It should be realized that the very fact that the patient is being observed for glaucoma and that he regularly undergoes specialist examinations, significantly reduces the risk of blindness due to glaucoma. Most cases of blindness occur in patients who have not been regularly examined by an ophthalmologist.
To whom and when does glaucoma surveillance begin?A patient monitored for glaucomais an adult who has symptoms that may be suspected in an ophthalmological examination. These symptoms are:
- intraocular pressure above 22 mmHg
- abnormal appearance of the optic nerves (widening of the cavity, visible ethmoid plate, abnormal HRT laser tomography)
- abnormal image of the retinal nerve fiber layer, found in the GDx laser polarimetry test
- glaucomatous abnormalities found in the FDT visual field examination.
It is also important to have a thorough interview with the patient. find out if the patient's family history has a history of glaucoma, is the patient he althy, is being treated for any systemic diseases, or if he or she has vascular risk factors such as migraine headaches, freezing hands and feet, low blood pressure or chronic exposure to stress.
Observation of intraocular pressure and assessment of the optic nerve
If a patient is diagnosed with increased intraocular pressure, it is not a sufficient symptom to recognize and treat glaucoma. However, clinical studies show that the higher the pressure in the eye and the longer it lasts, the greater the risk of developing glaucoma. In such cases, a detailed assessment of the optic nerve is recommended.
The gold standard is the performance of HRT, GDx, OCT, GCL and field of view tests in FDT technology and monitoring of the parameters obtained in these tests. If there is deterioration in the results of subsequent tests, treatment is indicated. The distinction between ocular hypertension and glaucoma is not easy and can only be made by a specialized ophthalmologist, only after very careful observation over a period of time. There is nodetailed guidelines as to when to initiate treatment, and this often depends on the experience of the treating physician.
Glaucoma - see what are its symptoms
If the patient has normal eye pressure, but the optic nerve image is suspect glaucomatous, then such patient should also be included in the group of patients observed for glaucoma and regularly examined for this. If the parameters of the optic nerve obtained in the HRT, GDx, OCT, GCL tests deteriorate on subsequent follow-up examinations, the patient should be treated despite the normal pressure in the eyes. Clinical studies show that lowering the intraocular pressure, regardless of the baseline pressure, significantly reduces the risk of developing glaucoma and related blindness.
The finding of recurrent visual field defects that meet the criteria for glaucoma damage adopted by the European Glaucoma Society should always be an indication for treatment irrespective of eye pressure.
Glaucomatous changes in the field of vision are accompanied by corresponding changes in the optic nerve. If the optic nerve is normal, the attending physician must look for causes other than glaucoma for visual field defects. The possibility of incorrect performance of the visual field examination should be taken into account, either as a result of errors made during the examination by the person performing it, or due to the lack of appropriate cooperation on the part of the patient during the examination.
In the observation of a patient suspected of glaucoma, it is also important to measure the thickness of the cornea, i.e. to perform a pachymetry test. A thin cornea is a poor prognostic factor and such a patient should be monitored more frequently. The corneal thickness measurement result also influences the interpretation of the intraocular pressure, and often allows the initial diagnosis to be verified and the decision to start treatment or to discontinue drugs.
Based on all the tests performed, the ophthalmologist must determine the patient's risk of developing glaucoma. You should consider together with the patient whether the degree of risk of developing glaucoma justifies the inconvenience of treatment. Unnecessary treatment exposes the patient to the side effects of medication, the psychological burden associated with the diagnosis of the disease, and financial costs. It should be considered whether the risk of developing glaucoma is greater than the treatment burden. The patient's willingness to cooperate with the doctor or the lack of it is also important, because if the patient does not report for the check-up, therisk of not recognizing early glaucoma lesions, if they appear.
About the authorBarbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Centrum Opulystowa Targowa 2, WarsawDr. 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
Glaucoma develops slowly, often asymptomatically. Glaucoma is usually detected by accident, during an eye examination with an ophthalmologist or the selection of glasses. What are the causes of this disease and how to recognize the first symptoms of glaucoma? Listen to our expert prof. Iwona Grabska-Liberek, head of the department of ophthalmology at the Clinical Hospital W. Orłowski in Warsaw