Glaucoma
Having many relatives with glaucoma was one of the reasons I pursued ophthalmology. Some of them were diagnosed at onset and so had the condition under control. The others’ were more progressive which caused visual defects and even blindness.
What is glaucoma? It is a major cause of blindness in adults 60 years and older. Sometimes the symptoms manifest themselves acutely. Patients complain of sudden severe headache and eye pain, vision loss, eye redness, sometimes accompanied by nausea and vomiting, which prompt them to go to the ER. However, some glaucomas are more sinister: painless, seemingly no visual disturbance until it is too late.
What causes it exactly? Aqueous fluid that flows within the eye sometimes gets its exits blocked increasing pressure in the eye. Over time, this pressure “strangles” the optic nerve causing permanent damage to its fibers leading to vision loss.
Who is likely to develop it? Those with a family history of glaucoma, or have diabetes and hypertension, age more than 40years old or those who have had eye trauma, are at increased risk. It is best for them to be more cautious and have their eyes checked.
How do we know if we have it? It’s important that we visit our ophthalmologist yearly so that our eyes are monitored, precisely because there may be no symptoms. A complete eye check up is performed on all patients. Vision is tested, external parts of the eye are examined. The retina is also evaluated as well as the status of the optic nerve. Eye pressure (IOP) is checked. The normal range is between 10-21mmHg. This range is relative: a type of glaucoma called normal tension glaucoma (NTG) may have all the findings of glaucoma damage but pressure is otherwise normal.
If glaucoma is suspected, adjunct tests are requested. The peripheral vision is affected first. We may not be aware of these changes until the defects have already encroached on our central vision. A visual field exam will show these changes objectively.
Other tests that may be ordered are the optical coherence test (OCT) to observe the optic nerve and its fibers, and enlarged photos of the optic nerve head for better visualization and assessment.
The only thing we can control in glaucoma is the IOP. This can be done by starting anti-glaucoma eyedrops which either decrease the production of aqueous or increase its flow. Some patients may need laser procedures, others actual surgery. All of these are to help the aqueous fluid to drain out better, ultimately decreasing the IOP.
Anti-glaucoma eyedrops may be lifelong. Even when the IOP is already controlled, patients still need regular check ups. They may develop allergies to the eyedrops or have more severe side effects that may warrant shifting to other drops.
Glaucoma damage, once it sets in, is permanent and irreversible. So early diagnosis is best to stop its progression and prevent blindness.
Be extra cautious with your eyes. We don’t want to be caught off guard and find out that there is a problem when it is too late and vision is already gone.
What is glaucoma? It is a major cause of blindness in adults 60 years and older. Sometimes the symptoms manifest themselves acutely. Patients complain of sudden severe headache and eye pain, vision loss, eye redness, sometimes accompanied by nausea and vomiting, which prompt them to go to the ER. However, some glaucomas are more sinister: painless, seemingly no visual disturbance until it is too late.
What causes it exactly? Aqueous fluid that flows within the eye sometimes gets its exits blocked increasing pressure in the eye. Over time, this pressure “strangles” the optic nerve causing permanent damage to its fibers leading to vision loss.
Who is likely to develop it? Those with a family history of glaucoma, or have diabetes and hypertension, age more than 40years old or those who have had eye trauma, are at increased risk. It is best for them to be more cautious and have their eyes checked.
How do we know if we have it? It’s important that we visit our ophthalmologist yearly so that our eyes are monitored, precisely because there may be no symptoms. A complete eye check up is performed on all patients. Vision is tested, external parts of the eye are examined. The retina is also evaluated as well as the status of the optic nerve. Eye pressure (IOP) is checked. The normal range is between 10-21mmHg. This range is relative: a type of glaucoma called normal tension glaucoma (NTG) may have all the findings of glaucoma damage but pressure is otherwise normal.
If glaucoma is suspected, adjunct tests are requested. The peripheral vision is affected first. We may not be aware of these changes until the defects have already encroached on our central vision. A visual field exam will show these changes objectively.
Other tests that may be ordered are the optical coherence test (OCT) to observe the optic nerve and its fibers, and enlarged photos of the optic nerve head for better visualization and assessment.
The only thing we can control in glaucoma is the IOP. This can be done by starting anti-glaucoma eyedrops which either decrease the production of aqueous or increase its flow. Some patients may need laser procedures, others actual surgery. All of these are to help the aqueous fluid to drain out better, ultimately decreasing the IOP.
Anti-glaucoma eyedrops may be lifelong. Even when the IOP is already controlled, patients still need regular check ups. They may develop allergies to the eyedrops or have more severe side effects that may warrant shifting to other drops.
Glaucoma damage, once it sets in, is permanent and irreversible. So early diagnosis is best to stop its progression and prevent blindness.
Be extra cautious with your eyes. We don’t want to be caught off guard and find out that there is a problem when it is too late and vision is already gone.
Margarita Bondoc-Hermosa
Margarita Bondoc-Hermosa is an ophthalmologist practising in Metro Manila and the Visayas. She can be reached here:
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