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Glaucoma

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  3. Glaucoma

Overview of Glaucoma

Glaucoma (kala motiya / کالا موتیا) refers to the combination of multiple eye conditions that cause vision loss due to damage to the optic nerve. The damage usually leads to the abnormal increase of pressure in the eyes. 

Glaucoma is one of the common causes of blindness, typically over the age of 60 yrs. The effect of glaucoma can be possible at any age but mainly affects older adults.

Glaucoma is a fatal condition that’s why it is difficult to detect at early stages. Most people diagnose glaucoma at an advanced stage. 

Prevalence of Glaucoma in Pakistan

In Pakistan, overall 2 million people were reported blind due to different eye conditions. From which 3.9 % or 0.08 million people suffered blindness from glaucoma.

Signs and Symptoms of Glaucoma

The signs and symptoms of glaucoma in eyes are based on the type and patient’s condition. The symptoms are majorly divided into its two main types which are as follows:

Open-Angle Glaucoma Symptoms

  • The appearance of patchy blind spots in the peripheral side or central vision, frequently in both eyes
  • Irregular tunnel vision in the advanced glaucoma

Acute Angle-Closure Glaucoma

 

  • Severe headache
  • Eye pain or glaucoma pain
  • Nausea and vomiting
  • Blurred vision
  • Redness of eyes

If it is left untreated, glaucoma causes blindness. About 15% of people with glaucoma is blind in at least one eye.

Types of Glaucoma

There are many types of glaucoma but the major one is open-angle glaucoma and angle-closure glaucoma. Glaucoma intraocular pressure (IOP) is a cause of these types. This includes:

1. Open-Angle Glaucoma

Open-angle glaucoma is the most common form which comprises about at least 90% of all glaucoma cases. Open-angle defines the angle where iris meets the cornea and this point is as wide and open as it should be. This is also known as primary, chronic or wide-angle glaucoma.

The open-angle glaucoma is caused by:

  • The slow clogging of the drainage canals which increase the eye pressure
  • The area where iris connects with the cornea is wide and open.
  • It develops slowly and is a lifelong condition.
  • By damaging the area where cornea and iris connect. It is not noticeable.
  • Has no symptoms

2. Angle-Closure Glaucoma

It is the less common form of glaucoma. It affects the people when the angle between the iris and cornea is closed. This type is stimulated by the sudden blockage of aqueous humour fluid that eventually builds up in the area. In this way, the severe or quick rise of intraocular pressure (IOP).  The apparent symptoms are pain, blurred vision or nausea.

This type requires immediate medical care if it becomes severe. Also known as acute glaucoma or narrow-angle glaucoma. 

3. Normal-Tension Glaucoma (NTG)

The optic nerves of the eye are damaged but the pressure is normal. This is also called low-tension or normal-pressure glaucoma. Researchers are still investigating the prime cause of glaucoma. Mainly, it is linked with other eye diseases.

4. Congenital Glaucoma

In this type, the babies are born with some defect in the angle of their eyes that slows the normal fluid drainage. Congenital glaucoma has some symptoms such as cloudy eyes, excessive tearing, or sensitivity to light. People can inherit from their families.

5. Secondary Glaucoma

Secondary glaucoma correlates with the injury or another eye condition, such as cataracts or eye tumours. Also, medication such as corticosteroids may be one of the causes of glaucoma. Less commonly, eye surgery also results in secondary glaucoma. Overall, it is the effect of multiple conditions.

6. Other Types of Glaucoma

There are several other types of glaucoma that include: 

 

  • Pigmentary Glaucoma
  • Pseudoexfoliative Glaucoma
  • Traumatic Glaucoma
  • Neovascular Glaucoma
  • Uveitic Glaucoma

Causes of Glaucoma

The cause of glaucoma is as aforementioned in its type. Majorly, glaucoma reasons rely on the types of glaucoma.

The glaucoma is usually caused by:

  • Damage to the optic nerve of eyes
  • Increase of IOP
  • Certain medications
  • Some underlying conditions such as cataract
  • People can get it inheritably
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Risk Factors of Glaucoma

Several triggers stimulate the risk of glaucoma before any sign and symptoms become apparent.  The main risk factors include:

  • The high internal eye pressure (intraocular pressure)
  • People over age 60
  • Mostly prevalent in black, Asian or Hispanic people
  • People have a family history of glaucoma
  • Some medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anaemia
  • People having thin corneas in the centre
  • Most individuals feel extremely nearsighted or farsighted
  • Another risk is due to eye injury or certain types of eye surgery
  • Using of  corticosteroid medications, especially eye drops, for a prolonged time

Complications of Glaucoma if left Untreated 

  • Gradual Loss of Vision
  • Foggy Vision 
  • Loss of Side or Central Vision 

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Prevention

These self-care strategies may detect glaucoma in its early stages. This helps to prevent vision loss or slow its progress.

