Glaucoma is the leading cause of irreversible blindness in highly developed countries. Terrifying statistics reflect the magnitude of the problem. In the world, 67 million people have glaucoma, and 7 million are completely blind because of it! Most often, blindness affects both eyes. About 800,000 people in Poland suffer from glaucoma, and 70,000 are treated, which means that only every tenth patient is aware of his disease. According to statistical data, it is estimated that about 4,000 people suffer from glaucoma in Głogów and its vicinity. The number of glaucoma patients continues to increase.
What is the essence of the disease?
Glaucoma causes progressive atrophy of the optic nerve that leads to blindness. In 90% of cases, it is an insidious and painless eye disease. It develops secretly, without any discomfort or visual disturbances noticeable for the patient until the moment preceding complete blindness. A sick patient may not be aware of it for many years. When he first experiences symptoms, the changes in the damaged optic nerve are so great that treatment may no longer be effective.
Are there any particular predispositions to getting sick?
Most often, glaucoma occurs after the age of 40, therefore every patient in their forties should undergo ophthalmological examinations to exclude its presence at least every 2-3 years. The older the patient is, the greater the risk of developing the disease.
Also, people who have been suspected of glaucoma at least once and are genetically burdened require systematic lifelong checkups. Even if at the time of the examination the doctor decided that the disease does not require treatment yet or has not made a definitive diagnosis of glaucoma, but only a suspicion, there is a high risk of its occurrence at a later time.
The risk of developing the disease is also very high in people: suffering from frequent headaches, especially migraines; with low blood pressure, with myopia, with circulatory disorders resulting, for example, from hypertension, diabetes, anemia, elevated cholesterol levels, in people living under stress and still having cold hands and feet
What is the treatment of sick people?
Patients with a diagnosed disease require continuous monitoring of the disease. The progress of glaucoma changes should be monitored on the basis of carefully kept medical records, preferably by one ophthalmologist. It should be remembered that the disease damages the optic nerve piece by piece, and nerve fibers that die as a result of the disease will never regenerate and will not recover.
What is the modern way of diagnosing a disease?
Glaucoma is not a single disease, but a group of diseases with a different cause and course of the disease. Therefore, diagnostics is difficult and requires many additional specialist ophthalmological examinations. In addition to the basic ophthalmic examination with stereoscopic assessment of the optic nerve disc and multiple measurements of intraocular pressure, gonioscopy, pachymetry, GDx or OCT of the optic nerve and retinal ganglion cells , field of view, and a digital photograph of the optic disc should also be performed.
The GDx VCC is a very valuable device. It was created as a diagnostic instrument for the early detection of glaucoma, monitoring its progress and the course of treatment of this disease. It allows you to objectively assess the thickness and degree of damage to the optic nerve fibers in glaucoma. The camera is a modern, high-class device based on laser polarimetry scanning technology, unique in Poland. The GDx apparatus can detect the presence of glaucoma with a sensitivity of 96% and a specificity of 100%. Only specialized glaucoma treatment institutes have it. It allows you to detect glaucoma 6 years before the appearance of changes in the computerized visual field examination! Changes in the field of vision indicate irreversible damage to at least 50% of the nerve fibers.
OCT (optical coherence tomography) is more and more often used in the diagnosis of glaucoma, as it assesses, apart from the thickness of the optic nerve, also other parts of the eye that affect this disease (the ganglion cell complex, pachymetric maps, the tear angle and the anterior chamber of the eye).
Can Glaucoma Be Cured?
Unfortunately not. Glaucoma is an incurable disease! Once a doctor has made a diagnosis, the patient requires lifelong treatment. It should be remembered that the later the treatment is started, the more difficult, costly and effective it is.
What is glaucoma treatment?
The aim of glaucoma treatment is to lower the intraocular pressure to a safe level, i.e. one at which the lesions do not progress further and which allows the remaining nerve fibers of the retina to be kept in an unchanged, healthy condition for the rest of life. The target pressure is different for each patient and should be selected individually. Typically, it should remain below 18.0 mmHg, but in some patients it may be as low as 10-12 mmHg .
What are the treatments?
