GLAUCOMA – WHAT YOU NEED TO KNOW

Glaucoma is an ocular multifactorial disease that most oftenly goes with eleveated eye pressure that results in visual field damage, loss and damage of nerve fibers and optic nerve. Glaucoma is the second largest cause of blindness in the world.
The optic nerve is responsible for the sense of sight because it sends stimuli to the visual center located in the brain. The aqueous (liquid inside the eye) serves to nourish eye structures, to remove products of metabolism and to maintain ocular (intraocular) pressure.
Glaucoma causes an increase in eye pressure, which by mechanical pressure causes damage to the optic nerve fibers.

Risk factors for glaucoma development

Glaucoma risk factors depend on the type of glaucoma. In open-angle glaucoma, which is the most common form of glaucoma, the prevalence increases significantly with age. Glaucoma shows no symptoms in the early stages, which is why screening in a population over 40 is important.

Glaucoma incidence M / F

Regarding risk factors, gender does not make a statistically significant difference.

Glaucoma causes

Risk factors for glaucoma are increased eye pressure (IOP), old age, race, genetics, cardiovascular disease, myopia, blood pressure fluctuations and sleep apnea.

How to detect glaucoma

Glaucoma is most often detected accidentaly on an ophthalmic examination. The reason is that the symptoms are vague at the initial stage. When the patient notices a visual impairment, the disease have usually lasted for years already.

Glaucoma symptoms

Symptoms of the open-angle glaucoma are gradual decline of visual acuity during  the disease progression, and so-called “tunnel vision”in the advanced stage of the disease.

In closed angle glaucoma the symptoms are:

• sudden eye pain,
• redness,
• blurred vision of you
• nausea and vomiting.

Glaucoma examination includes

• determining visual acuity,
• examination of the anterior and posterior segments of the eye,
• measurement of the ocular pressure (IOP) by applanation tonometry.
• In addition to basic tests, additional diagnostic tests should be performed:
• pachymetry (cornea thickness, which may affect IOP measurement),
• gonioscopy (assessmenat of the iridocorneal angle),
• visual field,
• OCT of the optic nerve.

Normal eye pressure / Low eye pressure / High eye pressure

Ocular pressure values in the general population range from 11 to 21 millimeters of mercury (mmHg). Normal daily values fluctuate between three and five mmHg during the day. The highest values are in the morning. In glaucoma, these oscillations may be more pronounced. High eye pressure is the most important risk factor for the development and progression of glaucoma.

High Eye pressure and headache

Headache is rarely a symptom of open-angle glaucoma (the most common form). The headache may not be directly related to elevated eye pressure and is more often associated with sinusitis or migraines. Headaches with nausea and vomiting can occur as a symptom of high ocular pressure in closed angle glaucoma.

How is eye pressure measured?

Eye pressure is most commonly measured with a Goldmann applanation tonometer installed on a slit lamp. This method is considered as the gold standard in measuring eye pressure. In addition to the gold standard, there are other instruments that measure the eye pressures – noncontact, eye response analyzers, Tono pen, Ocuton S and many others. The Knezovic Clinic exclusively uses the most accurate eye pressure measuring device in the world – DCT Pascal.

Are there any methods for natural glaucoma treatment?

Glaucoma is an idiopathic disease, meaning that the exact cause is not commonly known. As a result, there are no clear guidelines for how to naturally prevent or treat glaucoma.

Are there any eye drops for glaucoma treatment?

Treating glaucoma is commonly started with the eye drops that reduce eye pressure. Drops are usually used lifelong. In patients undergoing  therapy, continuous eye pressure and visual field check-ups are important to keep the eye pressure levels under control and, if necessary, to adjust the therapy.

Glaucoma progression

Glaucoma is an insidious disease, most commonly present with no visible symptoms at its onset. Early detection and continuous monitoring of the progression are of paramount importance. With the proper use of antiglaucoma therapy, the progression is significantly reduced.

What is the prognosis for people with glaucoma?

Glaucoma is a progressive disease and requires lifelong monitoring and treatment. Elevated eye pressure, if not regulated, damages the nerve fibers of the optic nerve, narrows the visual field and causes loss of vision.

