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Q. What is glaucoma?
A. Glaucoma is a serious eye disorder that can cause irreversible blindness. In this condition, there is destruction of the optic nerve leading to a progressive deterioration in vision. An increase in pressure within the eye is usually the culprit.
Q. What causes glaucoma?
A. In glaucoma, there is increased pressure in the eye. This increased pressure results when the liquid constantly produced inside the eye, called aqueous humor, is unable to drain out of the eye. As a result, blood vessels that nourish the retina and optic nerves are squeezed, effectively reducing the supply of oxygen and nutrients to these vital tissues. The increased pressure likewise causes mechanical damage to the structures that comprise the optic nerve. All these contribute to the development of visual loss.
Q. What are the different types of glaucoma? What are the symptoms?
A. There are two major types: open-angle and angle-closure.
People who have open-angle glaucoma generally feel fine and suffer no early warning symptoms. This makes this type of glaucoma, in a manner of speaking, treacherous. The intraocular pressure slowly rises because the right amount of fluid cannot drain out of the eye. In open-angle glaucoma, the entrance to the eye's drainage system is as wide and as open as it should be. The clogging problem occurs inside the drainage canals, like the clogging that can occur inside the pipe below the drain in a sink. If open-angle glaucoma is not diagnosed early enough, it causes gradual loss of patches of vision that are not noticeable until they enlarge and coalesce.
Angle-closure glaucoma is different. Here, eye pressure goes up very quickly. The pressure rises because the entrance to the drainage canals are blocked or covered over; very much like the blockage that would occur in a sink if a piece of paper or plastic completely covered the drain. The symptoms of acute angle-closure glaucoma - severe eye pain and redness, headache, nausea, and blurred vision - demand immediate medical attention because abrupt rises in intraocular pressure can lead to serious, immediate and permanent visual damage.
Knowledge of which type of glaucoma is present is essential in deciding the appropriate treatment.
Q. Who are at risk for glaucoma?
A. Glaucoma can occur in people of all ages. It is more common in people who are over 40 years old. Only about 1% to 2% of cases occur in infants, in whom it is called congenital glaucoma. People who are diabetic, very nearsighted, and those with relatives who have glaucoma, have an increased risk in developing the disease. Glaucoma can also result from steroid use, and occur as result of other eye disorders such as infection, inflammation, injury and cataract.
Q. What are the complications?
A. Undiscovered glaucoma will lead to progressive loss of vision, or even blindness. Peripheral vision --- the top, side and bottom areas of vision --- are usually affected, and lost, first. This loss in vision often goes unnoticed. Then, as the glaucomatous damage worsens, "tunnel vision" becomes narrower and narrower.
Q. Are there ways to prevent glaucoma?
A. There are certain eyes which possess anatomical characteristics that may predispose it to the development of glaucoma. Identifying these eyes and instituting the proper management may prevent the onset of glaucoma. The glaucomas which occur as a consequence of other disease conditions, may be prevented if these predisposing disease conditions are treated appropriately.
Q. How is glaucoma diagnosed?
A. Glaucoma is detected by a thorough eye examination made by an ophthalmologist.
In the clinic, specialized instruments and lenses are used to check the intraocular pressure (tonometry), the color, shape and contour of the optic nerve (ophthalmoscopy), the drainage system in the eye (gonioscopy), and the central and peripheral vision (perimetry)
Q. How is glaucoma treated? What are the treatments available?
A. The primary form of treatment for open-angle glaucoma is the use of one or a combination of medications that increases the drainage of fluid and/or decreases the production of fluid in the eye. Laser therapy (argon laser trabeculoplasty) may be combined with medical treatment for better pressure control.
Angle-closure glaucoma is treated using the laser (laser peripheral iridotomy), or in certain instances, surgically, to restore the drainage system in the eye.
In instances where there is progression of the glaucomatous disease process, despite maximum dosage of medications and laser surgery, then microsurgery (glaucoma filtering surgery) is done. Intolerance to medications and inability to sustain medical treatment are also indications for surgery.
Q. Can glaucoma be cured?
A. Generally speaking, glaucoma cannot be cured, but it can be controlled. With the availability of new drugs, new lasers and new surgical technology, ophthalmologists are now better able to control this disease.
Q. What is important to remember?
A. The key to successful glaucoma treatment is early detection, appropriate and adequate institution of treatment, and regular monitoring of the disease.
Once diagnosed, glaucoma requires constant lifelong care.
For patients with glaucoma, the importance of keeping eye pressure under control cannot be overemphasized. Eye drops, laser surgery, oral medications and microsurgery are quite successful in controlling eye pressure over long periods of time. Regular check-ups with the ophthalmologist are mandatory even after medications, laser or surgery have successfully controlled the eye pressures.
NORMAN M. AQUINO, M.D.
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