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VERIFIED CONTENTAuthor: Barbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Ophthalmology Center Targowa 2, Warsaw

Glaucoma is an eye disease that causes the optic nerves to atrophy and leads to irreversible blindness. Glaucoma develops slowly, often asymptomatically, and is usually detected by accident, during an eye examination with an ophthalmologist or when choosing glasses. What are the causes of this disease and how to recognize the first symptoms of glaucoma for the best results? What are the types of glaucoma?

Glaucomalike other serious eye diseases occurs mainly in the elderly. About 70 million people are sick worldwide. Despite the constantly progressing development of medicine, we still do not fully know the exact causes of its formation. We also do not have fully effective treatments for this disease. However, we can delay its development, which is why it is very important to perform diagnostic tests on a regular basis.

When talking about glaucoma, one should start with whatglaucomais NOT.GlaucomaThis is not one disease that can be easily defined and treated.Glaucomais a group of diseases that cause atrophy of the optic nerves and irreversible blindness associated with it. The disorder defined by the common term " glaucoma " consists of several disease entities.

Each of these diseases has different causes, risk factors, symptoms and prognosis, and requires different treatment. The common denominator is that, in the end, all these diseases lead to optic atrophy and complete blindness.

Symptoms of glaucoma

Glaucomamay be asymptomatic.The symptoms of glaucomaare the most common:

  • photophobia
  • frequent watery eyes
  • seeing rainbow circles or spots when looking at a light source
  • difficulty adjusting your eyesight to the dark

Since in the case of glaucoma, the fibers responsible for peripheral vision first disappear, the patient first loses the image of what is on the edge of the field of view.

In acute attacks of glaucoma, there are:

  • characteristic severe eye pain
  • nausea
  • stomach pains
  • headaches located above the brow ridge radiating backwards
  • visual disturbance
  • vomiting
  • heart abnormalities

The eye can become hard, red and painful. In the event of an acute attack of glaucoma, immediate help from an ophthalmologist is needed, often ending with a quick operation.

Prof. dr hab. Iwona Grabska-Liberek - 90 percent cases of glaucoma are asymptomatic. - In Poland, it is estimated that around 800,000 people suffer from glaucoma. Glaucoma, along with age-related macular degeneration and cataracts, is one of the most common causes of blindness. About 60 million people suffer from it worldwide and the forecasts are that by 2022 11 million people will go blind, says Prof. dr hab. Iwona Grabska-Liberek.


The mechanism of glaucoma

There is an uninterrupted circulation of fluid inside the eyeball, the so-called the aqueous humor that supplies the eye tissue with nutrients and carries waste away from them. The newly formed fluid drains into the blood vessels through a part of the eye called the drain angle.

If the drainage angle is closed or there are openings in it, the so-called the pores become clogged, the balance between fluid production and its outflow is disturbed. As a result, the pressure inside the eye, which is a closed sphere, increases and leads to irreversible destruction of the nerve fibers of the retina and the blood vessels that nourish them, atrophy of the optic nerve, and ultimately leads to blindness.

Types and classification of glaucoma

The basic classification distinguishes open-angle and closed-angle glaucoma, as well as primary and secondary glaucoma. To classify, it is necessary to know the width of the anterior chamber angle and the circumstances that may be a secondary cause of glaucoma. Glaucoma is classified based on:

  • width of the drainage angle (gonioscopic examination, AS-OCT tomography of the anterior segment of the eye),
  • image of the optic disc, layer of nerve fibers and retinal ganglion cells (HRT, GDx, glaucomatous OCT, GCL / GCC),
  • damage to the field of view (standard SAP perimetry and modern FDT technology),
  • main risk factors:
    • intraocular pressure
    • age
    • local and general vascular risk factors
  • accompanying ocular and extra-ocular diseases and their treatment that may be a secondary cause of glaucoma, and finally
  • other useful data:
    • blood pressure
    • heart rate
    • blood glucose level
    • migraine
    • freezing hands and feet
    • Raynaud's disease
    • thyroid disease
    • neurological diseases
    • history of kidney disease
    • history of loss of large amounts of blood
    • smoking
    • drinking alcohol
    • family history loss of vision
    • family glaucoma

Glaucoma breakdown

The European Glaucoma Society (EGS) uses the classification of glaucoma, taking into account the width of the tidal angle and the causes of the disease:

