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2.- What causes glaucoma?
There are a lot of risk factors that can contribute to the manifestation of glaucoma, being high intraocular pressure the most important one. In most cases, the rise of ocular pressure is secondary to a difficulty in eliminating the aqueous humour (intraocular fluid).
Intraocular pressure is considered normal under 22 mmHg, but some eyes suffering from glaucoma need to maintain lower pressures in order to avoid the progression of the disease.
3.- What can be done to avoid losing vision when suffering glaucoma?
The best thing that can be done nowadays is to prevent it, so attending an appointment with the ophthalmologist once a year is necessary in order to carry out early diagnostic tests. It’s especially important among people at risk for glaucoma.
4.- Who has more risk to suffer glaucoma?
• Those suffering from increased intraocular pressure: This is the main risk factor to develop glaucoma and decreasing the pressure with a suitable treatment is very important to improve the prognosis of the disease.
• Those having family history of glaucoma: There is between 4% and 16% of risk to develop glaucoma if some first grade relatives (father, mother and/or siblings) suffer it.
• The risk increases with age: 2% over 40 years and 4% over 60 years.
• Racial factors: Among the black population the incidence of glaucoma is higher than in the white one, and the onset of the disease tends to be earlier and also more aggressive.
• Myopia: People suffering from myopia have approximately double the risk to develop glaucoma than the rest of the population.
Totes les persones amb major risc de patir glaucoma haurien de ser avaluades per un oftalmòleg per a facilitar el diagnòstic precoç de la malaltia.
5.- Is there more than one type of glaucoma?
Glaucoma d'Angle estret:
Es pot presentar de forma aguda o crònica. La forma aguda sol cursar amb gran dolor ocular, vermellor de l’ull i visió borrosa, pel que la majoria dels pacients acudeixen a un servei d’urgències on se’ls realitza el diagnòstic. És una situació greu, amb un elevat risc de pèrdua de visió, on un diagnòstic precoç i la realització d’un làser preventiu (iridotomies/iridoplàstia) poden evitar-ho.
There are a lot of different types of glaucoma. The following types stand out from the rest:
Primary open angle glaucoma:
This is the most frequent type, and tends to start developing from the age of 40. Its evolution is slow and doesn’t present any symptoms until late stages (when vision loss takes place). It generally gets diagnosed during a regular check up at the ophthalmologist office.
Angle closure glaucoma:
It can appear as acute or chronic. The acute type involves a strong ocular pain, eye redness and blurred vision, so most patients that suffer it attend an emergency service where they carry out the diagnosis. It is a serious condition, with high risk of vision loss. It can be avoided with early diagnosis and preventive laser procedures (iridotomies/iridoplasties).
Secondary glaucoma:
This is a heterogeneous group of different glaucoma types. A primary anomaly in the eye, such as pigmentary glaucoma, pseudoexfoliative glaucoma, inflammation, trauma…, causes the glaucoma.
Congenital glaucoma:
It arises in newborns and is secondary to anomalies on the fetus development during pregnancy affecting the trabecular meshwork (where the drainage of the aqueous humour takes place)
6.- How is glaucoma diagnosed?
Glaucoma is a silent, slow and irreversible disease, so patients suffering from it are not aware of it until its late stages. For this reason, early diagnosis is very important.
Glaucoma diagnosis is carried out through a comprehensive ophthalmologic examination, addressed to evaluate intraocular pressure and the state of the optic nerve, and according the doctor’s judgment, also after carrying out one or more complementary tests. The fundamental complementary test is the campimetry, to assess the visual field. Technology is currently so evolved that we have new equipments that assist us in achieving an early diagnosis, such as: imaging techniques (GDX, OCT, HRT and new types of perimetry (FDT).
After finishing the first examination and according to the doctor’s opinion, the necessary check-ups will be provided. It must be taken into account that glaucoma is a disease with slow progression, and that the diagnosis with only one examination is not easily achieved, unless the disease is in a very late stage.
7.- What is the treatment for glaucoma?
És molt important el compliment del tractament per a aconseguir controlar la malaltia.
No aplicar-se les gotes correctament suposa un risc a la seva visió.
The main aim for the treatment is to preserve the vision of the patient and a good quality of life. Currently, this is only achieved by decreasing the eye pressure.
The main treatment is medical and it involves applying eye drops in the eye. The eye drops contain different medicinal drugs which contribute to decrease the eye pressure (intraocular pressure).
In some cases, the medical treatment is not enough, and surgical treatment will be the option to control the disease.
It is important to know that the eye is not naturally prepared to take eye drops, so applying too many eye drops will cause discomfort and irritation, especially if multiple drops need to be used.
It is very important to follow the treatment carefully in order to control the disease.
8.- When is surgical treatment required?
• In those cases where the eye pressure does not decrease after medical or laser treatment.
• In those cases where the disease progresses even after following medical or laser treatment.
• Some types of glaucoma require surgical treatment to be the first treatment option.
• In those cases where there is intolerance to medical treatment.
The most usual surgical techniques for the treatment of glaucoma are as follows:
• Trabeculectomy
• Non-penetrating deep sclerectomy
• Drainage device implants
• Destruction cicle through diode laser
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9.- Can laser be used for the treatment of glaucoma?
In glaucoma laser is used in two particular situations:
I. In those patients who suffer from a closed or ocludable angle, and therefore have the risk to develop acute closed angle glaucoma. For this kind of patients a particular type of laser, known as YAG Laser, is used to produce a little perforation of the iris (Iridotomies) which, in most cases, will be enough to decrease the risk to suffer glaucoma. However, the patient will still require periodic check ups to monitor the angle.
In some cases, this laser procedure is not enough and ARGON Laser is applied, in order to expand the iridocorneal angle (Iridoplasty).
II. There is a another procedure known as Laser Trabeculoplasty.
This type of treatment causes, on a temporary basis, a decrease of the eye pressure. It can be performed in certain open angle glaucoma cases.
It is worth mentioning that all laser treatments are outpatient procedures and are not risks free.
10.- Can glaucoma cause blindness?
Yes, some glaucoma types can cause blindness, but in most cases, with the right treatment, there is a favourable outcome.
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