Treatment is based on inhibiting the progression of the disease by systematically administering eye medications (drops, ointments or gel). Other methods of treatment are various types of laser and surgical treatments. In our clinic, we have ophthalmic lasers to treat glaucoma. The doctor individually selects the best treatment method for the patient, taking into account its advantages and disadvantages.
Inhibition of disease progression can be achieved by the use of appropriate eye drops, which reduce the production of aqueous humor or increase its outflow.
The selection of the right drops depends on many factors, the most important being the form of glaucoma, the degree of its advancement and the coexistence of other local and general diseases.
The use of eye drops is not always an effective method of fighting the disease. If, despite the use of two different anti-glaucoma drugs, the intraocular pressure is elevated and the disease progresses, we use other tools, such as laser treatment or anti-glaucoma surgery.
In our clinic, we have two ophthalmic lasers that we use to treat glaucoma. The doctor individually selects the best treatment method for the patient, taking into account its advantages and disadvantages. Laser treatments are performed on an outpatient basis, they are bloodless, quick and usually painless. The most popular are:
- Laser iridotomy involves making a hole in the iris with a laser, which improves communication between the anterior and posterior eye chambers. The procedure is performed using a neodymium YAG laser. The most common indication is angle-closure glaucoma. In most cases, this small procedure protects against subsequent attacks of glaucoma, which can lead to irreversible blindness.
- Laser trabeculoplasty is a procedure in which focal trabecular photocoagulation is performed, which improves the outflow of aqueous humor from the eye. The advantage of the procedure is that it is easy to perform, the risk of complications is low and that the patient is comfortable. The procedure is performed in open-angle glaucoma. The effectiveness of laser treatments in open-angle glaucoma is much worse than in closed-angle glaucoma. Treatments are reserved for the eyes with relatively small increases in pressure and the beneficial effect is transient. We perform trabeculoplasty with Nd: YAG lasers, micropulse and diode lasers.
- Laser cyclophotocoagulation is performed in more advanced, treatment-resistant forms of glaucoma. We perform two types of treatments: microplus sub-cyclophotocoagulation and cyclodestructive treatment.
Surgical procedures in glaucoma are the ultimate weapon that we use in the fight against this disease. Preparation for the anti-glaucoma procedure and the postoperative rigor are similar to those for other intraocular surgeries. It should be remembered that if there are indications for the procedure, it should be performed urgently.
In angle-closure glaucoma, the most popular procedure is glaucoma iridectomy . The procedure is similar to the laser iridotomy described above, but is performed using surgical instruments.
- Trabeculectomyis the most common surgical procedure performed in glaucoma. This procedure is more complicated than an iridectomy. It involves making a fistula, an artificial pathway through which the watery fluid drains away from the eye. During the procedure, a fragment of the trabecular structure is cut out along with the Schlemm’s canal, a hole in the iris and sclera is cut out, connecting the anterior chamber of the eye with the subconjunctival space. The procedure is highly effective, but it is burdened with numerous complications. Since cataracts are a frequent complication, a combined procedure is often considered in patients with coexistence of this disease: cataract surgery with anti-glaucoma surgery. Trabeculectomy surgery is more complicated than the cataract surgery itself, and the number of possible complications is greater. After glaucoma surgery, in the early postoperative period,
- Valve and drainage implants (iSTENT, Preser Flo, XEN, Cypass, Express, Ahmed’s valve) were initially used in the treatment of advanced cases of glaucoma. The indications for implant placement are cases of glaucoma that do not respond poorly to treatment with drops. They are usually used in eyes that have previously been operated on for glaucoma and are under insufficient pressure. It is also possible to implant the implant in eyes with other ophthalmic surgeries, e.g. after penetrating keratoplasty or vitrectomy. The treatment consists in creating an additional oran alternative route of outflow of the ventricular fluid from the eye. A tube connected to a specially constructed plate is placed in the anterior chamber of the eye, and through this device the fluid leaks from the eye into the subconjunctival space or Schlem’s canal. As implants are constantly being improved, the number of complications from this type of surgery has decreased and the procedures are becoming safer. Thanks to this, we started using implants as the first glaucoma treatment . We often combine simultaneous implant placement with cataract surgery.