What is glaucoma, and how can it be treated?

Glaucoma can affect people of any age, gender, or race but is most common in older people. Glaucoma is the second-most-common cause of vision loss in the world, and such loss cannot be restored. Regular controls and treatment can help to prevent or delay loss of vision; therefore, early detection is most important. Keep reading to find out how to recognize the symptoms and how to treat them.

What is glaucoma?

Glaucoma¹ is an eye condition caused by a damaged optic nerve. This nerve connects the eye to the brain, transmitting visual information and allowing you to see. Your vision may be impaired as optic nerve damage progresses and you begin to lose lateral vision. In most cases, glaucoma damage progresses very slowly over several years. However, sometimes such damage can progress faster. 

The vision loss begins with lateral or peripheral vision. Peripheral vision is very important in everyday activities such as walking and driving, allowing you to perceive objects around you. Loss of peripheral vision progresses until the disease is treated. If left untreated, vision loss can progress until it begins to affect the central, reading part of the eye. At this point, you may begin to notice vision problems.

If treatment is not carried out, then vision may be entirely lost. Glaucoma vision loss is irreversible; therefore, it is crucial to detect glaucoma before significant nerve damage occurs. Appropriate glaucoma treatment may be given to prevent further vision loss.

What causes glaucoma?

Increased intraocular pressure is considered a major risk factor for developing glaucoma. Normal intraocular pressure ranges from 11 to 21 mmHg². It is important to note, however, that an increase in intraocular pressure does not necessarily mean a person has glaucoma.

This normal pressure is necessary for proper eyesight. In glaucoma, there may be blockage of fluid drainage or excess fluid production, leading to high pressure inside the eye. If you have high eye pressure, it can damage your optic nerve. Some people, however, can tolerate high intraocular pressure without developing optic nerve glaucoma damage. The reason for this is unknown. 

The most common causes of increased intraocular pressure and glaucoma³ are:

• a family history of glaucoma and hereditary predisposition;
• diseases such as diabetes and high blood pressure;
• eye injury;
• use of certain medications, such as corticosteroids;
• high myopia or farsightedness;
• age over 60 years.
  

The most common symptoms of glaucoma

The most common symptoms of glaucoma⁴ are:

• increased eye pressure;
• blurred vision;
• sometimes redness of the eyes and eye pain;
• headache;
• nausea and vomiting.

These symptoms can vary depending on the type of glaucoma. That’s why routine eye examinations are important. They are the only way to detect glaucoma early and prevent permanent vision loss. When the patient notices that he or she has vision loss, it is too late, and vision cannot be restored. Peripheral vision is lost first, and then the central vision gradually weakens, which can lead to blindness.

Types of glaucoma

There are several types of glaucoma⁵, including:

Open-angle glaucoma. This is the most common type of glaucoma. The iridocorneal angle is open; however, aqueous humor drainage is slow, which leads to an increase in intraocular pressure. If left untreated, the optic nerve will be damaged, and vision will gradually be lost.

Closed-angle glaucoma. This type of glaucoma is rarer. Here the iridocorneal angle is narrow and the iris moves forward and closes completely. It may appear suddenly, accompanied by symptoms such as severe pain, severe redness of the eye, nausea, and vomiting. This condition, known as acute glaucoma, is an emergency medical condition that requires urgent treatment to prevent vision loss.

Secondary glaucoma. This occurs as a result of eye injury, damaged lining, tumors, advanced-stage cataracts, or diabetes. It can also be caused by drugs (e.g. long-term therapy such as steroid treatment). 

Congenital glaucoma. This occurs at an early age as a result of eye problems or injury.

Diagnosis of glaucoma

Several tests can be performed to diagnose glaucoma. The most basic is the measurement of intraocular pressure or tonometry. It can guide you on whether there is glaucoma and whether there is a risk of developing glaucoma, but it cannot determine its existence on its own. Diagnosis of glaucoma requires additional examinations, such as perimeter or visual field examination, to determine the presence and extent of peripheral visual impairment. Further gonioscopy is performed, such as examination of the iridocorneal angle, optical coherence tomography (OCT), measurement of corneal thickness, pachymetry, etc.

Glaucoma treatment

Glaucoma is still a disease that is incurable. However, with therapy and regular eye examinations, it can be successfully controlled. The treatment of glaucoma consists of topical therapy in the form of eye drops that have the effect of increasing the drainage of the aqueous humor or reducing its formation. These drops can be given individually or in combination. If, despite therapy, intraocular pressure does not fall and the glaucoma progresses, surgical treatment or selective laser trabeculoplasty may be performed.

The most important treatment for glaucoma is the detection and prevention of the disease before it causes serious damage to the vision. Therefore, regular eye examinations, even when vision is normal, are essential.

Methods for treating glaucoma

Because open-angle glaucoma is the most common type, there are several ways to treat⁶ it. 

Eye drops and medicines. Most often, treatment begins with eye drops designed to reduce the pressure in the eye. These drops are used 1–4 times a day, depending on the drug. They are designed to decrease the amount of fluid produced in the eye or to improve fluid drainage. 

Laser treatment. Another way to treat glaucoma is by laser. The laser is designed to increase the amount of fluid released from the eye, leading to reduced pressure in the eye. Laser treatment usually lasts only a few minutes and is painless.

Microsurgery. A third way to treat glaucoma is through microsurgery called a trabeculectomy. This procedure creates a small drainage hole in the eye, usually behind the upper eyelid. This allows fluid to drain out of the eye. This drainage allows the eye pressure to reduce, thus preventing further damage from glaucoma.

How can I be sure that glaucoma does not affect my vision?

The best way to prevent glaucoma vision loss is through regular eye examinations. Your eye doctor perform some standard tests and guide you further. More frequent tests (every 1–2 years) are recommended if you have any vision problems or have a family history of glaucoma. Regular examinations are also recommended if you have certain medical conditions, such as diabetes or high blood pressure. For children, routine annual screening by a pediatrician is usually sufficient, unless the child has vision problems or other eye discomfort.

To sum up

Regular examinations are always the key to having a healthy and long life. If you have any of the symptoms mentioned above or a family history of a condition, don’t wait for things to get worse: prevention is always a better option. If you detect glaucoma earlier and in time, you will save your vision, and the treatment can be more efficient.