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Glaucoma is a group of diseases of the optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy. Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness. Intraocular pressures between 10-20 mm Hg are considered normal. Like heart diseases and arthiritis, glaucoma has also several types. The most common types are open angle (chronic) glaucoma and closed angle (acute) glaucoma. Elderly people, people with a family history of glaucoma, diabetes, high myopia or hypermetropia, people who have been on steroids (e.g., long-term cortisone therapy) or who previously had eye injuries or eye diseases in the past have higher chance of developing glaucoma. Glaucoma usually occurs in people over 40 years of age. However, there are rare cases in which glaucoma occurred in new born babies or infants due to birth growth abnormalities. This causes excessive growth of eyes during childhood, which is known as buphtalmia.
Although high intraocular pressure is a significant risk factor for developing glaucoma, a person with relatively low pressure may also develop optic nerve damage. Therefore, numerous screening techniques should be used during the diagnosis and follow-up procedures.
Diagnosis: Glaucoma is diagnosed after a standard eye examination, intraocular pressure measurement, biomicroscope examination, fundus examination, anterior chamber (aqueous humor) and visual field examination.
Screening: Follow-up of a glaucoma patient should be done by regular intraocular pressure screening as well as by advanced technology instruments, such as automated peripheral visual field test, Heidelberg Retinotomography (HRT II) and Optical Coherence Tomography (OCT).
Treatment:
1- Medication: Intraocular pressure can be lowered with medication, usually eye drops. However, the eye drops should be used very regularly and the patient's intraocular pressure should be measured once in every 3 months.
2- Laser Treatment: Especially in closed angle glaucoma cases, surgery has been replaced by laser treatment. It is practical, quick and causes less pain. Argon and/or YAG laser is used.
3- Surgery: When medication and laser treatment is not sufficient, and despite high doses of medication therapy is used, loss of vision, optical nerve damage and visual field losses occur, glaucoma filtration procedure (trabeculectomy) is applied. For the treatment of secondary chronic glaucoma cases, retinal blood vessel blockages and neovascularization of iris, tubular ophthalmic implantation or diode laser treatment should be applied.
In addition, corneal thickness should be measured by Pakimeter.
Retinal thickness should be measured by HRT II, and optic nerve damage should be controlled by OCT.
Prevention: Annual intraocular pressure control, avoid sitting in the darkness without turning on the lights, avoid consuming excess amount of coffee and/or tea. If the mentioned above risk factors are present, intraocular pressure should be measured in every 3-4 months and an annual eye examination is necessary. If a patient is diagnosed with glaucoma, the treatment and screening procedures must be followed precisely.
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