Glaucoma
At a Glance: Glaucoma
First Parts of the Disease: The usually show very few or no symptoms
Last Forms: Slow degradation of the side vision, scotoma, blindness
According to: Complete dilation of the pupils and special visual field tests
Intervention: Medications, procedures or even surgery to lower the anterior eye pressure
Glaucoma in simple term
This eye condition affects the optic nerve, which transmits visual information from the retina to the brain.
This damage is typically the result of an increased pressure in your eye, known as intraocular pressure (IOP), but not always.
How exactly increased intraocular pressure damages the optic nerve is not yet completely understood,
however it has been proven that lowering eye pressure protects against future damage.
It manifests in various forms, with the two main types being open-angle and angle-closure (narrow-angle) glaucoma. These types are distinguished by the drainage structure of the eye and how fluid is drained.
What is Primary Open Angle Glaucoma ( POAG ):
This is the most common type of this eye condition. The drainage system of the eye gradually starts getting inefficient over time in POAG and as a result IOP keeps increasing slowly but steadily.
This type of glaucoma worsens gradually and usually has no signs it is happening until damage to your vision occurs.
What is Angle-Closure Glaucoma (ACG):
An alternative form of it happens when the peripheral part of iris is pushed against drainage angle in eye.
The more critical change is the in which this angle can become blocked, acute ACG or chronic ACG. In acute angle-closure glaucoma,
IOP can rapidly become elevated and cause permanent optic nerve injury; therefore,
this condition is a medical emergency that requires prompt intervention to decrease the pressure.
What is (NTG)?
An alternative form of it happens when the peripheral part of iris is pushed against drainage angle in eye.
The more critical change is the in which this angle can become blocked, acute ACG or chronic ACG. In acute angle-closure glaucoma,
IOP can rapidly become elevated and cause permanent optic nerve injury; therefore,
this condition is a medical emergency that requires prompt intervention to decrease the pressure.
What is Secondary Glaucoma:
The possible causes are secondary to an underlying condition and include eye injury, inflammation or infection.
a tumor can also lead to the development of exophthalmos as well as prolonged use of steroids in certain conditions Dr.Varun Agarwal PGIMER
What is Congenital Glaucoma:
A more uncommon, originating in infancy and young childhood. This happens from a failure in the development of the eye’s drainage system before birth.
Causes of Glaucoma:
Vision impairment often occurs when the balance between fluid production and drainage within the eye is disrupted, though it can be difficult to detect in the early stages.
The fluid helps nourish the eye and keep it its shape. It typically drains through a spongy tissue called the trabecular meshwork, at the point where your iris and cornea meet.
The fluid cannot drain out of the eye when its drainage system becomes defective, and thus pressure in the eye tends to build.
Over time, this pressure starts damaging the optic nerve; and the two most popular manifestations of glaucoma are: loss of vision.
What are the risk factors of glaucoma:
Genetics: A family history does have an effect on an individual’s predisposition to develop glaucoma.
Eye trauma: Damage to the eye is a risk for secondary glaucoma.
Steroid drugs: Long-term use of corticosteroid drugs, particularly in the eyes, can cause an elevation of intraocular pressure.
Eye disorders: Inflammation of the eye (uveitis), dislocation of the retina, or a tumor within the eye can raise intraocular pressure.
Medical diseases: Disorders, such as diabetes and hyper- tensive illness, also play a role.
Causes and Risk Factors for Glaucoma:
There are several risk factors that increase the likelihood of developing this eye condition, some of which are listed below.
Age: People aged over 60 years are at higher risks.
Ethnicity: This condition tends to develop at a younger age in individuals of African American and Hispanic descent.
Family history: This eye condition often runs in families.
Medical conditions: Diabetes, high blood pressure, and heart diseases put the patient at a higher risk.
Long-term steroids therapy: Application of steroid medications, especially eye drops increases the risk.
Eye injury: Trauma to the eye usually leads to an increase in IOP.
Signs and Symptoms of Glaucoma:
No symptoms will be present in the initial stages of glaucoma, especially in open-angle glaucoma.
This is also why glaucoma is oftentimes called the “silent thief of sight.” Signs and symptoms can start appearing as the disease advances, and some of these include:
What are Open-Angle Glaucoma Symptoms
Gradual loss of peripheral vision. This is usually seen in both eyes.
Tunnel vision in later stages.
