Treatment of glaucoma abroad
Glaucoma is a group of ophthalmic diseases that are characterized by the progressive narrowing of the visual field due to constantly or periodically increased intraocular pressure. This disease is widely spread and its risk increases with age.
Glaucoma incidence before age of 49 is 0, 1%. Starting from the age of 50 and up to 69 the incidence of the disease is about 3%. After the age of 80, glaucoma can be diagnosed in 14% of population. Glaucoma causes complete blindness in 15% of people.
Causes of Glaucoma
Main glaucoma risk factors:
- Heredity. If a family member suffered from glaucoma, the risk of illness increases 5 times.
- Age. Before age of 40 years the disease is very rare. Its probability is increasing exponentially with age.
- Myopia. Illness is peculiar with a decrease of intraocular structures rigidity that leads to higher chances of having glaucoma.
Additional risk factors that are defined by a specialist:
- Pseudo exfoliation syndrome
- Trabecular unit pigmentation
- Different intraocular pressure in both eyes
- Chorioretinal dystrophy
- Cerebral circulation disorders
Young patients with hypermetropia, good reaction of the pupil to the light, good functioning of ciliary muscle, and absence of cerebral circulation disorders have the lowest risk of glaucoma.
Symptoms of Glaucoma
Glaucoma is not just a single illness, but a wide group of ophthalmic pathologies. Each of them behaves differently, though any glaucoma is peculiar with:
- Eye hydrodynamics disorder
- Optic neuropathy
- An increase in intraocular pressure level
- Damage of visual functions
Most of glaucoma symptoms are result in optic nerve atrophy. Symptoms start to appear when more than 50% of cells are dead.
Symptoms of acute glaucoma attack are:
- Pain in the eye, often occuresalong with headache
- Mist in front of you, rainbow around the light sources
- Swelling of the cornea
- An increase in intraocular pressure up to 50-80 mm Hg
- Pupil dilation in the form of a vertically elongated oval
- Absence or reduction of the pupil reaction to light
- Clearly visible blood vessels in the sclera
- While checking the fundus - swelling of the optic nerve
Subacute glaucoma attack behaves the same way, but symptoms are less expressed.
Glaucoma - Diagnostics
Early diagnostics of glaucoma is impossible because of the asymptomatic course. But if a patient checks his eyes regularly at the ophthalmologist, the disease can theoretically be detected at the beginning stage.
Following methods are used for glaucoma diagnostics:
- Fundus analysis
- Intraocular pressure check
- Biomicroscopy of the eye (anterior division)
All the patients with suspicion for glaucoma have their intraocular pressure checked. It can be:
- Normal – up to 22 Hg
- Moderately increased - up to 32 mm Hg
- High – more than 33 Hg
To confirm the diagnosis doctors use:
- Intraocular pressure check
- Ultrasound biomicroscopy
- Eye hydrodynamics check
- Direct and indirect ophthalmoscopy
- Kinetic and static perimetry (in dynamics, the analysis is done twice a year)
Visualization methods are used more and more often. They help to examine anoptic nerve head and retina.
Following diagnostics procedures are applied:
- Scanning laser polarimetry
- Laser biomicroophthalmoscopy
- Optic coherence tomography
- Confocal laser scanning ophthalmoscopy
Glaucoma stages are:
- Stage 1 - the normal field of vision, extended excavation of the optic nerve, not reaching to the edges
- Stage 2 - the restriction of the visual field up to 10 degrees, the excavation of the optic nerve is disc extended, has an edge character
- Stage 3 - the restriction of the visual field up to 15 degrees, subtotal boundary nerve excavation is extended, does not extend to the edge of the disc
- Stage 4 – complete blindness or retention of a small island in the crotaphic sector
A detailed examination is needed to confirm the diagnosis. Glaucoma cannot be established just as a result of the increased intraocular pressure as cases are known when optic nerve atrophy is progressing even with the normal intraocular pressure.
Treatment of Glaucoma abroad
Conservative and surgical treatments of glaukoma are possible. Conservative treatment is directed at the reduction of intraocular pressure and stops the progression of the pathology. Patient is prescribed a life-long use of eye drops. Level of the aimed intraocular pressure is defined individually by the doctor.
Laser glaucoma treatment helps to strengthen the medicines action and sometimes to even completely abandon them.
Advantages of these treatment methods are:
- Stable result
- Minimal risk of complications
- Low injury rate
- Chance to perform the operation in an out patient setting
Depending on the type of glaucoma, various laser surgeries can be applied:
- Laser gonioplasty
- Transscleral cyclophotocoagulation (can be done by contact or contactless)
Surgical glaucoma treatment. Different operations are indicated for different forms of the illness. For instance, for the angle-closure glaucoma they use peripheral iridectomy or iridocycloretraction. Congenital glaucoma requires the use of goniotomy and sinus trabeculectomy.
Indications for surgical treatment are:
- Ineffectiveness of other therapies, inability to establish desired intraocular pressure
- Impossibility to use other treatment methods due to the number of reasons
- Presence of high numbers of intraocular pressure and fast progressing vision disorders
- Congenital glaucoma
Main aim of the surgical treatment is to create new or stimulate the existing ways for intraocular fluid outflow and normalize the intraocular pressure. The most important indicator of the successful operation is the absence of a need to apply the antihypertensive drugs after the surgery.
Glaucoma - Prognosis
Prognosis is unfavourable if the disease is not treated. Glaucoma will lead to the complete blindness with time because of optic nerve atrophy.
Whether conservative or surgical treatments are used, prognosis is favourable. It is desirable to start treatment as early as possible, because dead optic nerve neurons will not restore anymore. That way, your vision will not improve. It is possible to just stop its further worsening.
If glaucoma was detected on time, the latest treatment methods are applied, patient follows doctor’s all instructions, the prognosis vision preservation is good. Either vision disorder will not get complicated or disease progresession will slow down considerably.