

Addressing these global challenges requires collaborative efforts from healthcare providers, researchers, policymakers, and community leaders worldwide.

How can global efforts improve glaucoma care worldwide? Initiatives such as telemedicine, mobile eye clinics, and training programs for local healthcare workers can help bridge gaps in glaucoma care across different regions.

As research continues and our understanding of glaucoma evolves, the future holds promise for improved prevention, detection, and treatment strategies. By staying informed and proactive about eye health, individuals can play a crucial role in protecting their vision and supporting global efforts to combat this challenging eye disease.

What are the Symptoms of Glaucoma?

Glaucoma is a complicated disease in which damage to the optic nerve results in vision loss. There are several forms of glaucoma; the two most common forms are primary open-angle glaucoma (POAG) and angle-closure glaucoma (ACG). Open-angle glaucoma is often called “the sneak thief of sight” because it has no symptoms until significant vision loss has occurred.

Symptoms of Open-Angle Glaucoma

There are typically no early warning signs or symptoms of open-angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years.

Most people who have open-angle glaucoma feel fine and do not notice a change in their vision at first because the initial loss of vision is of side or peripheral vision, and the visual acuity or sharpness of vision is maintained until late in the disease.

By the time a patient is aware of vision loss, the disease is usually quite advanced. Vision loss from glaucoma is not reversible with treatment, even with surgery.

Because open-angle glaucoma has few warning signs or symptoms before damage has occurred, it is important to see a doctor for regular eye examinations. If glaucoma is detected during an eye exam, your eye doctor can prescribe a preventative treatment to help protect your vision.

In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve. It is the most common type of glaucoma, affecting about four million Americans, many of whom do not know they have the disease.

You are at increased risk of glaucoma if your parents or siblings have the disease, if you are African-American or Latino, and possibly if you are diabetic or have cardiovascular disease. The risk of glaucoma also increases with age.

Symptoms of Acute Angle-Closure Glaucoma

• Hazy or blurred vision
• The appearance of rainbow-colored circles around bright lights
• Severe eye and head pain
• Nausea or vomiting (accompanying severe eye pain)
• Sudden sight loss

In angle-closure glaucoma (also called narrow angle glaucoma), the angle is closed in many or most areas, causing increased eye pressure, which leads to optic nerve damage, and possible vision loss. This rise in eye pressure may occur suddenly (an acute attack of angle closure) or gradually. There are also early stages of the disease in which the angle is closed but the eye pressure may or may not be high and the optic nerve is not affected yet.

Symptoms of acute angle-closure glaucoma are very noticeable and damage occurs quickly. If you experience any of these symptoms, seek immediate care from an ophthalmologist.

If you are diagnosed with glaucoma, it is important to set a regular schedule of examinations with your eye doctor to monitor your condition and make sure that your prescribed treatment is effectively maintaining a safe eye pressure.

Article by Doreen Fazio, MD. Last reviewed on March 24, 2022.

Doreen Fazio, MD

Dr. Fazio completed her ophthalmology residency and glaucoma fellowship at Jules Stein Eye Institute, UCLA.  She currently practices as an ophthalmologist at Valley Eye Center in Van Nuys, California.

Glaucoma: Causes, Types, and Symptoms

What Is Glaucoma?

Glaucoma is an eye disease that can damage your optic nerve. The optic nerve supplies visual information to your brain from your eyes.

Glaucoma is usually, but not always, the result of abnormally high pressure inside your eye. Over time, the increased pressure can erode your optic nerve tissue, which may lead to vision loss or even blindness. If it’s caught early, you may be able to prevent additional vision loss.

The most common type of glaucoma is primary open-angle glaucoma. It has no signs or symptoms except gradual vision loss. For that reason, it’s important that you go to yearly comprehensive eye exams so your ophthalmologist, or eye specialist, can monitor any changes in your vision.

