Glaucoma

Everything you always wanted to know about Glaucoma

- What is glaucoma?
- Is the glaucoma test painful?
- Do you get different types of glaucoma?
- Are some races more prone to glaucoma than others?
- What types of treatment are available to treat my glaucoma?
- What if I struggle to put the drops into my eye?
- How does the laser surgery work?
- Some important reminders


What is glaucoma? 1, 2
Glaucoma is optic nerve damage, often associated with increased eye pressure that leads to progressive, irreversible loss of vision. Glaucoma is fairly common in adults over the age of 35 years. Glaucoma can eventually cause blindness, however if diagnosed and treated early, blindness is preventable.
 
 
Even with perfect vision you may already have glaucoma   If you don’t treat your glaucoma you may go blind

What causes glaucoma?1
In most cases high eye pressure (intra ocular pressure/IOP) damages the optic nerve. Some medication and treatments are designed to lower the pressure inside the eye; this can help to slow down the process of damaging the nerve. In some cases the damage to the optic nerve will continue in spite of the lower IOP.

Can the damage to the optic nerve be reversed? 1, 3
No. In glaucoma, once the optic fibres have been damaged, they die and they never grow back or recover.
The loss of these fibres causes your eyesight to get worse and can lead to blindness. The key to preventing optic nerve damage or blindness from glaucoma is early diagnosis and treatment.

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Is glaucoma painful? 1, 3
In most cases, no, and that is why it is so important to visit your ophthalmologist regularly so that so far that the damage has eyesight has already been affected and cannot be reversed.

Is the glaucoma test painful? 1
No. This test is painless. Your ophthalmologist (a medical doctor who is specifically trained to perform certain eye tests and treat eye diseases) will test for the following:
  • vision
  • damage on sensitive lining inside eye
  • normal eye pressure
  • visual field test

 

This test will take between 30 – 60 minutes.

What causes the pressure inside my eye to rise? 1
There are little canals inside your eye through which fluid inside the eye (aqueous humor) drain -these little canals can become clogged or even completely blocked. The eye can also produce too much of this fluid and then it cannot drain fast enough through the little canals.

What can I do to prevent my glaucoma from getting worse? 1
The most important goal is to prevent any further damage to your optic nerve. It is therefore very important to make sure the IOP does not increase. This is also the main reason why you should never stop using your medication!

Will my glaucoma ever go away? 1
The most common types of glaucoma are chronic, which means you will have to treat it for life. Remember as soon as you stop your treatment the pressure will rise again and cause more damage to the eye, which will affect your eyesight!

Do you get different types of glaucoma? 1
Yes you do. There are two major groups or types: Open-angle glaucoma and angle-closure glaucoma.


Open-angle glaucoma

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What is open-angle glaucoma? 1
A partial blockage in the drainage canals causes the IOP to rise slowly over time. The continuous high IOP causes optic nerve damage, resulting in visual field loss. The loss of eyesight is very gradual, and you only become aware of the impact when the optic nerve is damaged extensively. This type of glaucoma is the most common form of glaucoma.

What is angle-closure glaucoma? 1, 3
It is a far less common form than open-angle glaucoma. It is also called acute glaucoma. The drainage system is blocked by the iris (the coloured part of your eye). The fluid is not able to drain through the little canals. It is very different from open-angle glaucoma because the pressure rises very quickly and it can also be very painful; with severe headaches, eye pain and nausea. Unless this condition is relieved promptly, blindness can result very quickly.

What other types of glaucoma do you get?

  • Normal-tension glaucoma: this is a rare form of glaucoma. The optic nerve is damaged even though IOP is not high. 4
  • Secondary glaucoma: can occur as the result of an eye injury, inflammation or a tumour, or in advanced cases, cataracts or diabetes. This type might be mild or severe. 2, 1
  • Congenital glaucoma: occurs in infants, it is a very rare condition that develops as a result of incomplete development of the eye’s drainage canals during the prenatal period. The structural defects can be corrected with microsurgery. 1

Are some races more prone to glaucoma than others? 1
Yes. There appear to be substantial differences in racial susceptibility to glaucoma. It is the most common cause of blindness among black people of African-origin and probably also among Japanese individuals.

Can I prevent glaucoma from happening to me? 1
Currently there is no preventative method for glaucoma. Some people are more at risk of developing glaucoma than others. It is therefore important to visit your ophthalmologist regularly to test your eyes for glaucoma before it is too late.

