Detection & Treatment of Glaucoma
Guardion Health Sciences
Glaucoma is a group of eye disorders that affect the optic nerve, which is a bundle of about 1 million nerve fibers that transmits information from the eye to the brain. Nicknamed “the silent thief of sight,” glaucoma often progresses largely unnoticed until irreversible vision loss has already occurred.
Historically, much of the literature surrounding the causes of glaucoma has focused on elevated intraocular pressure. To understand intraocular pressure, you must recognize that the eye is constantly producing a clear liquid called aqueous humor that nourishes the inside of the eye and helps maintain the eye’s shape. Fluid is also constantly exiting the eye through tissue called the trabecular meshwork, which is located in the drainage angle where the cornea meets the iris. In a normal, healthy eye, there is a delicate equilibrium between the amount of fluid that is produced in the eye and the amount of fluid that drains out of the eye.
When the drainage angle becomes “clogged,” blocked or closed, fluid builds up inside the eye. This causes intraocular pressure to rise. Too much intraocular pressure damages the optic nerve, leading to permanent, irreversible vision loss.
Types of Glaucoma
The two main types of glaucoma are marked by an increase in intraocular pressure. With open-angle glaucoma, the drainage angle remains open, but fluid exits the eye too slowly (imagine a clogged kitchen drain). This causes a gradual increase in the amount of fluid in the eye, and a slow rise of intraocular pressure.
Angle-closure glaucoma is the more serious type of glaucoma, and it comes on very quickly. This type of glaucoma occurs when the drainage angle closes or becomes blocked suddenly and there is an instantaneous spike in intraocular pressure. Angle-closure glaucoma requires immediate medical attention to prevent permanent vision loss.
Normal Tension Glaucoma
Although most cases of glaucoma are thought to involve elevated intraocular pressure, many people experience optic nerve damage even when intraocular pressure does not exceed an acceptable range. Indeed, new research is showing that in many countries, more glaucoma patients have normal pressure than high pressure in the eye.
These cases are known as normal tension glaucoma, and are far less understood than other types of glaucoma. One common theory is that a reduction in perfusion pressure in the eye (i.e., a reduced amount of force driving blood to the eye) robs the eye’s tissue of the oxygen and nutrients it needs, eventually damaging the optic nerve. Underlying mitochondrial dysfunction — problems with the “power plants” of the cells that give them the energy they need to function — may also be to blame.
It can be difficult to detect open-angle glaucoma because often there are no noticeable symptoms at first. Gradually, there may be a reduction in peripheral vision.
Angle-closure glaucoma comes on very rapidly and causes noticeable symptoms such as eye pain, severe headaches, nausea and vomiting. It is considered a medical emergency and requires immediate attention.
Normal-tension glaucoma can only be detected by examining the optic nerve for signs of damage. Although it may cause slight changes in vision near the center to the edge of the field of vision, in many cases these changes are not noticeable to the patient.
Standard treatment has been directed at lowering intraocular pressure, even in patients with normal-tension glaucoma.
Often the first line of defense against open-angle glaucoma is the use of medicated eyedrops either to reduce the amount of fluid the eye produces or improve the way fluid exits the eyes. If eyedrops fail to manage intraocular pressure, or if there are compliance issues, laser and traditional incisional surgery may be considered. The type of laser or incisional surgery recommended will depend on the type and severity of the glaucoma.
Recently a new group of procedures known as minimally invasive glaucoma surgeries (MIGS) have become very popular. MIGS use tiny instruments and small incisions to improve the way fluid exits the eyes. MIGS procedures are considered safer and less invasive than traditional incisional surgeries.
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