Acute-angle closure glaucoma, which is also known as narrow-angle glaucoma, is a medical emergency. See your doctor immediately if you experience any of the following symptoms:

• severe eye pain
• nausea
• vomiting
• redness in your eye
• sudden vision disturbances
• seeing colored rings around lights
• sudden blurred vision

The back of your eye continuously makes a clear fluid called aqueous humor. As this fluid is made, it fills the front part of your eye. Then, it leaves your eye through channels in your cornea and iris. If these channels are blocked or partially obstructed, the natural pressure in your eye, which is called the intraocular pressure (IOP), may increase. As your IOP increases, your optic nerve may become damaged. As damage to your nerve progresses, you may begin losing sight in your eye.

What causes the pressure in your eye to increase isn’t always known. However, doctors believe one or more of these factors may play a role:

• dilating eye drops
• blocked or restricted drainage in your eye
• medications, such as corticosteroids
• poor or reduced blood flow to your optic nerve
• high or elevated blood pressure

Five major types of glaucoma exist. These are:

Open-Angle (Chronic) Glaucoma

Open-angle, or chronic, glaucoma has no signs or symptoms except gradual vision loss. This loss may be so slow that your vision can suffer irreparable damage before any other signs become apparent. According the National Eye Institute (NEI), this is the most common type of glaucoma.

Angle-Closure (Acute) Glaucoma

If the flow of your aqueous humor fluid is suddenly blocked, the rapid buildup of fluid may cause a severe, quick, and painful increase in pressure. Angle-closure glaucoma is an emergency situation. You should call your doctor immediately if you begin experiencing symptoms, such as severe pain, nausea, and blurred vision.

Congenital Glaucoma

Children born with congenital glaucoma have a defect in the angle of their eye, which slows or prevents normal fluid drainage. Congenital glaucoma usually presents with symptoms, such as cloudy eyes, excessive tearing, or sensitivity to light. Congenital glaucoma can run in families.

Secondary Glaucoma

Secondary glaucoma is often a side effect of injury or another eye condition, such as cataracts or eye tumors. Medicines, such as corticosteroids, may also cause this type of glaucoma. Rarely, eye surgery can cause secondary glaucoma.

Normal Tension Glaucoma

In some cases, people without increased eye pressure develop damage to their optic nerve. The cause of this isn’t known. However, extreme sensitivity or a lack of blood flow to your optic nerve may be a factor in this type of glaucoma.

According to the World Health Organization (WHO), glaucoma is the second leading cause of blindness around the world. The risk factors for glaucoma include:

Age

People over 60 are at increased risk of glaucoma, warns the NEI, and the risk of glaucoma increases slightly with each year of age. If you’re African-American, your increase in risk begins at age 40.

Ethnicity

African-Americans or people of African descent are significantly more likely to develop glaucoma than Caucasians. People of Asian descent are at a higher risk of angle-closure glaucoma, and people of Japanese descent have a higher risk of developing low-tension glaucoma.

Eye Problems

Chronic eye inflammation and thin corneas can lead to increased pressure in your eyes. Physical injury or trauma to your eye, such as being hit in your eye, can also cause your eye pressure to increase.

Family History

Some types of glaucoma may run in families. If your parent or grandparent had open-angle glaucoma, you’re at an increased risk of developing the condition.

Medical History

People with diabetes and those with high blood pressure and heart disease have an increased risk of developing glaucoma.

Use of Certain Medicine

Using corticosteroids for extended periods may increase your risk of developing secondary glaucoma.

To diagnose glaucoma, your ophthalmologist will want to perform a comprehensive eye examination. They’ll check for signs of deterioration, including loss of nerve tissue. They may also use one or more of the following tests and procedures:

Detailed Medical History

Your doctor will want to know what symptoms you’ve been experiencing and if you have any personal or family history of glaucoma. They’ll also ask for a general health assessment to determine if any other health conditions may be impacting your eye health, such as diabetes or high blood pressure.

Tonometry Test

This class of tests measures your eye’s internal pressure.

