Glaucoma is a disease that often proceeds unnoticed for a long time: usually a high intraocular pressure impairs the blood flow at the optic nerve; but glaucoma can also occur with “normal” eye pressure.
In glaucoma, the nerve fibers of the optic nerve gradually decays. As a result the image recorded by the retina can only be transmitted incompletely to the visual center of the brain. About 4% of all people will develop glaucoma in their lifetime; it usually occurs after the age of 40.

The important screening for glaucoma early detection

The disease can proceed unnoticed for years. Visual field defects occur only when around 2/3 of the nerve fibers have already perished. Some patients notice an increasing black spot (scotoma) in the visual field. As glaucoma progresses the field of vision narrows continuously. The disease can lead to complete blindness. A causal cure is not possible – once the nerve fibers have died, the damage cannot be repaired. It is therefore very important to detect glaucoma as soon as possible. At an early stage of the disease the ophthalmologist can treat glaucoma with medications or if necessary surgery to prevent progression and preserving valuable visual ability.

My recommendation: yearly check-ups from the age of 40 on.
The eye needs a certain internal pressure to keep its shape and maintain visual function. The aqueous humor is responsible for the intraocular pressure. Its production and outflow must be in balance. It is produced by the ciliary body and then flows from the posterior to the anterior chamber of the eye. It then flows into the circulation via the trabecular meshwork of the chamber angle and Schlemm’s canal.
Normal eye pressure ranges from 12-21 mm Hg, and eye pressure of greater than 21 mm Hg is considered higher than normal. The higher the intraocular pressure, the better the blood circulation in the eye has to be in order to retain a healthy optic nerve . If the blood circulation in the eye is poor, even a “normal” intraocular pressure can be too high. Therefore, the individual eye pressure limit above which damage to the optic nerve can occur is different for every patient. General diseases that can affect the blood flow at the posterior eye segment increase the risk of developing glaucoma. These include diabetes mellitus, high or low blood pressure, too viscous blood or age-related vascular damage.

With increasing age, especially after the age of 40, the trabecular meshwork becomes less permeable. If the production of aqueous humor remains the same and the outflow of aqueous humor is impaired the intraocular pressure can increase (there are also other causes that can lead to an increase in pressure in the eye, but these occur much more rarely).

Acute Glaucoma
Acute angle block (so-called glaucoma attack) is a special case: When the iris approaches the cornea, the drainage path for the aqueous humor via the anterior chamber angle is abruptly blocked. The result is a sudden, strong increase in eye pressure, which is accompanied by pain and possibly also nausea, as well as severely impaired vision and red eyes. Only immediate ophthalmological treatment can prevent permanent vision loss in such a case.

From the age of 40 you should visit your ophthalmologist regularly once a year. If you are diabetic, extremely short-sighted or if someone in your family suffers from glaucoma earlier examinations are recommended. Your ophthalmologist will measure the intraocular pressure and examine the anterior segment of the eye and the posterior segment of the eye with the optic nerve head. Optical coherence tomography (OCT) allows high-resolution cross-sectional images of the retinal layers. Smallest detectable changes in the nerve fiber layer can be detected even before defects in the field of vision occur. A visual field test checks whether and to what extent perception is restricted. It is always performed if there is any suspicion of a damaged nerve fiber layer.

Anti-glaucomatous eye drops to lower the intraocular pressure are usually used at the beginning of treatment. For a successful therapy it is important to ensure that the eye drops are taken consistently and at specified fixed times. Regular check-ups are also an important factor for successful treatment.

If the eye drops do not achieve a sufficient reduction in pressure there is the option of reducing the intraocular pressure through glaucoma surgery. Various techniques are available for this:

– Micro-invasive glaucoma surgery (MIGS) with micro-implants improves the outflow of aqueous humor in order to reduce intraocular pressure and prevent progression of the disease. The implants are inserted via micro-incisions, therefore the healing time is significantly shorter and less painful than after conventional glaucoma operations. After the implantation, patients usually do not need any or significantly fewer eye drops.

– In a conventional trabeculectomy (fistulating operation) a new drainage channel is also created under local anesthesia in order to reduce the eye pressure

– In laser trabeculoplasty a laser beam is directed at the trabecular meshwork. This improves drainage and reduces eye pressure.

There are numerous surgical procedures that I would be happy to inform you about in a personal meeting.

If you use the possibilities of early detection of glaucoma an eventual therapy can be initiated in good time. By working together with your ophthalmologist in a spirit of trust, the risk of permanent damage or even blindness from glaucoma can be greatly reduced. Of course will be happy to support you.