06/03/20What is Glaucoma and how can we treat it?

As it’s World Glaucoma Week, we are talking about glaucoma to raise awareness. Many people have heard of glaucoma but are unsure what it is, what the symptoms are and how to treat it.

Glaucoma is a leading cause of blindness worldwide. The World Health Organisation estimate that 4.5 million people are blind due to glaucoma and 60 million people are sufferers. Although damage caused by glaucoma cannot be recovered, early diagnosis, careful monitoring and regular use of treatments can limit further vision loss. In fact today, most patients retain useful sight for life. So what is glaucoma, who is at risk and how do we treat it?

What is Glaucoma?

Glaucoma is a group of conditions that cause optic nerve damage. Usually associated with raised eye pressure, glaucoma damages optic nerve fibres where they leave the eye, leading to vision loss.

In practice we most commonly see 3 types of glaucoma and these are;

  • Primary open angle glaucoma – This is the most common which develops very slowly over time
  • Angle closure glaucoma – This is rare and can occur slowly or it can develop rapidly.
  • Secondary glaucoma – This occurs as a result of an eye injury or another eye condition.

In some cases, we see glaucoma with normal eye pressures and occasionally, high eye pressures with no glaucoma. For this reason, glaucoma screening is more than just an eye pressure test.

What are the symptoms of Glaucoma?

For the majority of cases, there are no symptoms.

Primary open angle glaucoma is silent and begins with visual field loss in the periphery. Left untreated, the damage can progress to tunnel vision and eventual complete loss of vision. Fortunately, the condition is usually caught at an earlier stage and controlled to preserve vision. Having regular eye tests is recommended as this is the only form of detection.

In the rare case of angle closure glaucoma, some patients experience a sudden, painful build-up of pressure in the eye, redness, nausea, a headache or halos around lights. This should be checked immediately as it is a medical emergency.

Who is at risk?

As we age, our likelihood of developing glaucoma increases. According to the International Association for the Prevention of Blindness, among white Europeans, about 1 in 50 people over 40 years of age and this increases to 1 in 10 people over 75 years of age.

Other risk factors include:

  • Having a family member with glaucoma
  • Being of black African or black Caribbean ethnic origin
  • Being of Asian origin (particularly for acute angle-closure glaucoma)

If you are diagnosed with glaucoma, it’s important to tell your family as they may also be at risk. For those aged over 40 with a family history, we normally recommend an eye test every 12 months.

How do you treat glaucoma?

Open-angle glaucoma is most commonly treated with daily eye drops that reduce the pressure in the eye. Those diagnosed will be regularly monitored at the hospital for any changes and given recommended dosages for the eyedrops.

In cases of closed-angle glaucoma, damage occurs quickly and requires urgent medical attention. The first treatment is drops and tablets and sometimes intravenous drugs to rapidly reduce the pressure in the eye. Following this, sometimes laser treatment can be needed to allow fluid to flow through the eye more easily. If the laser treatment is unsuccessful, surgery may be required.

A new approach to treatment

Last year, Researchers at Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of Ophthalmology discovered that using a laser-based treatment on newly diagnosed cases of glaucoma is more successful and more cost-effective than using eyedrops. This pioneering treatment is called Selective Laser Trabeculoplasty or SLT for short.

SLT uses short pulses of relatively low-energy light to target the cells in the drainage channels of the eye. The laser pulses target only the area where fluid drains from the eye and they work by causing the body to release white blood cells in order to rebuild the affected area, reducing intraocular pressure (IOP) in the process.

Following the study, SLT has become available selectively both privately and on the NHS for certain cases of glaucoma. Until recently, there hasn’t been sufficient evidence to strongly support one form of treatment over the other so it isn’t currently offered as the standard first-line treatment. Later this year, a further study is aiming to give more information on the long term effects. You should discuss your treatment options with your ophthalmic surgeon who can explain the best options for you.

Whilst it is exciting to see medical advancements in the treatment of glaucoma, even with SLT, there is still no cure. Any lost vision cannot be restored, so early diagnosis is the best form of defence. Glaucoma can affect anybody and tends to remain silent until a late stage, so if it’s been a while since your last eye examination, give us a call!

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