Pachymetry Test

People with thin corneas have an increased risk of developing glaucoma. A pachymetry test can tell your doctor if your corneas are thinner than average.

Perimetry Test

This test, also known as a visual field test, can tell your doctor if glaucoma is affecting your vision by measuring your peripheral, or side, vision and your central vision.

Monitoring Your Optic Nerve

If your doctor wants to monitor for gradual changes to your optic nerve, they may take photographs of your optic nerve to conduct a side-by-side comparison over time.

The goal of glaucoma treatment is to reduce IOP to stop any additional eyesight loss. Typically, your doctor will begin treatment with prescription eye drops. If these don’t work or more advanced treatment is needed, your doctor may suggest one of the following treatments:

Medications

Several medicines designed to reduce IOP are available. These medicines are available in the form of eye drops or pills, but the drops are more common. Your doctor may prescribe one or a combination of these.

Surgery

If a blocked or slow channel is causing increased IOP, your doctor may suggest surgery to make a drainage path for fluid or destroy tissues that are responsible for the increased fluid.

Treatment for angle-closure glaucoma is different. This type of glaucoma is a medical emergency and requires immediate treatment to reduce eye pressure as quickly as possible. Medicines are usually attempted first, to reverse the angle closure, but this may be unsuccessful. A laser procedure called laser peripheral iridotomy may also be performed. This procedure creates small holes in your iris to allow for increased fluid movement.

If your increased IOP can be stopped and the pressure returned to normal, vision loss can be slowed or even stopped. However, because there’s no cure for glaucoma, you’ll likely need treatment for the rest of your life to regulate your IOP. Unfortunately, vision lost as a result of glaucoma cannot be restored.

Glaucoma can’t be prevented, but it’s still important to catch it early so you can begin treatment that will help prevent it from getting worse. The best way to catch any type of glaucoma early is to have an annual preventive eye care appointment. Make an appointment with an ophthalmologist. Simple tests performed during these routine eye checks may be able to detect damage from glaucoma before it advances and begins causing vision loss.

Treatment of glaucoma or why high intraocular pressure is dangerous?

Glaucoma is an eye disease caused by increased intraocular pressure. If eye pressure in glaucoma is not reduced to normal in time, the optic nerve may die, which leads to irreversible blindness.

A healthy eye has a constant intraocular pressure (18-22 mm Hg) due to the balance of fluid inflow and outflow. In glaucoma, the circulation of fluid in the eye is disturbed, it accumulates, and intraocular pressure begins to rise. In this case, the optic nerve and other structures of the eye experience an increased load, the blood supply to the eye suffers.

Vision in glaucoma

Normal vision

This is how the world looks like in glaucoma

As a result, the visual function of the eye suffers more slowly in glaucoma. At the beginning, a person simply begins to see worse, then peripheral vision is disturbed, the visibility zone is limited, and eventually blindness may occur. Moreover, these changes are irreversible, which is why it is so important to start glaucoma treatment on time. With glaucoma, there is also a sudden loss of vision (in the form of an acute attack of glaucoma).

GLAUCOMA – WHAT YOU NEED TO KNOW ABOUT GLAUCOMA

Glaucoma is insidious – it sneaks up imperceptibly, can carry out hidden destructive work for a long time, in order to then break out into a “sudden”, seemingly catastrophe. Untreated, advanced glaucoma inevitably leads to reduced vision and complete blindness. The eye, no longer distinguishing light, can cause severe pain, and then there is nothing left but to remove it. Keeping this in mind, you probably will not be too lazy to visit an ophthalmologist’s office and check the condition of your eyes.

Glaucoma is rare in young people and usually develops after the age of 40. If you are at this age, a preventive examination is mandatory. Diabetes mellitus and atherosclerosis predispose to the development of glaucoma. People suffering from these diseases should pay special attention to protecting their eyesight. Hereditary predisposition to glaucoma has been established. If any of your blood relatives have had or are suffering from glaucoma, you are at increased risk.

