Glaucoma, commonly known as ocular hypertension, is a stealthy, slow-progressing disease that causes permanent damage to the optic nerve due to an increase in intraocular pressure. If not diagnosed and treated early, glaucoma—a prevalent eye disease—can lead to a gradual narrowing of the visual field and irreversible vision loss.
In the early stages, glaucoma may not present any warning signs or symptoms. However, in cases of significantly elevated intraocular pressure, symptoms like eye pain, blurred vision, and seeing halos around lights may occur.
Since vision loss due to glaucoma occurs gradually and initially affects peripheral vision, it often goes unnoticed until advanced stages. As a result, people typically consult an eye doctor at a later stage when there is substantial optic nerve damage. Because glaucoma-related vision loss is irreversible, regular eye examinations and intraocular pressure checks are essential, particularly for individuals over the age of 40.
Normal intraocular pressure is defined as a level that does not cause optic nerve damage or visual field loss. Generally, a range of 9-22 mm Hg is considered normal. However, not every patient with high intraocular pressure has glaucoma. If there is no damage detected on an eye tomography (OCT) that assesses the optic nerve, the patient can be followed up without treatment.
Vision loss due to glaucoma can be prevented with early diagnosis and regular monitoring. As one of the primary causes of preventable blindness, glaucoma often remains asymptomatic until the diagnosis stage. Regular, comprehensive eye examinations are therefore vital for everyone, especially those with a family history of glaucoma. Without treatment, glaucoma can lead to blindness. Even with treatment, about 15% of patients may experience blindness in at least one eye within 20 years of diagnosis.
There is a balance between the production and outflow of aqueous humor, a fluid within the eye. Intraocular pressure is regulated by this fluid and is necessary for normal eye health. In glaucoma, an invisible blockage occurs in the outflow pathway (trabecular meshwork),causing an increase in intraocular pressure. This increased pressure damages the optic nerve.
Individuals with a family history of glaucoma have an increased genetic risk. In such cases, eye pressure measurement, visual field testing, and optic nerve tomography (OCT) should be conducted.
Individuals in these risk groups have a higher likelihood of developing glaucoma, making regular eye check-ups essential.
No. Elevated eye pressure does not automatically mean glaucoma unless it causes optic nerve damage and visual field loss. However, it does increase the risk of developing glaucoma.
The symptoms of glaucoma vary depending on the type and severity.
Open-angle Glaucoma: This is the most common form of glaucoma. The angle between the cornea and iris is open, but microscopic blockages develop in the trabecular meshwork. This gradually raises intraocular pressure, damaging the optic nerve. In open-angle glaucoma, blind spots usually develop in the visual field of both eyes, and over time, the visual field becomes progressively narrower, leading to tunnel vision.
Angle-closure or Closed-angle Glaucoma: In this type, the iris is pushed forward, narrowing or closing the angle between the cornea and iris, which increases intraocular pressure. Some people are anatomically predisposed to a narrow angle, putting them at higher risk for angle-closure glaucoma.
Angle-closure glaucoma can occur suddenly (acute) or develop gradually (chronic angle-closure glaucoma). Acute angle-closure glaucoma is a medical emergency, characterized by severe headache and eye pain, blurred vision, seeing halos around lights, nausea, vomiting, and eye redness.
Glaucoma can appear in children from birth or within the first few years of life, often due to congenital abnormalities in the drainage angle.
Glaucoma is one of the leading causes of treatable blindness in those over 60. Without treatment, it leads to blindness in most patients. Early diagnosis is crucial in treating glaucoma (eye pressure) since about 15% of patients experience blindness in at least one eye within 20 years despite treatment.
No, which makes early diagnosis and treatment essential.
Starting from age 40, everyone should have regular eye exams. Detailed eye exams and patient history are crucial for diagnosis. Those with high intraocular pressure, a family history of glaucoma, thin corneas, diabetes, migraines, hypertension, or vascular issues have a higher risk of developing glaucoma. Advanced imaging technologies are used to assess any damage to the optic nerve.
After evaluating examination findings and test results, we plan diagnosis, treatment, and follow-up procedures.
Since glaucoma is a progressive disease, regular follow-up is vital. Through periodic eye exams, visual field testing, and OCT, we monitor treatment efficacy and disease progression, and tailor treatment plans accordingly.
Because glaucoma-related optic nerve damage is irreversible, early diagnosis, regular glaucoma checks, and treatment are essential for preventing and slowing vision loss. The goal is to control intraocular pressure to protect the optic nerve, visual acuity, and visual field. Treatment varies according to the type and severity of glaucoma and may include eye drops, oral medications, laser, or surgical interventions.
Eye drops are the initial treatment phase. Various drops exist to lower eye pressure by either enhancing fluid drainage or reducing fluid production. OCT evaluation helps determine if treatment is necessary based on nerve damage presence. If there is no damage and no damage develops during follow-ups, medication-free monitoring is possible.
For patients needing treatment, prescribed medications are typically used lifelong. After initiating drops, follow-up exams occur within a few weeks to assess effectiveness. A second or even third drop may be added, or other treatments may be explored if pressure remains high. Glaucoma drugs may have side effects on the eye and body, so selecting the most effective treatment with minimal side effects is crucial.
Use drops at the times recommended by your doctor, applying one drop per dose. If unsure, an additional drop can be used. Overuse can increase side effects, so wait at least five minutes between different drops.
Laser therapy aims either to lower intraocular pressure (therapeutic) or as a preventative measure. The most common laser treatment is laser trabeculoplasty (argon or selective laser) for open-angle glaucoma, enhancing fluid drainage. This treatment is an option when medication is insufficient.
For acute angle-closure crises, once under control, a YAG laser creates a hole in the eye’s colored layer (laser iridotomy),which may also be performed preventively in eyes prone to crisis.
Glaucoma surgery aims to reduce eye pressure by creating a new drainage pathway for fluid. Trabeculectomy is the most commonly used method, enabling high-pressure fluid to drain out. In advanced cases, special tubes (shunt implants) may be placed to transport intraocular fluid out of the eye.
For certain glaucoma types (e.g., exfoliative glaucoma),cataract surgery carries higher risks. To prevent complications, early cataract surgery may be recommended.
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PROFESSOR YONCA AYDIN AKOVAOphthalmologist and Eye Surgeon
