Glaucoma

The optic nerve, which connects the eye and the brain, is damaged by the common eye disorder known as glaucoma.

The most frequent reason is fluid buildup in front of the eye, which increases the pressure of the eye. Timely diagnosis and treatment of glaucoma can eliminate the possibility of vision loss. While it can affect people of all ages, it primarily targets individuals in their 70s and 80s. (1)

Definition and Overview

The American Academy of Ophthalmology describes glaucoma as a group of eye conditions which can damage the optic nerve in the back of the eye, eventually resulting in vision loss and blindness.

The eye continually produces aqueous humor by flowing out the same amount as it flows in. This fluid balance helps maintain constant pressure in the eye, known as intraocular pressure (IOP). However, if the drainage angle does not work properly, fluid builds up and the pressure inside the eye increases, which causes damage to the optic nerve.

The optic nerve includes more than a million tiny nerve fibers. As these nerve fibers disappear, blind spots occur in the vision. Most optic nerve fibers may go unnoticed until they die. Complete loss of fibers leads to blindness.

Glaucoma symptoms can start so slowly that they can be easily missed. A thorough dilated eye exam is the best method to detect if a patient has glaucoma. (2)

Procedures

Glaucoma has two types including 

• Open-angle glaucoma 

Open-angle glaucoma, the most common type of glaucoma, occurs gradually when the eye does not drain fluid as it should. This disease can cause glaucoma and damage to the optic nerve.

In open-angle glaucoma, there are no obvious symptoms or warning signs in the early stages of disease onset and blind spots occur in peripheral (side) vision as the disease progresses. Some people may have optic nerves that are sensitive to normal eye pressure. This indicates that they have a higher than average chance of getting glaucoma. Regular eye exams are important to find early signs of damage to your optic nerves.

Most open-angle glaucoma patients might not become aware of any changes in their vision until the damage is fairly severe. Because of that, glaucoma is called the "silent thief of sight". Patients should have regular eye exams to help ophthalmologists detect this disease before patients lose their sight.

• Angle-closure glaucoma

This type occurs when someone's iris is too close to the drainage angle in their eye. The iris may block the drainage angle. When the drainage angle is completely blocked, the eye pressure rises very quickly, and this situation is called an acute attack. This is a true eye emergency and can cause eye loss if not treated in a timely manner.

This type occurs when someone's iris is too close to the drainage angle in their eye. The iris may block the drainage angle. When the drainage angle is completely blocked, the eye pressure rises very quickly, and this situation is called an acute attack. This is a true eye emergency and can cause eye loss if not treated in a timely manner. Angle-closure glaucoma frequently develops gradually in many patients. Chronic angle-closure glaucoma is what is causing this. Patients don't discover they have it until the damage is severe or they've had an attack because there are no symptoms at first. Halos, blurred vision, light headaches, or eye pain are some of the early indications of an attack. (3)

If glaucoma is diagnosed, medications, laser treatment, and surgery may be preferred as treatment procedures. These procedures won't undo any damage to your vision, but they can prevent the disease from progressing and getting worse.

• Medications

The most common treatment is prescription eye drops. They lessen the pressure in your eye, preventing damage to the optic nerve. 

• Laser treatment 

To lower your eye pressure, lasers may aid in the drainage of fluid from the patient's eye.

• Surgery (4)

If medications and laser therapy are in a position to not work, doctors may recommend undergoing surgery. There are several different types of surgery that can help the fluid drain out of your eye, these can be listed as Trabeculectomy (tra-BECK-yoo-LECK-toh-mee), Glaucoma implant surgery, Minimally invasive glaucoma surgery (MIGS). (5)

Candidates

At first, glaucoma normally has no symptoms, but it gradually worsens over time and first affects your peripheral vision (the edges of your field of vision).

Due to the fact that many people are not aware they have glaucoma, it is frequently detected during a routine eye exam.

Glaucoma treatment should be started as soon as patients become aware of a glaucoma symptom.

Patients with the following symptoms who were diagnosed with glaucoma by the doctor can be candidates for glaucoma procedures. 

• intense eye pain
• nausea and vomiting
• red eye
• headache
• tenderness around the eyes
• seeing rings around lights
• blurred vision (6)

Risks and Side Effects

Glaucoma medications do not have much risk, but rarely the following may occur.

• stinging, itching, burning, and redness in your eye
• blurred vision
• changes in your eye color or the skin around the eyes
• dry mouth
• changes in your energy level, heartbeat, or breathing

Laser therapy can cause side effects, as with any procedure. These side effects are;

• swelling and pain,
• cornea scratch

The cornea can become extremely dry after being scratched, which can be uncomfortable, but the pain often decreases as the cornea heals.

As with any surgery, glaucoma surgery can have side effects including;

• eye swelling and pain
• cataract
• problems with the cornea (the clear front layer of your eye)
• too low eye pressure
• vision loss (7)

Post-Procedure and Follow-up

Multiple follow-up appointments are scheduled with the treating doctor to ensure that the patient's eye heals properly after glaucoma surgery. It is very important to attend all scheduled appointments in the postoperative period, especially during the first few weeks after surgery, to promote long-term function. (8)

Recovery

Recovery time after glaucoma surgery varies depending on the type of surgery and treatment applied. For most people, improvement in vision can be noticed within days to weeks after the procedure. Very rarely, some patients may experience a long recovery period, extending beyond several months.

Results

As a result of the treatments, the intraocular pressure decreases and visual stability can be maintained for a long time. Continuous monitoring of glaucoma is necessary to monitor treatment outcomes.