The essence of this disease is a periodic or constant increase in intraocular pressure. Why is it rising? Imagine the events that take place day and night in your eye: every minute about two cubic millimeters of moisture enters it and the same amount must flow out. The value of intraocular pressure is determined by the balance of inflow and outflow, and in glaucoma the outflow is disturbed, excess moisture remains in the eye, and the pressure rises. The fact is that moisture flows through a special drainage system, consisting of a porous diaphragm, which is located in the corner of the anterior chamber of the eye, and microscopic tubules that remove moisture after filtration through the diaphragm into small blood vessels on the surface of the eye. As a result of changes in the drainage system (in the form of slagging), the outflow of fluid is significantly reduced and the pressure inside the eye increases. Increased pressure compresses, deforms the outflow of fluid, which contributes to a further rise in IOP.

You may not feel high blood pressure, but that doesn’t make it any less dangerous. The higher the pressure, the longer it remains at high levels, the more the optic nerve suffers. Gradually, its atrophy sets in, it fades, dies. And with it, vision dies. Normal intraocular pressure is considered to be between 9 and 22 mm. rt. Art. But if your blood pressure was measured with a Maklakov tonometer and it turned out to be a little higher – do not be alarmed! At the time of measurement, the tonometer (weight) presses on the eye, which increases the performance. The so-called tonometric pressure is considered normal within 17-26 mm. rt. Art.
Having established glaucoma, the doctor usually tells you its form – open-angle or closed-angle. The difference between them is in the mechanism that increases the pressure. Angle-closure glaucoma occurs when the peripheral iris blocks the angle of the anterior chamber of the eye, making it difficult for fluid to reach the drainage system. Having no way out, it accumulates in the eye, and intraocular pressure rises. With an open-angled form, access to the drainage system is open, but its own filtration capacity is impaired, and therefore moisture again flows out of the eye with difficulty. The end result is the same – an increase in intraocular pressure.

The open-angle form is “worse”, perhaps, only because it is asymptomatic for a particularly long time and is detected already in the later stages. Angle-closure is more frank – with a strong increase in pressure, it can declare itself with an acute attack: there is pain in the eye, superciliary arch, temple, the affected eye seems to be covered with fog, when looking at a lamp or other light source, iridescent circles appear.
The attack may be stronger and weaker, more often it occurs in the evening. So, you need to hurry to the doctor immediately! A mixed form of glaucoma is also possible, when there is both a partial blockade of the angle of the anterior chamber of the eye, and a deterioration in the filtration capacity of the drainage system.

In the conclusion that the doctor will write to you, there may be Latin letters A, B, C. This is how the level of intraocular pressure is indicated: A – within the normal range, B – moderately elevated (up to 33 mm Hg), C – high ( above 33 mm Hg). The following diagnosis is also possible: “Normal pressure glaucoma”. Most often in these cases, the pressure is kept in the zone of the upper limit of the norm, but the blood circulation in the optic nerve is sharply worsened and, therefore, its functions are impaired. The doctor selects the treatment taking into account not only the characteristics of glaucoma, but also your general condition.

It is almost impossible to completely cure this disease – it is chronic. But with proper and systematic treatment started in a timely manner, the development of glaucoma can be stopped and good vision can be maintained. Tune in to resist the disease, which means accurate, accurate, patient fulfillment of doctor’s prescriptions. The basis of treatment is drugs that reduce intraocular pressure. As a rule, these are eye drops, and it is likely that you will have to bury them all your life. However, you have a chance: with age, glaucoma can become “burnt out” – this means that vision is maintained within certain limits, pressure stabilizes, so there is no longer a need to constantly lower it.

