Why does glaucoma develop?
Glaucoma is an increase in intraocular pressure independent of arterial pressure. To date, no specific factor leading to glaucoma has been identified. However, there are certain risk factors, and among the main ones is genetic predisposition. If the patient’s parents or close relatives have glaucoma, he is most likely at risk.
– Who else can suffer from it?
– The risk of glaucoma increases in patients with high myopia, diabetes, and sleep apnea. People with metabolic disorders, smokers, suffer from hypotension. Also, regardless of other factors, the likelihood of developing glaucoma begins to rise after the age of 40.
– How exactly does high blood pressure cause vision problems?
– High intraocular pressure damages the optic nerve. It has the same consistency as the substance of the brain – a very soft substance. And it bends under increasing pressure.
If the optic nerve is in this state for a long time, this leads to trophism, a violation of nutrition, and eventually to complete atrophy of the optic nerve.
Has glaucoma become more common in recent years?
Yes, glaucoma is very common now. And this is due to two main factors. First, glaucoma is an age-related disease. That is, it develops in patients older than 40 years. Now the quality of life has greatly increased, and accordingly, there are patients between the ages of 90-100. As a result, the prevalence of glaucoma has increased in the elderly population.
Second, we learned how to diagnose glaucoma in its early stages. This also affected the data on the prevalence of the disease: we can count such cases because we can detect them.
These two factors have of course increased the prevalence of glaucoma not only in Russia but also all over the world.
– You said that people with myopia are at risk. Is it more common today?
– Yes, myopia (myopia) is also a big scourge of eye diseases. Its prevalence has increased significantly and there are more cases of moderate to high myopia.
These patients have a thin cornea and a large optic nerve. These are factors that predispose to an increase in intraocular pressure and, accordingly, the development of glaucoma.
Therefore, patients with myopia should be examined more frequently by an ophthalmologist for glaucoma.
– How common is glaucoma in Russia today?
– In the general population in Russia, regardless of age, glaucoma occurs in 3% of the population. Today, there are approximately 1 million 800 thousand cases. But if we consider age groups, 6% of people aged 40-50 have glaucoma, while in the age group 50-60 there are twice as many cases – 12%. And among people 70 years and older, that’s one in three patients.
How often does glaucoma cause blindness?
Glaucoma is an irreversible, chronic disease. And if glaucoma is left untreated, it leads to complete and irreversible blindness in 100% of cases.
It’s going pretty slow, isn’t it?
– Slowly, if controlled and not progressing. And without treatment, you can go completely blind in 5-6 years. With treatment, visual impairment can last for decades, and the patient can live for a lifetime, preserving his vision.
But unfortunately there are no guarantees. Glaucoma always progresses even with treatment. Therefore, it is important that the patient is observed by a doctor and that the intraocular pressure is checked for timely adjustment of therapy, this will minimize the risk of blindness.
– Is it possible to suspect yourself of glaucoma in the early stages, when your vision is still intact?
– Unfortunately, glaucoma in its initial stages does not give any complaints. That’s what makes it scary. The person does not feel the increase in intraocular pressure. Pain does not occur. The only thing that can happen is a minor inconvenience. Sometimes patients come to us with complaints that reading becomes difficult or tears appear. We examine them and find glaucoma.
Unfortunately, glaucoma has no specific symptoms.
Therefore, the Ministry of Health has an instruction for the clinical examination and active detection of glaucoma. Intraocular pressure measurement should be made in all patients over the age of 40 and should be examined specifically for glaucoma, so that ophthalmologists can detect the disease at the very beginning, even without the patient’s complaint.
– A characteristic symptom of glaucoma is a decrease in the visual field. Missing in the early stages?
– Yes, the narrowing of the visual field is already observed in the later stages. This is due to atrophy of the optic nerve. And if it has arrived, the vision cannot be returned.
Another problem is that patients realize this deterioration too late. Up to a certain point, the second eye compensates for the field of view. In general, glaucoma is the most insidious disease.
– What is the treatment?
– The first stage is conservative treatment. The patient is prescribed antihypertensive drops that reduce intraocular pressure. We now have a large number of effective tools in our arsenal. Just 20 years ago, glaucoma was operated more often than conservatively. Now, on the contrary, we have moved significantly away from surgery.
– But are there situations where it is necessary?
– Yes, there are aggressive types of glaucoma where drops do not help. But surgery is the last option when other methods fail. There is an intermediate option between drops and surgery – laser therapy. Like other methods, it is aimed at lowering intraocular pressure.
How does laser therapy work?
– One of the main ways to lower intraocular pressure is to improve the outflow of intraocular fluid. Especially drop therapy is aimed at this. Laser surgery allows you to open the way out. We make such holes with a laser in the trabeculae, which are the “frame” of eye tissues. Intraocular fluid flows through these artificially created holes and the pressure drops.
Is it possible to somehow predict the effectiveness of treatment?
– Much depends on the shape of the glaucoma. The most common open-angle glaucoma responds well to conservative treatment. But in pigmented, pseudoexfoliative and other aggressive complex forms, surgery is indispensable.
However, in any case, the patient should regularly visit an ophthalmologist. We assign quarterly monitoring and see if there is progress, if the pressure has been compensated. If it is not possible to compensate with drops, laser therapy is performed, if it does not help, surgery is performed.
– Have new therapeutic approaches emerged in recent years?
– The same laser treatment can be attributed to new approaches. It is low-impact and gives good results. There is one “but” – it needs to be periodically repeated or operated.
But perhaps the newest method could be considered the placement of a biodegradable implant that releases the drug over time.
For the treatment of glaucoma, it is important for the patient to regularly use the drops, but in practice, people often violate the regimen. The implant works similarly to an insulin pump – it ensures an even supply of medication when the intraocular pressure rises. Thus, the patient does not have to drip anything – he lives quietly, and the implant helps to control the intraocular pressure. It is small, located under the conjunctiva or inside the eye cavity. This is the most promising method for minimally invasive treatment. However, as with laser treatment, the implant will need to be updated periodically.
– Are these implants already in use somewhere?
– Abroad, the first stages of clinical trials are currently underway. But at least I personally have already seen such an implant in one patient. It was a brimonidine implant and indeed it helped control the intraocular pressure quite well.
In addition, new minimally invasive surgical techniques are being developed. Literally in 2-3 minutes the eye is drained and fluid flows through it. And another great aspect in glaucoma treatment is the support of the optic nerve. It is necessary to protect and, if possible, restore the optic nerve during atrophy.
Since patients with glaucoma are older, they have neurodegenerative changes, and against this background, atrophy is exacerbated.
Therefore, neuroprotection is very important. Extensive research is being carried out in this area all over the world. Unfortunately, progress is still small.
– Is there any protection from glaucoma?
– The only way to prevent it is to go to an ophthalmologist and measure the intraocular pressure. There are no other events. A healthy diet, an active lifestyle, giving up bad habits – all this, of course, is useful in the prevention of any disease. But glaucoma occurs gradually, unnoticed, and after 40 years you need to see an ophthalmologist once a year in order not to miss this moment. At an earlier age, as a rule, there is nothing to worry about – at least for those who are not at risk.