14 March 2019 Author : Maria da Luz Freitas This disease causes irreversible loss of vision and its frequency increases with age: around 2% in the 40+ age group and 5% in the 80+ age group. It is estimated that 80 million people around the world suffer from glaucoma , 10% of whom are blind in both eyes. Glaucoma: find out more about the "silent disease" Faced with this reality, it is important that we learn more about this disease : how it can manifest itself and what each of us can do to diagnose it. It is also important that we know about possible treatments and the importance of every one of us - doctors and patients alike - in monitoring the progression of the disease. There are different kinds of glaucoma, with the most frequent type among the Western population being open-angle glaucoma. This type of glaucoma is mainly caused by increased intraocular pressure . This is the result of an imbalance in the production and drainage of an important liquid produced in our eye - the aqueous humour. In most cases, the elevated intraocular pressure gives no symptoms , but it silently and progressively leads to the death of the cells that receive (capture) what we see. The cells that die are not replaced and this leads progressively to loss of visual field and, ultimately, to blindness . That is why it is called ‘a silent disease'. Diagnosing glaucoma: the sooner the better Anyone can develop glaucoma, but some people are at greater risk; these are: People with a family history of the disease; Diabetics; People with reduced corneal thickness or who have undergone structural changes to the optic nerve; Afro-Caribbean people; People using chronic corticoid medication. As open-angle glaucoma is a silent disease, it is only detected by the patients themselves at a very advanced stage , when the visual field is already very damaged or even when one of the eyes has gone blind. The importance of glaucoma screening Screening is the crucial element in combating this disease. If you are over 40 years of age or have any of the risk factors described, you should have a full and thorough eye examination, including the following key tests: Observation of the optic disc; Measurement of intraocular pressure; Assessment of the chamber angle. There is often a need to supplement information with: Computerised visual field analysis; Determination of corneal thickness (pachymetry); Structural analysis of the optical nerve and nerve fibre layer (HRT and OCT). If there is no disease, screening should be carried out again in 1 or 2 years . However, if there is a suspicion of the disease being present, close monitoring should be kept up. If the disease is confirmed , treatment must be started. How is glaucoma treated? Essentially, there are 3 types of treatment that are primarily intended to lower intraocular pressure: Medical treatment; Laser treatment; Surgical treatment. These forms of treatment can be used alone or in combination. Medical treatment The first stage of treatment for open-angle glaucoma is medical treatment in the form of eye drops. Drops may be applied 1 or 2 times a day, but in order to achieve treatment efficacy it is essential that they are applied daily, observing prescribed times. This strict compliance is so important that it is one of the primary factors for controlling the disease. In order for prescription times to be observed, the ideal scenario is one where the patient is responsible for the application of their own drops ; they may use memory aids such as mobile phone alarms, keeping the drops in a visible place, leaving written reminders for themselves and so on. In addition, patients must not forget to take their drops with them when they are away from home for any length of time. Together with therapy, glaucoma patients should see their ophthalmologist regularly and undergo additional periodic diagnostic examinations (visual field and sometimes HRT or OCT) depending on the stage or management of the disease. When medical treatment is not effective or not tolerated, surgical treatment and, in special cases laser treatment , should be performed. Surgical treatment Surgical treatment has very precise indications. In spite of the risks inherent in any surgical procedure, and often with the use of drops maintained, surgery is a very important therapeutic weapon for controlling glaucoma. As with cataract surgery, there have been advances that mean today’s surgical techniques are: Less invasive; Safer; Faster in terms of recovery (e.g. deep sclerectomy). How do you prevent glaucoma? Glaucoma is a worldwide public health problem and it is one of the most frequent causes of irreversible blindness. Its symptoms are silent, but there are treatments available. Lowering the number of severe situations of glaucoma is dependent upon: Awareness of the disease among the general population; Early diagnosis; Patients’ understanding of the disease; Very strict compliance with therapy. Health professionals working with the problem are committed to the development of new diagnostic tools , such as: 24-hour intraocular pressure monitoring; Development of less patient-dependent treatments (e. g. eye drops given weekly or monthly); Development in other areas of the disease - neuroprotection, consolidation of genetic studies and possible genetic therapy. Be aware that: Open-angle glaucoma is caused by increased intraocular pressure; There are no symptoms, but the sight receptor cells that die are not replaced and cause progressive loss of vision; Diabetic patients and patients on long-term corticoids are more prone to glaucoma; After the age of 40, screening is essential; Treatment must be strictly complied with. In the hospitals and clinics of the Hospital da Luz network, there are ophthalmologists who specialise in the diagnosis and treatment of eye diseases and who can perform the necessary examinations for your condition. Meet the ophthalmology team from Hospital da Luz network and book your consultation or exam . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