The technique of instillation is simple, you can easily master it yourself, and very soon this procedure will become as familiar as, say, brushing your teeth in the mornings and evenings. So, look up, pull the lower eyelid with the index finger of one hand, and instill the medicine with the other. The conjunctiva holds only one drop, no more is required. Bury the second one if you are not sure of the exact hit. Try not to touch the eyelashes and the eyeball with the tip of the pipette, so as not to violate the sterility of the medicine and not to injure the eye. True, most bottles of eye drops are now equipped with plastic droppers with a safety tip. If you are prescribed pilocarpine, pay attention – in which version. An aqueous solution should be instilled 3-4 times a day, and extended-release solutions (based on methylcellulose, polyvinyl alcohol) – only 2-3 times a day.

Timolol maleate is now widely used in the treatment of all types of glaucoma. In pharmacies, this drug comes under different names: oftan timolol, okumed, timoptik. Timolol is not only effective, but also convenient – it is usually instilled only 1-2 times a day. The shelf life of factory-made eye drops is at least 2 years, but after opening the bottle they can be used for no more than a month. Prepared in a pharmacy have a short shelf life – 7 days from the date of preparation. These and other drops can be stored before opening the bottle at room temperature in a dark place, and after opening – in the refrigerator. Like any medicine, eye drops can also have side effects. For example, clonidine (clonidine), by reducing intraocular pressure, can simultaneously reduce the total arterial pressure, which, for example, is undesirable for a hypotensive patient.

Hypersensitivity to this or that drug is possible, and then immediately after instillation there is a burning sensation, discomfort, the eye may turn red, and sometimes a headache begins, the heartbeat quickens, arrhythmia appears. Such sensations must be reported to the doctor, and he will select another remedy or advise how to mitigate the complications that arise. For an ophthalmologist, information is also important about what chronic diseases you suffer from. After all, some eye drops are contraindicated in diabetes, bronchial asthma, chronic lung diseases, heart failure. Such patients are usually prescribed betaxolol (betoptik).

Glaucoma is treated not only with eye drops, but also with drugs taken by mouth, such as acetazolamide (diacarb). This drug, which reduces the production of intraocular fluid, also has a moderate diuretic effect, and potassium, which is necessary for cardiac activity, is washed out with urine. Therefore, together with diacarb, potassium orotate, panangin are usually prescribed. Try to enrich your diet with foods that contain a lot of potassium. These are baked potatoes, dried apricots, zucchini, bananas. Glycerol is also taken inside in the form of a 50% solution. To improve the taste, it can be diluted with fruit juice, add citric acid. This drug is usually prescribed for an acute attack of glaucoma. If you have such an attack, and it is impossible to get to the doctor quickly and glycerol is not at hand either, use a saline laxative, for example, magnesium sulfate (“bitter salt”), dissolving about 30 g (full tablespoon) in 1/^ glass of water . The complex of medicinal treatment of glaucoma also includes agents that improve cerebral circulation, stimulate metabolic processes – trental, vinpocetine, cavinton, multivitamins. Perhaps you are taking such drugs as prescribed by a therapist or neurologist – tell your eye doctor about this so that he can correct the treatment.

If the intraocular pressure is insufficiently compensated, you may be offered laser treatment. It is quite effective and completely safe. It is performed under local anesthesia with drops for several minutes. Treat with confidence and surgical methods – the operation can be a lifesaver for you in a situation where other means have already been exhausted. Surgical interventions for glaucoma are now well developed, performed quickly and painlessly. Do not delay the operation – time is precious in the treatment of glaucoma! The course of this disease largely depends on your lifestyle.

