What is glaucoma?

When glaucoma occurs, there is a disturbance in the outflow of aqueous humour, which creates increased pressure on the optic nerve and leads to its permanent decline. It is a common disease which has led to blindness in more than five million people. This disease can appear at any age. It can also be congenital, i.e. present since birth, but it is most common in the elderly population.

Glaucoma often occurs without pronounced symptoms and warnings and gradually damages eyesight. Since it works quietly and imperceptibly, it is also called the silent thief of sight. Therefore, it is not surprising that its diagnosis is often missed until it reaches a state in which visual impairment is already clearly progressing and begins to affect quality of life. This underscores the importance of advancing knowledge and promoting awareness about glaucoma, alongside regular ophthalmic examinations, as primary directives for disease prevention and the maintenance of eye health.

Glaucoma is often considered a synonym for increased eye pressure. However, glaucoma does not mean elevated eye pressure but most often occurs as a consequence of it. In other words, if you have elevated eye pressure, it serves as an indicator of possible glaucoma. Additionally, glaucoma is characterised by functional and structural damage. The state of increased eye pressure itself, without such damage, is called ocular hypertension.

Risk factors for the development of glaucoma should be assessed in patients with ocular hypertension. This assessment is important because it determines whether the patient will be prescribed a specific therapy or whether regular monitoring will be sufficient. Aside from ocular hypertension, other risk factors for glaucoma are age, positive family history, high degree of nearsightedness, migraines and diabetes.

Despite glaucoma frequently manifesting without distinct and easily recognisable symptoms, specific cues exist that can be linked to its onset. These cues deserve attention in matters concerning eye health.

We distinguish between open-angle and closed-angle glaucoma. The angle refers to the place where the iris and pupil meet in the area of the eye’s anterior chamber. The angle is also where the largest proportion of aqueous humour drains from the eye. Open-angle glaucoma is the most common form of glaucoma and generally has no pronounced symptoms. Narrow-angle glaucoma can cause pain and redness, heralded by signs such as blurred vision or circles around light sources.

In addition, there is an acute and chronic type of glaucoma. The chronic type is much more common and occurs in 90% of all glaucoma cases. It occurs when the aqueous humour cannot drain freely from the eye, so it accumulates in the eye and causes increased eye pressure. This puts pressure on the nerve fibres and the optic nerve blood vessels.

Optic nerve damage occurs slowly and first affects peripheral vision. In the early stage, visual field losses occur and spread from the periphery towards the centre, resulting in a narrowed field of vision. Chronic glaucoma does not have clear signs of the disease, but patients may have symptoms such as pressure in the eyes, watery eyes, blurred vision and occasional headaches over a longer period of time.

As a result, patients who don't undergo regular eye pressure checks often struggle to suspect glaucoma until their field of vision starts narrowing. The disease should be recognised and treated as soon as possible; otherwise, damage to the central vision and blindness will occur. Therefore, it is extremely important to be informed and regularly perform ophthalmic examinations for disease prevention.

Glaucoma treatment depends on its type and degree of disease or damage. Since hypertension is the most significant risk factor for the development and progression of glaucoma, treatment is aimed at lowering eye pressure. The goal of treatment is to achieve the target pressure based on an individual approach. This means that the target pressure represents a value that, in an individual patient, does not lead to the onset or progression of the disease.

Glaucoma can be treated with medication, laser or surgery. The most common form of treatment is medication. If medication or laser therapy is not effective, it is necessary to lower the eye pressure with surgery. The treatment can be carried out with different eye drops prescribed only by an ophthalmologist specialist. Moreover, when using some drops, certain side effects may occur, so caution is required when using them. This is exactly why an ophthalmologist’s assessment is crucial for choosing the appropriate drops, and patients should never choose or change therapy independently.

Glaucoma is a chronic disease. This means that once diagnosed, it is treated for the rest of a person’s life. The purpose of glaucoma treatment is to preserve the patient’s vision as much as possible. Therefore, it is important that the patient, the ophthalmologist and the family doctor are involved in the treatment process and that they cooperate well and regularly.