What are the types of glaucoma

Glaucoma is divided into congenital and acquired one. Acquired glaucoma types are open-angle glaucoma (by far the most common, over 90% of all glaucoma), normotensive glaucoma, ocular hypertension, and closed-angle glaucoma. There is also a secondary glaucoma, which is a complication of other eye diseases, such as neovascular glaucoma, pigmentary glaucoma, pseudoexfoliative glaucoma, phakogenic, corticosteroid, inflammatory, post-traumatic, and glaucoma caused by intraocular tumor.

What other glaucoma treatment modalities do exist?

Glaucoma treatment may be classified into
medical,
laser and
surgical therapy.

Medical therapy include antiglaucoma drugs, which include beta-blockers, alpha-2 agonists, myotics and others.
Laser therapy creates new openings in the eye’s drainage system to improve aqueous outflow. Other treatment modalities include diode laser (older generation), selective laser trabeculoplasty (SLT – newer laser), YAG laser and cyclophotocoagulation.
Glaucoma surgery includes trabeculectomy and drainage implants.

Glaucoma in children

Glaucoma in children is called congenital glaucoma.  Impaired aqeous outflow in this type of glaucoma is due to trabeculodysgenesis, or malformation of the iridocorneal angle. Characteristics of congenital glaucoma are blurred cornea, epiphora, photophobia, blepharospasm and buphophtalmus (big eye).
Treatment is by surgical goniotomy and trabeculectomy.

Glaucoma surgery

Glaucoma surgery involves the creation of additional pathways to drain aqeous (eye water). The most commonly performed surgical procedures are trabeculectomy and drainage implants. Trabeculectomy improves the outflow of aqueous (eye water) from the anterior chamber into the subconjunctival space by means of openings on the sclera and iris root. Drainage implants use a tube or peripheral reservoir which drains aqueous (eye water) from the anterior chamber into the subtenon space.

Dr. Knezovic performed hundreds of trabeculectomies, using special instruments to form the aperture to drain eye water. Nowadays, these procedures are less performed because of the fact that disease can be treated earlier by other treatment modalities.

Knezovic Clinic is equipped with a state-of-the-art dual laser for glaucoma treatment (YAG / SLT laser). The SLT laser is a revolution in the treatment of the most common form of glaucoma – open-angle glaucoma.
The great advantage of this laser over others is that it does not lead to thermal tissue damage and the formation of adhesions that can lead to unwanted complications. The SLT laser beam gently illuminates the area of ​​the trabeculum (drainage system of the eye) and has a metabolic effect on the cells contained therein – melanocytes. Under the influence of the laser, the melanocytes change shape within a couple of weeks and thus increase the permeability through the drainage system. This laser works in over 80% of treated patients.

The procedure is painless and without side effects. Dr. Knezovic has performed hundreds of these procedures and is one of the pioneers in SLT laser glaucoma surgery in Croatia.

Why choose Knezovic Clinic for glaucoma treatment?

Knezovic Clinic is equipped with state-of-the-art devices for early glaucoma detection.
DCT Pascal Ocular Pressure Tonometer is the only device that measures ocular pressure independently of corneal parameters (thickness and hysteresis). This means that it gives the most accurate measurements, which is especially important for patients who have undergone laser surgery.

Furthermore, we use the highly analytical visual field perimeter – Octopus 900, made by the renowned Swiss manufacturer Haag-Streit. It is possible to detect a early functional visual impairment with this device, years before the patient notices the changes himself.

We also have a newer OCT device that measures the thickness of the nerve fibres of the optic nerve. If thinning of nerve fibre layer is detected, there is a reason to suspect the development of the disease in the future and to prevent vision loss. This is the so-called preperimetric diagnosis, which can be started up to 5 years earlier and completely avoid any consequence of this insidious disease.

Glaucoma lasers at Knezovic Clinic are the latest generation in rank with world-class centers of excellence. They are characterized by high efficiency and absence of unwanted tissue damage during and after the procedure.

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