• Work as long as your age and general health allow, don’t strain. Avoid physical and nervous overload. The maximum weight that can be lifted is 10 kg.
• Even weeding beds can become overload for you if you work on an incline. Adapt some bench, chair – and do not bend over. Whatever you do – read, draw, knit, do not sit with your head tilted and in poor lighting.
• You can watch TV, but also in good light (not in the dark!) and in the correct position so that your head is neither tilted nor thrown back.
• When reading and other intense visual work, take small, 10-15 minute breaks every hour.
• Eat rationally according to age, prefer vegetable dishes, fish, raw vegetables and fruits, limit animal fats and sugar.
• Liquid, if there are no other indications for this, can not be particularly limited, but you can not immediately drink more than a glass. Tea is even useful, since the caffeine contained in it improves blood circulation in the tissues of the eyes, and increases intraocular pressure in rare cases. A cup of coffee is also not forbidden, but to be sure, it is better to do a caffeine test: measure intraocular pressure before you drink coffee, and 1-1.5 hours after that.
• If you are a smoker – stop smoking immediately! Nicotine is bad for your eyes.
• Do not wear tight collars, ties – anything that impedes blood circulation in the head and neck.
• Good sleep is very important to you. Enter evening walks into the daily routine; if you can’t sleep, take 2-3 teaspoons of honey at night with warm water, do warm foot baths.
• Follow the prescribed drip regimen exactly. If you have to leave home for a long time, be sure to take them with you.
• With angle-closure glaucoma, a sharp change in illumination is difficult for the eyes. Take pilocarpine before going to the cinema or other darkened rooms to prevent pupil dilation.
• See your doctor regularly. Even when intraocular pressure stabilizes, a follow-up examination is recommended every 3 months.

Professor told who is at risk of sudden blindness in Volgograd – July 16, 2021

Irina Gndoyan told who is at risk of irreversible blindness in Volgograd

Photo: VolgGMU

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Blindness, which is a natural result of glaucoma, is irreversible. What is the main symptom of the disease? What is the insidiousness of glaucoma? Who is at risk? What forms of glaucoma are known to doctors? About the causes of the disease, methods of prevention and treatment in the next series of the project “Call the Professor!” says the head of the department of ophthalmology of the Volgograd State Medical University, Doctor of Medical Sciences, Professor Irina Gndoyan.

Blindness is a sad and natural outcome of glaucoma, which is irreversible. What is this disease? With it, the main symptom and the main driving factor is increased intraocular pressure.

Which patient should be on the lookout for early diagnosis of glaucoma? Firstly, these are people whose parents or some close relatives had glaucoma. Glaucoma is a genetically transmitted disease. Moreover, according to the laws of the same genetics, the descendants get the development of this disease earlier than their ancestors. Therefore, the alertness must be very high.

Who else should be on the lookout? People who once suffered eye injuries, penetrating wounds and concussions. These influences can lead to a shift in the balance in the system of hydrodynamics or fluid outflow, which work in a very balanced way inside our eye. It is necessary to keep an eye out for patients who have undergone intraocular inflammation, the so-called uveitis, since glaucoma also occurs after such inflammatory diseases.

What is glaucoma like? We usually talk about primary glaucoma and secondary. If secondary glaucoma develops just after injuries, inflammations and some kind of vascular accidents, then primary glaucoma is a genetically determined independent disease.

First of all, primary glaucoma is a disease that occurs in patients of the older age group. There is also congenital glaucoma, but it is much less than primary or secondary. This question interests more parents of children and children’s ophthalmologists.

So, most of the glaucoma in the structure of this pathology falls on primary glaucoma. It is divided into two main subtypes – primary open-angle glaucoma and primary angle-closure glaucoma. These are two different forms, with different course, with different symptoms.

Angle-closure glaucoma is characterized by a rather rapid onset of the disease. The manifestation begins, as a rule, with an acute attack of glaucoma, when everything “screams” inside the eye and on its surface, and the patient himself screams from acute pain.

With this form of glaucoma, as a rule, everything is clear even to a patient who quickly enough turns to an ophthalmologist due to a pronounced pain syndrome, and the ophthalmologist does not have the question “What happened to this patient?”. After the acute attack has been resolved, the patient is given appropriate treatment, and the future now depends on the cooperation of the patient with the ophthalmologist, since from this moment until the end of life, any patient with glaucoma must be under the supervision of a doctor.

