Primary open-angle glaucoma, also referred to as chronic simple glaucoma, is the most common type of glaucoma in Poland. Primary open-angle glaucoma is a disease in which the optic nerve is damaged, resulting in defects in the visual field. What are the other symptoms of this condition? What are the risk factors? What is the treatment?

Primary open-angle glaucoma , also referred to as chronic simple glaucoma, is the most common type of glaucoma in Poland. It is a binocular disease, although it usually develops asymmetrically and almost always one eye is much more damaged than the other. The optic nerve is damaged, resulting in defects in the visual field.

Primary open angle glaucoma - risk factors

1. Family history of glaucoma (inheritance is multigeneous and the presence of glaucoma in family members significantly increases the patient's risk of developing this disease) 2. Age (this type of glaucoma most often develops in the elderly, less often before the age of 40) 3. Increased intraocular pressure (from a statistical point of view, an intraocular pressure higher than 22 mm Hg is considered abnormal, although higher intraocular pressure may also occur in he althy people who will never develop glaucoma; particularly suspicious fluctuations in this pressure during the day, which he althy person should not exceed 4 mm Hg)

Primary open-angle glaucoma is most often detected in patients over 35 years of age.

4. Myopia (due to worse blood supply to the optic nerve in the course of myopia and less tolerance of the optic nerve to even a slight increase in intraocular pressure, although the greater detectability of glaucoma in this group of people may be the result of more frequent ophthalmic control examinations when selecting glasses) 5. Diabetes mellitus (some clinical studies do not confirm the relationship between the occurrence of diabetes and glaucoma, although microcirculation disorders occurring in the course of diabetes may impair the nutrition of the optic nerve); 6. Cardiovascular disease (there is no strong evidence of atherosclerosis or diseaseischemic heart disease affects the development of glaucoma, although some studies indicate the negative impact of elevated cholesterol levels on the development of the disease, and systemic arterial blood pressure may favor the development of this disease due to weaker blood supply to the optic nerve) 7. Other vascular factors (migraines now and in the past, cold hands and feet, exposure to chronic stress)

How to recognize glaucoma?

Primary open angle glaucoma - causes

There are two main theories explaining the mechanism of the development of glaucomatous damage to the optic nerve:

1. The ischemic theory proves that glaucoma damage is caused by blood supply disorders and impaired microcirculation within the optic nerve.

2. The theory of mechanical damage proves that long-term high intraocular pressure causes pressure on the nerve fibers at the level of the optic nerve and their atrophy, and on small blood vessels, causing them to collapse and associated ischemia.

Primary Open Angle Glaucoma - Symptoms

Primary open-angle glaucoma is characterized by an insidious onset, slow progress and no pain. Although it is a binocular disorder, it is usually characterized by asymmetry. Because central vision remains relatively normal until late in the disease, the loss of vision can be significant before visual field defects are noticed by the affected patient. Very advanced glaucoma usually leads to deterioration of vision, eye pain and redness.

Primary open angle glaucoma - diagnosis

The patient's examination and history do not reveal any abnormalities that could be the cause of the developing glaucoma. Primary open-angle glaucoma is most often detected in patients over 35 years of age. To recognize this type of glaucoma, your doctor must test that:

  • the intraocular pressure increased to over 21 mm Hg
  • there is an open angle of the anterior chamber (gonioscopic examination or AS-OCT laser tomography of the anterior segment of the eye)
  • there was glaucomatous damage to the optic nerve (HRT, GDx, GCL, OCT)
  • there are glaucomatous defects in the visual field (FDT or standard static HFA perimetry)

In some patients with glaucoma, the intraocular pressure never exceeds 22 mmHg and they should be included in the group of patients with normal-pressure glaucoma.

Primary open angle glaucoma - treatment

Treatment of glaucoma is a long-term process that lasts for the rest of your life. It aims to lower the pressure in the eyes tothe value at which no further damage to the optic nerve will progress. Treatment must always be tailored to the individual case and provide the patient with maximum safety. Usually, in the initial stages of glaucoma, drug treatment in the form of eye drops is used. If lowering the pressure is not enough, laser therapy is used. In more advanced cases, and when conservative treatment is ineffective, surgical procedures are performed.

Primary open angle glaucoma - prognosis

Most properly treated patients retain useful visual acuity for the rest of their lives. If glaucoma is detected in the early stages of the disease, the chances of stopping the disease are high. Therefore, it is necessary to perform screening tests at least once a year in the patient's family and in people from high-risk groups. Every he althy person, regardless of whether they have any risk factors for developing glaucoma, should undergo regular eye check-ups at least once a year and should always be referred for detailed glaucoma examination if any suspicious symptom is found.

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 degrees of specialization 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).

Glaucoma - treatments for glaucoma

Glaucoma is treated with various methods - their choice depends on the stage of the disease - from the least invasive - drops - to surgical treatment. What method of glaucoma treatment bringsthe best results? 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.

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Eye diseases and vision disorders