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Glaucoma What is Glaucoma? Glaucoma is a group of eye diseases that damage the optic nerve. Damage to the optic nerve is usually a result of increased intraocular pressure (IOP). Increased eye pressure develops when the fluids in the eye improperly drain. Over time, an increase in IOP may damages the optic nerve and cause vision loss and blindness. Symptoms Glaucoma is often referred to as the “sneak thief of sight” because it produces no symptoms until later stages. Glaucoma is diagnosed through regular, routine eye examinations, which can help to catch glaucoma before it progresses. Visual loss from glaucoma is irreversible. This is why early detection and treatment is very important: they allow measures to prevent progression and preserve remaining vision or slow down the progression of vision loss. Most Common Types Acute Closed-Angle Glaucoma Closed-angle glaucoma occurs when the iris prevents proper intraocular fluid draining. This may result in an acute glaucoma attack when eye pressure may increase rapidly, producing severe headache, eye pain, nausea, and halos and result in significant vision loss in hours. Open-Angle Glaucoma Open-angle glaucoma does not present any symptoms unless it progresses to its later stages. However, patients eventually lose vision; most often peripheral vision is lost first but central vision may also be affected or lost. Open-angle glaucoma can lead to total, permanent vision loss. Normal-Tension Glaucoma Also known as low-tension glaucoma, normal-tension glaucoma is a condition in which vision loss and optic nerve damage occur despite what is usually considered to be normal intraocular pressure levels. This type of glaucoma may also result in peripheral vision loss. These are more common types, however many other types of glaucoma exist. Testing Frequent, routine eye examinations help detect glaucoma. The trained physicians at Albany Eye Associates use a variety of special glaucoma tests to evaluate the eye’s drainage angle (gonioscopy), measure eye pressure (tonometry), evaluate the optic nerve (ophthalmolscopy), and test visual fields. Information gathered during these evaluations is compared at regular intervals over time to evaluate whether glaucoma is present or how the glaucoma has progressed. An Intraocular Pressure Check (Tonometry) measures intraocular pressure (IOP) and is used in the diagnosis and monitoring of glaucoma. For this test, an ophthalmologist uses eye drops to numb the patient’s eyes before using a special device to measure IOP. This test is painless and only takes a few minutes to complete. The Optic Nerve Examination (Ophthalmoscopy) is an examination of the inside of the eye, focusing on the optic nerve and retina. For this test, the pupils are dilated and then magnified using an opthalmoscope, an instrument with a small light on the end). This allows the ophthalmologist to view the color and shape of the optic nerve. If there is any unusual finding to the optic nerve, the ophthalmologist will perform additional tests such as drainage angle inspection, computerized optic nerve imaging and visual field testing. Drainage Angle Inspection (Gonioscopy) determines if the area where fluid drains of out of the eye is open or closed. If this area, called the drainage angle, is damaged, blocked, or clogged, pressure may increase within the eye. Visual Field Evaluation primarily measures peripheral vision to reveal areas of vision loss. A decrease in the visual field is often an early glaucoma sign. The test is conducted by a technician who will ask a patient to look directly ahead at a central target. The patient is instructed to press a button on a buzzer when he or she sees a small, white light appear (or grey shimmery lines depending on the test doctor ordered). If a patient is unable detect the small, white light it may indicate a decreased visual field. Treatment While there is no recognized cure for glaucoma, there are several treatments available that can help to manage the disease by lowering intraocular pressure. Laser or eye drops are common treatments. If intraocular pressure cannot be managed with laser or eye drops alone, surgery may be recommended. Surgery can help to alleviate pressure by increasing the eye’s existing drainage mechanism, for better intraocular fluid drainage. Medical treatment of glaucoma Often initial treatment for glaucoma is the use of eye drops. These work to reduce intraocular pressure by increasing the amount of fluid drainage from the eye or by reducing the amount of fluid produced within the eye. Several types of glaucoma eye drops exist and your doctor will help to select the ones that work the best for you. Oral glaucoma medications may also be prescribed. Oral medications may be used in conjunction with topical medications to reduce intraocular pressure. Laser treatment of glaucoma - Laser Peripheral Iridotomy (LPI) – For patients with narrow-angle glaucoma. A small opening is made in the iris to increase the angle between the iris and cornea and encourage fluid drainage. - Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT) – For patients with primary open angle glaucoma (POAG). The trabecular passages are opened to increase fluid drainage. - Nd: YAG Laser Cyclophotoablation (YAG CP) – For patients with severe glaucoma damage who have not been helped with other surgeries. The ciliary body that produces intraocular fluid is treated to reduce the amount of intraocular fluid produced. If intraocular pressure cannot be controlled with oral or topical medications, an ophthalmologist may recommend glaucoma surgery. Surgical treatment of glaucoma - Filtering Microsurgery (Trabeculectomy) – For patients who have not been helped with laser surgery or medications. A new drainage passage is made by creating a small opening in the sclera (the white shell of the eye), creating a collection pouch between the sclera and conjunctiva (the outer covering of the eye). - Tube Shunt Surgery –In this procedure, a thin, flexible tube (a shunt) with a silicone pouch is inserted in the eye to facilitate drainage. - Endoscopic cytophotocoagulation- This procedure is recommended for several types of glaucoma. For the endoscopic cyclophotocoagualtion (ECP) procedure, an ophthalmologist uses a laser on the ciliary tissue to decrease the production of fluid within the eye. Performed under local anesthesia, the procedure is one of the newest glaucoma surgeries. Studies have shown that the ECP procedure has significant success rate with a relatively low complication risk. If you are a patient with glaucoma or would like to be examined for glaucoma, call Albany Eye Associates to schedule an appointment If you would like to read further about glaucoma, you can do so at the American Academy of Ophthalmology or National Eye Institute. To learn more about Glaucoma contact Albany Eye Associates at 518-434-1042 to schedule an appointment with one of our Board Certified Doctors.
