Glaucoma – blindness threatens

If the Diagnosis If glaucoma is diagnosed, quick action is usually required. Various eye diseases can be the cause of this diagnosis, but in any case, vision is threatened.

If glaucoma is diagnosed, quick action is usually required. Various eye diseases can be the cause of this diagnosis, but in all cases, vision is threatened without any significant symptoms initially occurring.

The first so-called "visual field defects" appear at the outer edge of the visual field. The optic nerve deteriorates, the signals between the eye and the brain are hindered. If the optic nerve is destroyed, vision is lost.

These images show the typical loss of peripheral vision:
normal visual field (left), early stage glaucoma (middle) and advanced stage glaucoma (right).

Glaucoma permanently damages the optic nerve

If detected early, vision can be preserved in most cases. However, it is crucial that those affected visit the ophthalmologist regularly for check-ups and follow the treatment diligently.

When the eye is under pressure

The normal pressure inside your eye keeps the eye in shape and ensures optimal functioning. The eye pressure is regulated by the inflow and outflow of "aqueous humor". This fluid inside the eye washes around the lens and cornea. Where the iris and cornea meet - in the chamber angle of the eye - the aqueous humor flows out again.

The aqueous humor provides the eyes with new nutrients and at the same time rids them of unnecessary tissue residues. The level of eye pressure determines how quickly the fluid is produced in the front part of the eye and whether it can drain away easily.

A disturbed drainage

If the drainage system in the chamber angle is blocked, the eye pressure increases. Depending on the cause of the blockage, two different forms of glaucoma can arise:

• Angle-closure glaucoma
This form of glaucoma occurs when the angle between the cornea and the iris is blocked or narrowed. The impaired drainage then increases the pressure in the eye. With age and with cataracts, the chamber angle narrows. There can also be a sudden blockage (acute angle-closure glaucoma), the "glaucoma attack".

• Wide angle or open angle glaucoma
Structural changes in the tissue of the chamber angle or deposits can make it increasingly difficult for the aqueous humor to drain, even if the chamber angle remains open. The drainage channels can also become blocked. As a result, the pressure in the eye increases.

Wide-angle or open-angle glaucoma is the most common form of glaucoma in Germany.

eye pressure and nerve damage

Increased eye pressure does not always lead to glaucoma, but glaucoma can also develop when eye pressure is normal.

The development of glaucoma can be genetic. Biological factors that cause damage to the optic nerve are: when the optic nerve does not receive enough blood, the immune system does not respond appropriately to damage to the retina and the pressure in the brain is too low, which leads to a problematic pressure difference between the eye and the brain.

People with previous eye injuries, severe short-sightedness and those undergoing cortisone treatment are more likely to develop glaucoma. Narrow-angle glaucoma occurs in people with long-sightedness and in families with a history of glaucoma. The risk of glaucoma also increases with age.

Glaucoma-prevention

The Professional Association of German Ophthalmologists recommends that people aged 40 and over should have an annual eye examination, during which glaucoma prevention is carried out with eye pressure measurement plus assessment of the optic nerve head. If there is an increased risk, an earlier check is advisable. We measure as part of our complete health check eye pressure and visual field.

Possible treatment options

If the optic nerve is damaged, it cannot be reversed. However, therapy can help control glaucoma. Possible therapies include:

• medication
The first step is usually to prescribe prescription eye drops to reduce the pressure in the eye. If that doesn't help, other medications are available. In addition to eye drops, tablets or capsules are also administered for a limited period of time.

• Laser therapy
If medication does not reduce the pressure sufficiently, a so-called "laser trabeculoplasty" may be recommended for wide-angle glaucoma. Doctor A low-level laser is aimed at the tissue of the chamber angle so that the aqueous humor can drain more easily and the eye pressure is reduced.

• Operation
If necessary, surgery can improve the drainage of the aqueous humor. The standard procedure is a "trabeculectomy", in which a small valve-like opening is created in the eye through which the aqueous humor can drain.

With the aim of reducing eye pressure, numerous new surgical methods and devices have been developed in recent years to help resolve the outflow obstruction in the tissue of the chamber angle.

Glaucoma as an Emergency

The sudden closure of the angle between the iris and cornea (acute angle-closure glaucoma) is a medical emergency. If symptoms or signs such as visual disturbances, severe eye pain, headaches, nausea and vomiting occur, you should seek medical attention immediately. Only by starting treatment in good time can the impending loss of vision be averted.