Glaucoma

Glaucoma is a group of eye diseases that cause optic nerve damage, often due to high intraocular pressure, leading to vision loss and peripheral vision defects.

Primary glaucoma occurs when the drainage structures in the eye, specifically the trabecular meshwork in the angle of the anterior chamber, naturally degenerate, leading to elevated intraocular pressure.

Secondary glaucoma is caused by other underlying factors, such as iris inflammation (uveitis), steroid use, eye trauma, or other conditions that lead to blockage or dysfunction of the trabecular meshwork, resulting in elevated intraocular pressure.

Intraocular Pressure (IOP) refers to the pressure exerted by the fluid inside the eye. This fluid, called aqueous humor, is produced by the ciliary body and provides nutrients and oxygen to the internal structures of the eye. The fluid drains out through the trabecular meshwork at the angle of the anterior chamber, returning to the bloodstream. IOP is the pressure created by this fluid within the eye.

Symptoms:

Acute Glaucoma: Patients with acute glaucoma may experience sudden onset of red eyes, pain, and blurred vision. In severe cases, symptoms can include headache and nausea.

Chronic Glaucoma: Chronic glaucoma often presents with no obvious symptoms in the early stages. Vision and peripheral vision are gradually damaged without the patient being aware. It is only when central vision is affected and the visual field significantly narrows that the patient may notice problems with their eyes.

Once the optic nerve is damaged, it cannot be restored, making early diagnosis of glaucoma crucial for preventing further vision loss.

High-Risk Groups for Glaucoma

  • Family History

  • Individuals over the age of 40

  • High Myopia or Hyperopia

  • Hypertension, Diabetes

  • Use of Steroid Medications

  • Eye inflammation or Injury

Glaucoma Diagnosis and Monitoring

1. Optical Coherence Tomography (OCT)

For patients suspected of having glaucoma, OCT is used to scan the optic nerve and the surrounding retinal nerve fiber layer.

2. Visual Field Test

Visual Field Test is used to detect loss of peripheral vision, a key symptom of glaucoma. During the test, the patient focuses on a central point while lights or targets are presented in different areas of their visual field. The patient presses a button each time they see a light, allowing the doctor to map the visual field and identify areas of vision loss. This test helps detect changes in vision that may not be noticeable to the patient, enabling early diagnosis and intervention for conditions like glaucoma..

Treatments

The most effective treatment for glaucoma is controlling intraocular pressure (IOP) to a safe level to prevent further damage to the optic nerve. Most patients require medication, either in the form of eye drops or oral drugs. Acute glaucoma patients may need laser treatment or surgery. For chronic glaucoma, long-term medication is typically necessary, and if IOP remains uncontrolled, surgical intervention may be required.

Selective Laser Trabeculoplasty (SLT): In this procedure, the ophthalmologist uses a microscope to direct a laser at the trabecular meshwork to improve fluid drainage from the eye, thus lowering intraocular pressure (IOP). SLT can be repeated as needed, depending on the individual case.

Laser Iridotomy (LPI): In this procedure, a laser is used to create a small opening in the iris to improve fluid flow between the eye's chambers, reducing intraocular pressure (IOP) and preventing angle-closure glaucoma.

Although glaucoma cannot be cured, early diagnosis and appropriate treatment can effectively prevent vision loss.