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Glaucoma

glaucomaGlaucoma is an eye condition that sets in when the optic nerve of the eye is damaged by the pressure in the eye being too high, leading to a compromised blood supply to the optic nerve or a combination of these. See Eye Diseases – Glaucoma. sets in when the optic nerveThe optic nerve transmits the visual signals from the retina to the visual cortex in the brain, where it is interpreted as the images we see. See Info on Eyes – Anatomy. of the eye is damaged either by an elevated intra-ocular pressure within the eye (normal pressure is between nine and 21 mm Hg), by compromised blood supply to the optic nerve, or by a combination of these two factors.  Elevation of the intra-ocular pressure may occur as a result of decreased drainage or alternatively an overproduction of the intra-ocular fluids.  The additional fluid volume in the eye causes the pressure to rise, which is applied to the most sensitive structure - the optic nerve which exits from the back of the eye.  The increased fluid pressure leads to changes within the optic nerve which result in a “cupped” or concave appearance thereof.  Damage to the optic nerve, which is responsible for sending visual information to the brain, leads to progressive visual loss.  This damage initially appears as gradual visual field changes and finally to total loss of vision.  The early visual changes are very slight and do not affect the central vision.  Parts of the peripheral vision are affected and will not be noticed by the patient at first on casual observation.  Glaucoma often affects both eyes, but fluid pressure may initially be seen in only one eye.

Although glaucoma is more common in older patients, it may occur at any age.  The tendency to develop glaucoma may be inherited, since relatives of glaucoma patients are more susceptible to develop glaucoma.  Those who are at higher risk to develop glaucoma should have their intra-ocular pressures and optic nerves checked annualy .  Glaucoma seldom leads to blindness if diagnosed early and treated in the appropriate fashion.  Although visual loss as a result of glaucoma cannot be recovered, early diagnosis and careful, lifelong treatment can help prevent further visual deterioration.

IS THERE A CURE OF GLAUCOMA?

Thus generally speaking, glaucoma can not be cured - it can only be controlled.  It is not a problem that comes and goes.  Once diagnosed, it requires constant, lifelong care.  The importance of maintaining eye pressures under control cannot be emphasized enough.

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3 factors are taken into account for the diagnosis of glaucoma:

  • The intraocular pressure.
  • The optic nerve configuration.
  • Visual field analysis.

Treatment options for Glaucoma

Medication FOR GLAUCOMA

The primary form of treatment for glaucoma is the use of medication that either increases the drainage of fluid from the eye, or decreases the production of fluid in the eye.  In the majority of cases, medication alone is effective in the control of intra-ocular pressure.  Glaucoma medications come in different strengths and combinations.  The goal is to use the least number of medications that would produce the best result with the least amount of side effects.

Laser surgery for Glaucoma

Various modes of laser surgery are available, depending on the type of glaucoma to be addressed.

The most common type of glaucoma is primary open angle glaucoma.  This may be treated by ALTP (or argon laser trabeculoplasty), which is the older technique, or more recently with a diode laser by selective laser trabeculoplasty (SLT).  These procedures aim to improve the drainage of fluid via the natural channels from the eye.

In angle closure, pupil block or pigment dispersion glaucoma, a YAG laser is used to create a small hole (an “iridectomy”) in the peripheral iris through which fluid may pass from the back to the front section of the eye to relieve obstruction to flow, since this is the mechanism which induces the pathology in these types.

Microsurgery for Glaucoma

This is most often done under local anaesthetic.  Again, a variety of procedures are available, including trabeculectomy, trabeculotomy, deep sclerectomy, visco-canulostomy, and the placement of artificial valves (a glaucoma shunt) into the eye.

All of these procedures are aimed at improving the drainage of fluid from the eye.  Some would lead to drainage of fluid into a potential space underlying the mucous membrane (conjunctiva) that covers the exterior (trabeculectomy and artificial valves), while other procedures concentrate to restore drainage through the natural drainage channels from the eye.