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Glaukom je skupina promjena na oku koje oštećuju vidni živac. Glaukom nastaje kao posljedica poremećenog normalnog protoka tekućine kroz oko. Zbog zadržavanja previše tekućine u oku, raste očni tlak. Može se javiti u bilo kojoj životnoj dobi, ali je najčešći među starijom populacijom. Neliječeni glaukom može dovesti do gubitka perifernog vida, a postupno i do sljepoće, stoga je bitno ići na redovne preglede oftalmologu, posebno nakon četrdesete godine života, kako bi se pravovremeno otkrio i liječio. Povećani rizik od glaukoma imaju osobe s dioptrijom većom od -4, stariji od 40. godina, dijabetičari te osobe s pozitivnom obiteljskom anamnezom. Glaukom otvorenog kuta najčešći je oblik glaukoma i uglavnom nema simptoma, ali ako vam se javljaju neka od sljedećih stanja treba se javiti oftalmologu, jer se jedino preventivnim odlaskom na oftalmološki pregled i mjerenjem očnog tlaka može ustvrditi imate li glaukom. Povremena bol i osjećaj pritiska u očima te glavobolje iznad očiju i obrva mogu biti znakovi povišenog očnog tlaka. Glaukom otvorenog, ali češće zatvorenog kuta, mogu uzrokovati efekt duginih boja ili probleme s noćnim vidom kao halo (ili zvjezdana prašina) i zamagljen vid oko svijetlih točaka. To može biti problematično za vozače s glaukomom koji osjete ekstreman pritisak i naglu sljepoću kad se zjenica otvori, pogotovo po noći ili u slabo osvijetljenim okruženjima. Primarni glaukom otvorenog kuta tipično se ukaže sa sporijim smanjenjem perifernog vida pacijenta (koji uzrokuje tunelski vid) i prekidajući kutove vidnog polja u oba oka. Ponekad dođe do većeg gubitka vidnog polja prije negoli pacijent primijeti promjenu , a tada je očni živac već znatno oštećen. Akutni glaukom zatvorenog kuta nema znakova upozorenja i najčešće se manifestira izrazitim crvenilom oka, proširenom zjenicom, jakom glavoboljom i mučninom s povraćanjem. Za akutni glaukom potrebna je hitna terapija. Ako vam je dijagnosticiran glaukom postoje različite metode liječenja kao što su lijekovi(kapi), laser ili operacija, što ovisi o vrsti glaukoma i oštećenju vida u trenutku kada je glaukom dijagnosticiran. Liječenje glaukoma kapima često dovodi do suhoće oka koja pacijentima izaziva nelagodu. Ukoliko se to dogodi važno je da se ne odustane od terapije, nuspojavu treba prijaviti liječniku ili ljekarniku. Važno je i da se kapi pravilno primjene jer se pravilnom primjenom smanjuju nuspojave. Povodom obilježavanja svjetskoga tjedna glaukoma od 11.-17.03. u našim ljekarnama provodit ćemo edukaciju o glaukomu. Ako se brinete da imate glaukom ili imate dijagnosticiran glaukom te vas zanima nešto o terapiji posjetite naše ljekarne gdje će vam kao i uvijek naši ljekarnici pomoći.