Angle-Closure Glaucoma Symptoms:
Sudden severe eye pain.
Nausea.
Vomiting.
Blurry vision.
Halos appear around lights.
Redness in the eye.
What are Normal-Tension Glaucoma Symptoms:
Vision loss despite normal intraocular pressure.
Symptoms of Congenital Glaucoma.
Eye is often cloudy
There is tearing
It is overly sensitive to light
Mostly, people suffering from this condition do not experience noticeable symptoms. Thus, early detection and treatment are reliant on routine eye exams for those with predisposing conditions, such as family history, age, or other medical conditions like diabetes.
Diagnosis of glaucoma
Diagnosing this eye condition requires a comprehensive eye examination, whereby several tests are conducted, including an assessment of the optic nerve,
measurement of IOP, and any loss of peripheral vision. Among the common diagnostic tests are:
Tonometry-this is measurement of intraocular pressure.
Ophthalmoscopy: Scanning of the optic nerve for damage.
Perimetry (Visual Field Test): It evaluates the peripheral vision.
Gonioscopy: It is the examination of the drainage angle of the eye.
Pachymetry: It is the measurement of the corneal thickness.
Treatment of glaucoma
While there is no cure for this condition, early detection and treatment are crucial in managing it and preventing further vision loss.
It depends upon the reduction in intraocular pressure to delay further damage to the optic nerve.
Medicines:
The most common first-line treatment for this condition is eye drops.
Such drops either reduce fluid production or enhance drainage from the eye. Basic types of glaucoma medications are as follows:
Prostaglandin analogs: Drugs which enhance the drainage of fluid, such as latanoprost and bimatoprost.
Beta-blockers: These drugs reduce fluid production, such as timolol.
Alpha-adrenergic agonists: These drugs reduce its production, as well as enhancing the drainage, such as brimonidine.
Carbonic anhydrase inhibitors: Such drugs reduce fluid production, such as dorzolamide.
Rho kinase inhibitors: These drugs enhance the drainage of fluid.
Laser Treatment of glaucoma
Laser treatment may aid in increasing fluid drainage. Laser trabeculoplasty enhances the function of the drainage system in open-angle glaucoma.
In angle-closure glaucoma, a laser iridotomy creates a small hole in the iris to allow fluid drainage.
surgery of glaucoma
Surgery is usually necessary when medications and laser treatment are not sufficient to reduce IOP.
Surgery on the eye is usually performed to establish a new drainage channel for fluid to exit the eye through methods, such as the following:
Trabeculectomy: Creates a new drainage channel for fluid to exit the eye.
Glaucoma drainage implants: They implant small devices to help drain excess fluid.
Minimally invasive glaucoma surgery (MIGS): A newer, less invasive surgical treatment that can reduce IOP with fewer side effects than conventional surgeries.
Lifestyle and Home Remedies:
While medical treatment is crucial for managing this condition, certain lifestyle changes can help control it:
Consumption of healthy diet full of fruits, vegetables, and omega-3 fatty acids.
Regular exercise lowers IOP but avoids headstands, which stretch the optic nerve and elevate pressure on it.
Other condition control including hypertension and diabetes mellitus.
Avoidance of caffeine that elevates intraocular pressure.
Prognosis:
The prognosis depends on the stage when the disease is diagnosed and how well the condition is managed.
Once identified early and treated the right way, it can easily slow down or even halt vision loss.
However, once lost through glaucoma, they can’t be regained. Therefore, timely detection with regular eye exams are critical; especially to those who are more at risk.
In advanced stages, when significant vision loss has occurred, low vision rehabilitation can help individuals adapt to their changed sight and maintain independence.
Prevention of glaucoma
Glaucoma cannot be fully prevented; however, you can take certain measures that will decrease your chances or detect the disease at an early stage :
Routine Eye Examination: The best technique to prevent vision loss is early diagnosis.
Individuals aged 40 and above are encouraged to have a comprehensive eye examination every
2-4 years while the frequency of examination rises with advancing age or if they are categorized at a greater risk.
Exercise Regularly: Evidence exists that regular exercise lowers intraocular pressure in some people.
Protect Your Eyes: Wearing protective eyewear during sports or when using power tools can help prevent eye injuries that could contribute to vision problems
Know your family history; If this condition runs in your family, inform your eye doctor so they can monitor your eye health more closely.