Glaucoma

"It is very important to have your eye pressure checked from the age of 40 onwards and to repeat it frequently in order to diagnose the disease as soon as possible.

DR. JAVIER MORENO MONTAÑÉS
SPECIALIST. OPHTHALMOLOGY DEPARTMENT

Glaucoma is a progressive optical neuropathy secondary to an increase in eye pressure that causes a loss of visual field and can even lead to blindness.

There are several types, the most common being chronic glaucoma that appears after the age of 40.

With early detection programs, glaucoma has been detected in very early stages. With the appropriate treatment, it can be prevented to avoid the loss of vision that, when it appears, is irreversible.

Glaucoma detection tests are performed:

  • Before the age of 40, every two to four years.
  • From age 40 to 64, every one or two years.
  • After age 65, every six to 12 months.
  • Anyone with high risk factors should have a complete eye exam every year or every two years after age 35.
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What are the symptoms of glaucoma?

Glaucoma produces a loss of peripheral visual field that does not influence central vision until the final stages.

Chronic glaucoma, which is the most frequent, does not give any signs, except sometimes a certain headache. It is usually ignored and therefore is serious, progressive and irreversible if not treated.

From the age of 40 onwards, it is advisable to take the eye pressure to see if it has increased and to treat it before this irreversible damage has occurred.

The most common symptoms are:

  • Loss of visual acuity.
  • Loss of central vision.
  • Halos of light or colors around bright lights.
  • Headache or eye pain.
  • Nausea or vomiting.

Do you have any of these symptoms?

You may have glaucoma

What are the causes of glaucoma?

The cause of the increased eye pressure is the failure of the aqueous humor to escape. It is a disease with a hereditary component.

The risk factors according to the American Academy of Ophthalmology for having this disease are

  • Family history of glaucoma.
  • High myopia.
  • Use of some medications such as steroids.

Risk factors for glaucoma

Currently, it is not known what risk factors can lead to this disease. Its relationship with coffee, tobacco, diet rich in fat, sugars and salt, or lifestyle has been studied and no clear association has been found.

What is clear is that to avoid the loss of vision that glaucoma can cause, it is best to make a periodic visit to the ophthalmologist from the age of 40 onwards.

At that age, tired eyesight usually appears and it is recommended that you take your eye pressure when you go to the optician. A high level of intraocular pressure, which does not always lead to the appearance of glaucoma, makes a visit to the ophthalmologist advisable. 

Types of glaucoma

Open-angle glaucoma: the intraocular fluid drains too slowly, causing a gradual increase in pressure, almost always bilaterally, causing progressive loss of vision and damage to the optic nerve.

It is the most frequent form of glaucoma, the loss of vision characteristically begins in the periphery of the visual field and, if not treated, ends up producing blindness.

Closed-angle glaucoma: causes sudden increases in eye pressure, usually in just one eye. Any factor that causes the pupil to dilate causes the exit hole of the aqueous humor to narrow and causes a rise in intraocular pressure. It produces a loss of vision and a sharp or pulsating pain in the eye. Nausea and vomiting are common.

Secondary glaucoma: when the eye suffers an infection, inflammation, cataract... the passage of the aqueous humor can be interfered with and it does not drain correctly. 

How is glaucoma diagnosed?

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The specialist will suspect that glaucoma may exist when the patient presents:

  • Characteristic problems in the visual field that are objectified when performing the campimetry.
  • Examination of the abnormal optic nerve in ophthalmoscopy.
  • Intraocular pressure normally > 21 mm Hg (although not necessary for diagnosis).
  • If other causes are excluded.

Glaucoma is diagnosed when characteristic signs of optic nerve damage appear and other causes are ruled out (e.g. multiple sclerosis).

The tests that are routinely performed are the measurement of eye pressure by tonometry and the examination of the optic nerve by ophthalmoscopy, for which it is necessary to dilate the eye.

In addition, a campimetry can be performed to assess the visual field, a gonioscopy to study whether the angle between the iris and the cornea is open or closed, and a pachymetry to study the thickness of the cornea.

How is glaucoma treated?

The medical treatment of glaucoma consists of instilling eye drops to lower eye pressure. Most drops must be used 2 or 3 times a day throughout life.

Sometimes, after a while, they are not well tolerated and the patient must be treated with laser or operated on.

Laser trabeculoplasty is an outpatient treatment that is performed in a consultation room in a few minutes. It is only useful in older patients and in many cases, its effect disappears after a while. Period laser cyclophotocoagulation is only useful in very advanced glaucoma.

The most widely used surgical technique is trabeculectomy, whether perforating or non-perforating, which consists of looking for a new outlet for the aqueous humor in the eye to the outside.

Where do we treat it?

IN NAVARRE AND MADRID

The Department of Ophthalmology
of the Clínica Universidad de Navarra

Equipped with the latest technology, the Department of Ophthalmology has the necessary equipment, both technical and human, to offer comprehensive and specific assistance to each patient.

We are one of the few centers that have a microsurgery laboratory for the improvement of clinical practice.

Organized in specialized units

  • Cornea and eye surface
  • Retina
  • General Ophthalmology
  • Refraction defects
  • Oculoplastic
  • Pediatric ophthalmology
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Why at the Clinica?

  • More than 25 years of experience.
  • Experts in the diagnosis and treatment of ocular pathologies.
  • With the security and guarantee of a prestigious hospital.

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