Glaucoma

Glaucoma is one of the leading causes of irreversible blindness in the world, and it is especially concerning because in many cases it does not present obvious symptoms until significant and irreversible damage has occurred to the optic nerve. This chronic eye disease is characterized by an increase in intraocular pressure, which damages the optic nerve and progressively affects vision. Although there is no cure, early diagnosis and proper treatment can slow or stop its progression, preserving vision and improving the patient's quality of life.

What is Glaucoma?

Glaucoma is a group of eye diseases that damage the optic nerve, which is responsible for collecting the images we see and carrying them to the brain. In most cases, damage to the optic nerve is caused by an increase in intraocular pressure (IOP). IOP is elevated when there is an imbalance between the amount of fluid produced inside the eye known as aqueous humor and the amount of fluid that drains out of the eye. This imbalance causes an increase in pressure inside the eye that damages the optic nerve, losing fibers irreversibly.

There are several types of glaucoma depending on the ocular characteristics that we can observe under a microscope. The most common is open-angle glaucoma, in which the pressure rises without giving any symptoms; There is also closed-angle glaucoma in which there is a problem with space inside the eye that is responsible for the difficulty in draining the aqueous humor and therefore, for raising the pressure. Then there are special types of glaucoma in which certain materials accumulate in the trabecular meshwork (eye structure that acts as a "filter or strainer" of the aqueous humor) such as pigmentary glaucoma and pseudoexfoliative glaucoma. And there are also other less frequent types of glaucoma such as uveitic, congenital, juvenile, cortisonic, traumatic...

An accurate diagnosis of the type of glaucoma the patient suffers from is necessary to choose the most appropriate treatment they need.

Risk Factors

Glaucoma can affect anyone, but some factors increase the risk of developing it:

• Older age: The risk increases from the age of 40.
• Family history: Glaucoma can run in families, so it's important for people with a family history to get regular checkups.
• High myopia
• diabetes
• Hypertension and low blood pressure
• Long-term use of corticosteroids
• Previous eye trauma

Symptoms of Glaucoma

Open-angle glaucoma usually has no symptoms until damage to the optic nerve is significant, which can lead to progressive loss of peripheral vision and, in advanced cases, total vision loss. However, when people with narrow angles have sharp angle closure, they can suffer significant pain that can even lead to vomiting, intense eye redness and blurred vision. This condition requires urgent treatment.

Diagnosis of Glaucoma

Early diagnosis is essential to preserve vision in glaucoma patients. At our clinic, we perform a full evaluation using the following tests:

• Applanation tonometry: Measures intraocular pressure. An elevated IOP is a major sign of glaucoma, although it is possible to have glaucoma with a normal IOP.
• Visual campimetry: Evaluates the patient's visual field to detect loss of peripheral vision, one of the first signs of glaucoma.
• Gonioscopy: Examines the drainage angle of the eye, helping to classify the type of glaucoma.
• OCT (Optical Coherence Tomography): Provides detailed images of the optic nerve and retina, allowing any structural damage to be detected at very early stages.

Glaucoma Treatment

Although the damage caused by glaucoma cannot be reversed, treatments are designed to reduce intraocular pressure and prevent further vision loss, i.e. to try to slow the progression of glaucoma. Treatments vary depending on the severity of the disease and the patient's individual needs.

1. Pharmacological Treatment
   Eye drops: Eye drops are the first line of treatment for most patients. They are designed to reduce the production of aqueous humor or improve its drainage, thus lowering eye pressure. It is important to follow the treatment strictly to control the disease.
   
2. Laser Treatment
   -Laser Trabeculoplasty (SLT): It is currently a first-line treatment for patients with wide eye angles. This intervention facilitates the drainage of the aqueous humor, which produces significant drops in IOP, so much so that sometimes we can stop using hypotensive eye drops.
   -Peripheral laser iridotomy: This treatment is indicated for patients with angle-estecho glaucoma. The laser creates a small hole in the iris, allowing the liquid to flow better and preventing the angle from closing sharply.
3. Surgery
   When medical treatments and lasers are not enough to control glaucoma, surgery may be necessary to reduce intraocular pressure. There are several surgical techniques that are used depending on the type of glaucoma and the patient's response to previous treatments:
   -Trabeculectomy: It is the most common surgical procedure to treat glaucoma. It consists of creating a new drainage route for the aqueous humor, thus reducing intraocular pressure.
   -Minimally Invasive Glaucoma Surgery (MIGS)

In recent years, minimally invasive surgery has gained popularity. This surgery consists of the introduction of small drainage devices that are placed in different parts of the eye to facilitate the exit of the aqueous humor. They can be performed as independent surgical acts or take advantage of cataract surgery for their introduction.
The most common are the Xen® implant that is placed under the conjunctiva, or from the trabeculum to Schlemm's canal like the iStent®. Other devices for MIGs are the Preserflo® Microshunt which is placed in a scleral tunnel.

Commitment to your Visual Health

At our clinic, we understand the importance of preserving your vision and quality of life. Our team of glaucoma specialists is highly trained to offer personalized, state-of-the-art treatments. We continuously monitor our patients to ensure that intraocular pressure is controlled and minimize the risk of further damage to the optic nerve.

If you have a family history of glaucoma or are experiencing symptoms such as blurred vision or loss of peripheral vision, don't hesitate to contact us for a full evaluation. Early detection is key to preventing blindness caused by this silent but devastating disease.