Frequently Asked Questions about GLAUCOMA

Glaucoma, also known as silent blindness, is a potentially serious disease that slowly, progressively and irreversibly damages the optic nerve. As a result of the damage caused to the nerve fibers of the retina, a milder or more severe loss of vision occurs depending on the degree of degeneration of the nerve. At first, peripheral vision is affected, and over time, central vision is affected.

The main risk factor for developing glaucoma is high intraocular pressure, which occurs when it exceeds 22 millimeters of mercury (mm Hg). For intraocular pressure (IOP) to remain constant, there needs to be a balance between the amount of aqueous humour produced and eliminated, thus contributing to the proper functioning of the eye.

People with a family history of glaucoma and myopia are other risk groups that should be especially vigilant, undergoing periodic ophthalmological evaluations in order to rule out the disease or diagnose it as soon as possible.

One of the frequently asked questions about glaucoma is the age at which it appears. Glaucoma is present in 2% of the population over 40 years of age, and its incidence increases with age. However, it can develop at any stage of life, even at birth (congenital glaucoma).

Only half of glaucoma patients know they have the disease. This is due to the absence of symptoms, which makes it very difficult to detect until it is in an advanced and irreversible stage. For this reason it is known as silent blindness, because it arrives and slowly robs us of our vision, without warning.

It is essential to carry out routine check-ups to facilitate an early diagnosis to avoid vision loss and, if detected, to receive treatment aimed at improving the prognosis of this condition. In fact, with early treatment, irreversible vision loss is avoidable in more than 95% of cases.

There are several classifications of glaucoma:

Depending on the amplitude of the angle between the cornea and the iris:

• Open-angle glaucoma: This is the most common and usually appears from the age of 50-60. Its evolution is slow and does not present symptoms until advanced stages in which vision loss occurs.
• Angle-closure glaucoma: Despite its low incidence, it is an acute form of glaucoma that carries a high risk of vision loss, so it should be considered a medical emergency.

According to their origin:

• Primary glaucoma.
• Secondary glaucoma.

Depending on when the disease appears:

• Congenital glaucoma.
• Glaucoma in children.
• Glaucoma in juvenile age.
• Glaucoma in adulthood.

In most cases, glaucoma is characterized by the absence of symptoms. Hence, this disease is also known as silent blindness.

In chronic glaucoma, which is the most common, vision loss occurs very slowly and progressively. In addition, the signs that the patient can perceive are almost imperceptible, since it does not cause discomfort until the disease is in a very advanced stage and the damage is irreversible. The general symptoms are headache above the eyebrows, loss of peripheral vision, generating tunnel vision or night blurriness.

In the case of angle-closure glaucoma, it is accompanied by more severe symptoms such as severe eye pain, halos around bright lights, nausea and vomiting or sudden loss of vision, which is why ophthalmological emergencies are usually visited.

To diagnose glaucoma, the patient’s intraocular pressure (tonometry) is first measured. If it exceeds normal levels (more than 22 millimetres of mercury), other specific tests are carried out in order to check the state of the optic nerve (ophthalmoscopy), the visual field (perimetry), the angle of the eye where the iris joins the cornea (gonioscopy) and the corneal thickness (pachymetry), and thus determine if glaucoma is present.

There is currently no cure for glaucoma. But you can control your symptoms and stop the progression of vision loss. This is achieved by reducing intraocular pressure and preventing optic nerve damage from progressing, and for this purpose there are two options: pharmacological treatment and surgical treatment. The first is the most widespread, the second being reserved for the most serious cases.

Most glaucoma treatments are aimed at reducing intraocular pressure and preventing the deterioration of the optic nerve from progressing. The treatment indicated by the specialist will depend on the type of glaucoma that the patient presents, the time at which it has been diagnosed, as well as its foreseeable evolution.

Intervention is usually not the first treatment option, unless the diagnosis reveals considerable damage to the optic nerve. In general, the ophthalmologist usually resorts to drugs in the form of eye drops, which must be administered continuously given the chronic nature of the disease. This treatment is the most common and appropriate for moderate and controlled glaucoma.

When pharmacological treatment is not effective, there are other alternatives aimed at improving the drainage of the aqueous humour or reducing its production levels, such as laser treatment (Argon laser trabeculoplasty) and surgical treatment (trabeculectomy).

The absence of appreciable symptoms and the fact that the loss of vision is irreparable make regular complete ophthalmological check-ups from the age of 45 essential to keep intraocular pressure and the condition of the optic nerve under control. If the patient follows these preventive guidelines to detect and treat the disease in time, the visual loss it causes can be stopped and therefore irreversible blindness can be avoided.