  • primary congenital glaucoma

  • primary open angle glaucoma

  1. juvenile primary glaucoma
  2. primary open angle glaucoma (JPOK)
  3. Normal Pressure Glaucoma (JNC)
  4. ocular hypertension (NO)
  • secondary open angle glaucoma (JWOK)

  1. glaucoma in the course of pseudo-exfoliation syndrome - pigmentary glaucoma - glaucoma associated with lens pathology - glaucoma associated with uveitis;
  2. glaucoma associated with retinal detachment - glaucoma associated with intraocular haemorrhage - glaucoma associated with intraocular tumors;
  3. glaucoma caused by eye trauma - glaucoma caused by steroid treatment - glaucoma caused by surgery or laser surgery - glaucoma caused by a disturbance in the outflow of blood from the eye socket.
  • primary closed angle glaucoma (JPZK)

  1. angle-closure glaucoma, acute, subacute, or chronic;
  2. state after sharp closing of the percolation angle
  3. closure of the drainage angle in the course of pupillary block, flat iris syndrome or lens pathology.
  • Secondary Closed Angle Glaucoma (JWZK)

  1. secondary glaucoma associated with a swelling or displaced lens;
  2. neovascular glaucoma related to the disturbance of microcirculation in the eye;
  3. malignant glaucoma- glaucoma with congenital anomalies of the angle.

Glaucoma: risk factors

  • family history of glaucoma (first degree of relationship: parents, siblings)
  • over 40
  • hypertension or hypotension
  • diabetic retinopathy
  • high cholesterol
  • frequent headaches, migraine
  • constantly cold hands and feet, i.e. peripheral circulatory disorders
  • smoking
  • myopia, hyperopia
  • eyeball diseases
  • stress
  • trauma
  • corticosteroid treatment
  • long-term use of oral contraceptives

Presence of 3 or more risk factorsrequires a visit to a specialist.

Glaucoma: the basis of diagnostics

If the disease is to be properly treated, the first step is a detailed diagnosis of glaucoma and a proper diagnosis. Each type of glaucoma often requires completely different treatment procedures for the patient.

The biggest diagnostic problem is the most common in Polandglaucomaprimary open angle glaucoma (JPOK), which in the vast majority of cases does not give any warning symptoms at the beginning and the patient does not is aware that he is going blind and does not go to an ophthalmologist for help andglaucoma treatment .

Worth knowing

Pioneering treatments for drug-resistant glaucoma

Pioneering ultrasound treatments of the ciliary body plastic surgery, used in glaucoma resistant to pharmacological treatment, were carried out by a team led by prof. Edward Wylęgała in Katowice. Ultrasound plasty of the ciliary body is used in drug-resistant glaucoma. It is an innovative procedure that uses ultrasound energy to reduce the production of aqueous humor. The procedure is performed under local anesthesia. The surgeon's task is to precisely position the transducer emitting ultrasounds on the eye. After sucking on the plastic interface with a micropump, the surgeon controls the treatment process. The healing beam is applied to the six sectors of the sclera, under which the ciliary body is located. The procedure takes less than five minutes; Due to the precision and innovation, complications are rare and mild.

Glaucoma - treatments for glaucoma

Treatment of glaucomais carried out using various methods - their choice depends on the stage of the disease - from the least invasive - drops - to surgical treatment. What is the best glaucoma treatment? When do we use non-surgical treatment and when is surgery necessary? Our expert, prof. Iwona Grabska-Liberek, head of the department of ophthalmology at the Clinical Hospital W. Orłowski in Warsaw.

About the authorBarbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Centrum Opulystowa Targowa 2, Warsaw

Dr. Barbara Polaczek-Krupa, MD, initiator and founder of the T2 Center. She specializes in modern diagnostics and treatment of glaucoma - this was also the subject of her PhD thesis defended with honors in 2010.

Dr. med. Polaczek-Krupa has been gaining experience for 22 years, since she started working at the Ophthalmology Clinic of CMKP in Warsaw, with which she was associated in 1994-2014. During this period, she obtained two degreesspecialization in ophthalmology and the title of doctor of medical sciences.

In the years 2002-2016 she worked at the Institute of Glaucoma and Eye Diseases in Warsaw, where she gained knowledge and medical experience by consulting patients from all over Poland and abroad.

For years, as part of cooperation with the Medical Center of Postgraduate Education, he has been a lecturer at courses and trainings for doctors specializing in ophthalmology and primary he alth care.

He is the author or co-author of numerous publications in scientific journals. Member of the Polish Ophthalmology Society (PTO) and the European Glaucoma Society (EGS).

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