  • Regular dilated eye examinations help to identify the cause of glaucoma.   
  • Making a habit of regular moderate eye exercise of the eyes prevents glaucoma especially for people with weakened eye muscles. 
  • Protect the eyes from the injury. For this, wear eye protection materials such as goggles, helmet etc.

Seek medical care if the individual is experiencing vision problems such as weak eyesight, blurred vision, glaucoma headache or any other conditions etc.

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Diagnosis

Ophthalmologists will review the medical history and conduct a comprehensive eye examination. They may recommend following eye tests, which includes:

  • Tonometry Tests- This measures the intraocular pressure of glaucoma.
  • Pachymetry Test- Determine the thickness of the cornea in the eyes.
  • Perimetry Test- A doctor checks the areas of vision loss from different sides of the eye such as peripheral, or side, vision and central vision.
  • Monitoring the Optic Nerves- Helps to test the optic nerve damage with a dilated eye examination and imaging tests.
  • Gonioscopy- Determine the angle of drainage.

Treatment of Glaucoma | When to Consult a Doctor

The treatment of glaucoma is possible if a person treats glaucoma at early stages. As it gets worse, the treatment is difficult and irreversible. But continuous treatment and careful monitoring are to prevent vision loss.

There are a variety of treatment options involved for its treatment such as home remedies, prescription eye drops, oral medications, laser treatment, surgery or a combination of any of these.

1. Home Remedies

Following are the natural herbs or products that are beneficial for strengthening the eye muscles and reducing the IOP of the eye. 

  • Frankincense oil
  • Cypress oil
  • Ashwagandha
  • Ginkgo Biloba
  • Bilberry Extract

2. Eye Drops

Glaucoma treatment begins with prescription eye drops. These are beneficial for reducing eye pressure and improving the fluid drainage of eyes. 

A doctor prescribes the eye drops one or more than eye drops depending on the measurement of reducing the pressure.

Following are the prescription eye drop medications used for the treatment of different types of glaucoma. The eye drops treat the patients by maintaining the IOP fluid according to their condition.

  • Prostaglandins- latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta)
  • Beta Blockers- timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic)
  • Alpha-Adrenergic Agonists- apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana)
  • Carbonic Anhydrase Inhibitors- dorzolamide (Trusopt) and brinzolamide (Azopt)
  • Rho Kinase Inhibitor- netarsudil (Rhopressa) 
  • Miotic or Cholinergic Agents- pilocarpine (Isopto Carpine)

3. Oral Medications

The medications are used sometimes alone or in combination with eye drops. A most common medication used for the treatment of glaucoma is carbonic anhydrase inhibitor. 

General side effects by the usage of the medications:

Important Note: Do not take any medications without doctor’s consultation.

4. Surgical Therapies

Other treatment options contribute to laser therapy and various surgical procedures. The following techniques are used to treat the drainage of fluid within the eye, thereby lowering pressure:

  • Laser Therapy- Laser trabeculoplasty is used for open-angle glaucoma. Laser for glaucoma is used to eliminate the open clogged channels in the trabecular meshwork. The duration of the procedure may take a few weeks, so that the glaucoma is treated properly.

  • Filtering Surgery- Along with the trabeculectomy, a doctor makes an opening in the sclera of an eye (white area of the eye) and removes the part of the trabecular meshwork.

  • Drainage Tubes- This method is used for lowering the excess fluid pressure by inserting the small tube shunt in the eye.

  • Minimally Invasive Glaucoma Surgery (MIGS)- MIGS procedure may recommend lowering the eye pressure. These procedures generally have less risk and postoperative care as compared to trabeculectomy or installing a drainage device. It can be used in combination with cataract surgery depending on its type and patient's condition. It is available in the number of MIGS techniques available but the doctor selects the best therapy for it. 

After the procedure, follow up is required for close monitoring of eyes.

5. Acute Angle-Closure Glaucoma Treatment

This is a medical emergency condition. Therefore, immediately reducing the pressure of the eye is needed for these kinds of patients. All therapies are required for the treatment of acute angle-closure glaucoma.

An additional procedure is a laser peripheral iridotomy. In this therapy, the doctor makes a small hole in the iris with a laser to prevent the blockage of aqueous fluid. This helps to relieve eye pressure.

 

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