Glaucoma is a chronic disease. If it appeared (especially if we are talking about primary glaucoma), then this is a burden that the patient will carry all his life. He must be observed and receive adequate timely therapy. Only in this case he will retain his vision throughout his life. Otherwise, the outcome is very sad – irreversible blindness.

This is a formidable and rather insidious disease, because blindness is irreversible. There is such a common expression, which is used by both ophthalmologists and advanced patients: “What glaucoma has gnawed, it does not give back.” From the point of view of medicine, this is explained by gradually developing atrophies of the optic nerve, which occur against the background of increased intraocular pressure, against the background of various circulatory disorders and trophic disorders inside the eyeball, and are mainly aimed at destroying the optic nerve.

What is the insidiousness of pathology? This insidiousness is more typical of primary open-angle glaucoma. If angle-closure glaucoma either weakly or violently expresses its presence and development, then this lady, on the contrary, is very silent. She sneaks up on the patient, and often our patients realize that they have glaucoma too late.

I remember a case 20 years ago from my practice, when a patient on a fishing trip caught a midge with his right eye and, while blinking, trying to get it, he suddenly realized that his left eye, which he had open and looked at the world around him, was nothing does not see! In this way, practically terminal glaucoma was revealed – glaucoma in the fourth stage, when we no longer expect that the patient will be able to return his visual functions at least in a minimal amount.

So, the insidiousness of this pathology lies in the fact that the course is very quiet, without any external manifestations on the surface of the fundus and without any special complaints.

No, there are complaints, of course. Imagine that we have a patient in his sixties who complains of a gradual decrease in visual acuity. Let us also recall the awareness of eye diseases that our ordinary people have without a medical education.

The older age group thinks that this is probably a cataract – the most common and most typical disease characteristic of this age.

— Probably, I have an initial cataract, — the patient thinks, — so my eyesight should be like this by age, and when it becomes bad, I will go to the doctor, he will give a referral for surgery, and everything will be corrected.

Not at all. This is not always the case. Since one of the symptoms is a decrease in visual acuity, it is also typical for primary open-angle glaucoma.

What to do? You should definitely consult a doctor. It is necessary to measure intraocular pressure and undergo a study called perimetry, or assessment of the visual field, because fairly early manifestations of glaucoma are detected precisely perimetrically.

There is another insidious type of this pathology. There are variants of glaucoma that can show infrequent and low elevations in intraocular pressure without showing visual field defects. Therefore, now the initial early diagnosis of glaucoma is supported in these cases by other methods – more subtle and more sensitive.

There is a so-called optical coherence tomography – a method that allows you to assess the condition of the optic nerve and the retina adjacent to it, revealing early markers of the glaucoma process. That is, patients who have a hereditary predisposition to the development of glaucoma, who have had injuries and inflammations, who have high degrees of refractive error, that is, high hyperopia or high myopia, after 40 years should be examined by an ophthalmologist for the possible detection of glaucoma.

If the diagnosis of such a patient with risk factors is made or confirmed, timely and adequate therapy should be started. In general, the principle of treating glaucoma patients both in our country and abroad is a ladder of three steps.

The first step is the use of conservative therapy, that is, the appointment of antiglaucoma drops.

The second step (if the drops are ineffective) is laser surgery.

The third step that neither surgeons nor patients like to climb is glaucoma surgery with a scalpel.

If we talk about the first step, then conservative therapy is eye drops. This is the same insulin that is used for a patient with diabetes. The patient instills glaucoma drops every day and regularly (ideally once a month) appears at the doctor’s office to check whether the pressure has reached a safe level for the optic nerve. We call it target pressure, or optic nerve tolerance pressure.

If the desired level is reached, then this is the very guarantee of maintaining vision for many years. If the achievement of the target pressure is not possible with the help of drops, then the patient is offered laser surgery. There are various methods here. The patient learns about them when he talks with a specialist in laser treatment.

What are the benefits of laser surgery? It allows you to solve problems that drops cannot cope with.