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.
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 GlaucomaAcute 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.
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.