Glaucoma Eye Condition
Glaucoma is usually, but not always associated with raised pressure in the eye. As vision lost through glaucoma cannot be recovered, early diagnosis and treatment of the condition is important.
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What is Glaucoma?
Glaucoma encompasses a group of conditions which cause progressive damage to the optic nerve which can lead to loss of vision. Glaucoma is usually, but not always associated with raised pressure in the eye. As vision lost through glaucoma cannot be recovered, early diagnosis and treatment of the condition is important. The eye requires a certain pressure to function normally and this is measured routinely in patients over the age of 40 years when you attend an Optician. Confusingly, raised pressure in the eye does not always lead to glaucoma, a condition called ocular hypertension exists where the pressure in the eye is above normal but no damage to the optic nerve follows, this condition may require monitoring only, or if the pressure rises above certain levels, treatment as for glaucoma.
The International Glaucoma Association (IGA) is a registered charity to support people with glaucoma with information on the condition, how to donate, raise funds or become a member available by following this link here.
A comprehensive guide to glaucoma is available in this IGA booklet: Glaucoma: A Guide
What are the risk factors for glaucoma?
There are a number of risk factors for glaucoma, these are:
About 2% of people over the age of 40 years rising to around 5% of people over 80 years.
People with a first degree relative affected by glaucoma (parent, sibling or child) are at increased risk of developing glaucoma. Free NHS sight tests are available for those over 40 years with an affected relative.
People with African-Caribbean heritage are at a higher risk of developing open angle glaucoma than people of European heritage, are more likely to be affected earlier in life and more likely to suffer more advanced disease.
Drugs such as corticosteroids particularly applied to the eye over the long term can cause raised pressure in the eye which can in turn lead to glaucomatous damage to the optic nerve.
People who are myopic or short-sighted are at increased risk of open angle glaucoma, people who are long-sighted or who have an eyeball with short axial length or crowded anterior chamber may be at risk from angle closure glaucoma.
People with low blood pressure relative to their eye pressure may be at increased risk as the perfusion pressure of the optic nerve may be to low.
What are the types of glaucoma?
There are four main types of glaucoma:
- Primary Open Angle Glaucoma
- Primary Angle Closure Glaucoma
- Secondary Glaucomas
- Developmental Gluacoma
Primary open angle glaucoma
Primary open angle glaucoma (POAG) is the most frequently occurring type in the UK and is often referred to as chronic glaucoma. Many affected people will not have symptoms because the condition is not painful and loss of vision typically occurs to the field of vision. As we have two eyes, loss of visual field in one eye may be masked by the presence of the same area of visual field in the other eye. This condition may be suspected by an Optician who will then refer for a medical opinion and further tests e.g. a field of vision test or an imaging test for the optic nerve e.g. 3D OCT
More detailed information on this condition is available in this IGA booklet: Primary Open Angle Glaucoma.
Primary angle closure glaucoma
Primary angle closure glaucoma (PACG) is more frequently found in people of Asian origin and less frequently in people of European origin; it increases in frequency with age above 40 years and may develop slowly or it can occur suddenly in acute angle closure glaucoma. More detailed information on this condition is available in this IGA booklet: Primary Angle Closure Glaucoma.
Secondary glaucoma occurs when an underlying eye or medical condition causes raised pressure in the eye that then results in glaucoma through damage to the optic nerve. Secondary glaucomas have a number of causes including secondary angle closure glaucoma, pseudoexfoliation, trauma and following surgery or use of certain medications. More detailed information on these conditions are available in this IGA booklet: Secondary Glaucomas.
Developmental glaucomas, also called congenital glaucoma occurs in babies and children. These are fortunately rare conditions that requires expert Paediatric specialist glaucoma care in centres of excellence.
What treatments are available for glaucoma?
The mainstay of treatment for glaucoma is the use of eyedrops. If you have been prescribed eyedrops it is important that you use them regularly as prescribed and in the correct way.
Laser treatments for glaucoma
Surgery for glaucoma
Surgery for glaucoma can be divided into three main types: Trabeculectomy and minimally Invasive Glaucoma Surgery.
Trabeculectomy is an operation in which a one-way valve is created in the sclera or white part of the eye at the 12 o’clock position and covered with conjunctiva, the this mucous membrane that covers the sclera. The fluid within the eye has an additional draining pathway through this valve and this leads to the formation of a small bump or bleb hidden underneath the upper lid reducing the pressure.
Minimally Invasive Glaucoma Surgery
Minimally invasive glaucoma surgeries or MIGS have been developed to improve the safety of glaucoma surgery. The term encompass a group of operations that use microscopic sized equipment or procedures designed to reduce the risks associated with conventional glaucoma surgeries but may be less effective at lowering intraocular pressure. MIGS procedures include the use of the XEN® Gel Stent, the iStent inject® and the PRESERFLO™ MicroShunt.