Who are the people that are more at risk of getting glaucoma? 1
Anyone can suffer from glaucoma - however in some cases you are more at risk:
  • high intra ocular pressure
  • African-origin
  • old age
  • family history of glaucoma
  • nearsightedness (myopia)
  • medical diseases ­
    • diabetes
    • high blood pressure
    • migraine headaches
  • long term use of steroids
  • eye injuries


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What types of treatment are available to treat my glaucoma? 1
There are three basic options for open angle-glaucoma:
  • eye drops or tablets to lower the pressure in the eye
  • laser surgery
  • incisional surgery


How do the eye-drops work? 1
The drops reduce the pressure in the eye in one of two ways:

  • they decrease the amount of fluid production (aqueous humor)
  • they increase the drainage of the fluid through the little canals

In most cases your doctor will start with this type of medical treatment. Some drops have only one way to lower the pressure; others are called combination drops because they have more than one way of lowering the pressure and may be more effective.

Do the drops have side-effects? 1
Like other medications, drops do have some side effects. Ask your doctor for an option with the least side effects.

What are the most common side-effects? 1
Side effects are generally infrequent. Problems are mostly temporary and will go away as soon as you stop using the drops. Some problems include redness, burning and blurred vision. Ask your ophthalmologist for the best option for you.
Best results will be achieved with:

  • convenient dosing, e.g. once a day dosing
  • easy application, e.g. devices to administer
  • better tolerability, e.g. less side-effects

What if I struggle to put the drops into my eye? 3
Some of the drops have useful devices. These devices will assist you to make your daily routine much easier. Ask your ophthalmologist about this option.

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What if I forget to use my drops? 2, 3
It is very important to keep the pressure inside the eye low – remember as soon as the pressure gets high your optic nerve gets damaged and your eyesight will get worse! It is therefore VERY important to make sure you do not miss doses and do not stop your treatment. You may go blind if you do not adhere to your treatment programme as indicated by your ophthalmologist. Get into a daily routine to ensure that you do not forget to use your drops – for example use the drops straight after you have brushed your teeth every morning and /or evening.If you do forget – use your drops as soon as you remember, then continue as per your normal schedule. If it is already close to the time for your next drop, do not try to catch-up by applying extra drops.

What is the best way of using the drops? 1, 2, 3
Take the right dose at the right time every day, as prescribed. Do not miss a dose, do not increase the dose, and do not take the drops at different times every day. Use the drop instilling devices to make it easier for you to insert the drops into your eyes.

What will happen if I insert more drops than what the ophthalmologist prescribed? 1, 2

Remember to keep to the schedule prescribed by your ophthalmologist. Contact him/her before you change that schedule.

How does the laser surgery work? 1
If you do not respond well to medical treatment or you experience lots of side effects, laser surgery might be an option for you. The ophthalmologist uses the laser to burn small marks next to the canals. These marks stimulate the canals to drain more effectively.

Is the effect of laser surgery permanent?
The effect may only be temporary.

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What does the incisional surgery involve? 1
If medical treatment and laser treatment do not work to lower the pressure in your eye, incisional surgery may be considered. With this type of surgery the ophthalmologist will make an entirely new drainage system for your eye. New canals will be created to drain the fluid from your eye.

Some important reminders 1 - 4
  • From the age of 40 years and onwards – you should have an eye examination every 1-2 years.
  • Ask your ophthalmologist or optometrist to measure your intra ocular pressure.
  • If you have any of the risk factors make sure that you mention it to your ophthalmologist.
  • If you have any of the risk factors, you should go for an eye examination at least once a year.
  • If you have been diagnosed with glaucoma -inform your relatives so that they can also go for an eye examination.
  • Once you start with your treatment - do not stop!! You should never stop using your medication without first consulting with your ophthalmologist. As soon as the pressure rises - the damage to the optic nerve will continue.
  • Ask your ophthalmologist how drop instilling devices can assist you in applying the drops to ensure maximum protection against glaucoma.
  • Your treatment will only be effective if you adhere to your prescribed schedule.
  • Visit your ophthalmologist as directed – do not miss a visit!

*Disclaimer:
The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.

References:
1. The Merck Manual of Medical Information. Second Home Edition 2003. 2. Oxford Concise Medical Dictionary 1996. 3. The Royal College of Ophthalmologists. Mardeno Patient Atlas. Ophthalmology 2003-2005. 1st Edition. 4. Kanski JK, McAllister JA, Salmon JF. Glaucoma A colour Manual of Diagnosis and Treatment. Second Edition 1996. Pfizer Laboratories (Pty) Ltd. Reg. No.: 1954/000781/07. PO Box 783720, Sandton, 2146. Tel: 0860 PFIZER (734937). Fax: (011) 783 0912.


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