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GLAUCOMA What is glaucoma? Glaucoma is a potentially blinding eye condition that results from damage of optic nerve. It is usually but not always accompanied by raised eye pressure. The optic nerve transmits image from the eye to the brain so that we would be able to see. The eye pressure is controlled by a balance between production of fluid (aqueous humor) and drainage from the front part of the eye (trabecular meshwork). Imbalance between the two, usually a blockage in the outflow, would result in the build-up of eye pressure. This can in turn, damage the optic nerve. Glaucoma is generally divided into 2 types: Open Angle Glaucoma Primary open angle glaucoma is the type of glaucoma wherein the drainage is visually open but has optic nerve damage and visual field changes. Raised eye pressure often accompanies the disease. This is a slow and progressive condition, often does not present with any symptoms during the early stages but can lead to blindness if not controlled. Visual field damage usually starts from the periphery. Angle Closure Glaucoma Angle closure glaucoma is characterized by narrow and closed anterior chamber angle, optic nerve damage as well as visual field changes. This type of glaucoma gives rise to acute attack wherein eye pressure suddenly goes up giving rise to severe eye pain, redness, cloudy vision, nausea and vomiting. Urgent treatment to lower the eye pressure is needed to save vision. How is glaucoma diagnosed? Glaucoma is generally screened on routine eye check-ups. Basically, the eye pressure is checked through tonometry. Anterior chamber angle is seen through gonioscopy. And optic nerve head is examined through ophthalmoscopy with the use of a slitlamp and the help of lenses. Optic nerve head can also be examined through photographs and computerized imaging. If glaucoma is highly suspected, damage in the visual field is examined through perimetry. In this test, the patient is asked to sit in front of a screen and focus at a fixation target. Series of light is presented at different areas of vision and the patient is asked to press a button if seen. Missing areas in the visually field is detected through this test. How is glaucoma treated? Basically, glaucoma is controlled but not eliminated. Once damage has occurred in the optic nerve, the loss if vision is permanent. The goal of glaucoma treatment is to bring down the eye pressure to a safe level preventing further damage to the optic nerve. Because of this, glaucoma management is lifetime. Depending on the type and severity, treatment for glaucoma can be in the form of medication, laser and surgery. Medication Usually comes in the form of eye drops. Initially started using one eye drop but may progress to using multiple medications. The aim of using the medication is to lower down the eye pressure to prevent further damage to the optic nerve and therefore preserve vision. Some of the eye drops have side effects. It is important to press a finger against the lower lid at the area of the junction to the nose or to close the eye 1 minute after instilling the eye drop to prevent systemic absorption. In cases where multiple eye drops is required, make sure to wait 5 minutes before instilling the next drop. Surgery This is often performed if the medications cannot control the glaucoma. The most common form of glaucoma surgery is trabeculectomy. An opening is done for the fluid inside the eye to escape and be absorbed by the surrounding tissues. This allows the eye pressure to go down. There are other forms of glaucoma surgery depending on the type of glaucoma. This comes in the form of tube surgery for complicated glaucomas, goniotomy and trabeculotomy for congenital glaucoma. Laser Usually done in cases of angle closure glaucoma, laser is done to create a channel inside the eye to allow fluid to drain to prevent acute attacks of glaucoma. There are other uses of laser in glaucoma depending on the indication and type of glaucoma. * Visual loss from glaucoma can be prevented by early treatment. It is therefore important to be diagnosed early. Seek consult right away if you develop painful red eye and blurry vision. Since glaucoma is proven to run in families, have your eyes regularly checked once you are 40 y/o and above most especially if you have a family history of glaucoma. |
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