Glaucoma

Glaucoma is a group of eye diseases that damage the optic nerve, whose health is crucial for good vision. This damage is often caused by unusually high pressure in the eye. Glaucoma is one of the main causes of blindness in people over the age of 60.

We asked the ophthalmologist Dr Maya Mineva to explain the phenomenon of glaucoma to us in more detail and show us the treatment options. Read more about the crucial information she has given us to protect yourself against glaucoma!

What is glaucoma?

Dr Mineva points out that glaucoma narrows the visual horizon very slowly. The appearance of „blind spots“ initially occurs only in the periphery of the visual field. Glaucoma, however, is the second cause of irreversible blindness around the world.

That's because glaucoma belongs to the group of neurodegenerative diseases. That means that the damage to the optic nerve causes permanent loss of vision – the visual information does not travel from the eyes to the brain.

It is, therefore, worrying that people, who may be seriously affected by this disease, are usually unaware that they are developing the condition.

There are two main types of glaucoma – primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Whatever its form, glaucoma impairs the quality of life and the ability of patients to cope with their daily routines. It is therefore important for people who might be at risk from this illness to visit an ophthalmologist regularly.

Please consult your ophthalmologist if you notice abnormalities in your vision, your eyes and your general well-being, or if glaucoma has already occurred in your family.

How can you diagnose glaucoma?

Dr Maya Mineva demonstrates the different ways to identify glaucoma.

Among the factors listed, the family history is very important – this is essential information that you must share with your eye doctor.

Then comes the monitoring of various parameters through specialised studies – intraocular pressure control, corneal thickness measurement and a peripheral vision examination. The condition of the optic nerve is paramount and should be examined using the most appropriate methods.

The most popular choice is the Goldman's method, which provides greater precision. It requires a special prism mounted on the biomicroscope, a dye substance and a local anaesthetic.

Furthermore, genetic studies allow us to identify patients who carry the genetic factors responsible for the development of glaucoma, so that they can be closely monitored and start treatment at an early stage, to preserve vision.

Glaucoma in a nutshell: Glaucoma affects the optic nerve and can lead to permanent blindness if untreated. Regular checkups and early detection can prevent a worsening of the eye disease. You can treat glaucoma by eye drops, laser treatment and surgery. The treatment goal is to prevent further damage.

What is primary open-angle glaucoma (POAG)?

Dr Maya Mineva points out that open-angle glaucoma is common in patients over 40 years of age. It is not characterised by specific symptoms – intraocular pressure increases slowly and painlessly. Patients realise that they are losing their vision only when they reach the extreme stages of the disease when the injury is irreversible. POAG cannot be cured, but with appropriate and timely therapy, its development can be controlled and restricted. For example, a group of patients who is affected by one or more risk factors, may be identified by age, ethnic origins, genetical factors and myopia.

What is primary closed-angle glaucoma (PCAG)?

Unlike primary open-angle glaucoma, which is slow and asymptomatic, the manifestation of closed-angle glaucoma is dramatic and introduces itself in the patient's life in a painful way.

An ophthalmologist's examination is mandatory, in the presence of one or more of these symptoms: pain, redness, headache, vomiting and coloured circles around lights. After a first attack, before high pressure can permanently damage the optic nerve, vision can still be rescued.

What means secondary glaucoma?

Whereas the causes of the development of primary glaucoma may remain largely unclear, secondary glaucoma is the result of specific previous conditions. It could be due to inflammatory, degenerative and tumor processes in the eye and possibly after surgery. Secondary glaucoma is a very diversified category in which two main groups can be distinguished – secondary open-angle and secondary-angle glaucoma.

What are congenital and childhood glaucoma?

Furthermore, our eye doctor Dr Maya Mineva explains that glaucoma in children is rare but has long-lasting negative consequences, if not diagnosed in time. Due to abnormal development, anomalies in the eyeball and its fine structures it may even develop during pregnancy.

Primary glaucoma in children can develop immediately after birth, up to the age of 3, and in this case, it is referred to as congenital glaucoma. If it develops between the age of 3 and 10, then it is called childish glaucoma.

Congenital glaucoma presents a unique clinical picture that sets it apart from other types of glaucoma – the baby is restless, avoids light (photophobia), prefers to keep his or her eyes closed, rubs them, has abundant tears, and the cornea gradually loses transparency. The eyeball is abnormally enlarged and children with congenital glaucoma have impressively large eyes.

The diagnosis is made by examination of the anterior ocular segment and the optic nerve, measurements of the cornea and mesh size. Given the age of the patients, these tests are often performed under general anaesthesia.

Despite the systematic use of eye drops, definitive treatment is surgical.

Surgery performed at an early stage of the disease provides chances of maintaining a satisfactory condition of vision.