Glaucoma. Below you’ll find informations on Glaucoma, diagnosis and symptoms, surgery, therapy, laser surgery, new medications and all the latest news about how to treat Glaucoma, illustrated by Dr. Badalà, that is an ophthalmologist in Milan and Catania, and introduced in Italy important innovations for glaucoma treatment.
Glaucoma affects 2% of the italian population over 40 years of age and this trend seems to be increasing; today, risks can be diminished and consequences limited thanks to an early and exact diagnosis. The term Glaucoma stands for a series of diseases that usually lead to an increase of the endocular pressure that could compromise the optic nerve. This is why it is considered to be one of the major causes of blindness in the western world.
Glaucoma is an underhand disease and there are no symptoms to be spot early on: it only shows when the damage is irreversible. This is why an early diagnosis is fundamental to prevent the loss of sight.
Glaucoma therapy usually consists in reducing the endocular tone as much as needed, in relation to the kind of the patient’s glaucoma. Since there is no way to spot symptoms early on, it is crucial, especially for people at risk, to book an ophthalmogic exam every now and then.
Glaucoma usually appears during adulthood, around 40 years of age. It is important to pay special attention to genetic factors too, and alto so african people that are more subject to the disease. Other important factors are: arterial hypertension, diabetes and other sistemic diseases. Several studies identify the ones below as the more risky factors for glaucoma:
being more than 60 years old
familiar anamnesis that shows the presence of the disease
african people that are more than 40 years of age
diabetes or arterial hypertension.
Every person included in these categories at risk, should have regular ophthalmologic exams, every year, in order to achieve an early diagnosis and avoid complete blindness. All people that are not at risk, should be examined every 2 or 3 years when they are more than 40 years old, and every 1 or 2 years when they’re more than 60.
Glaucoma symptoms depend ont he kind of the patient’s glaucoma: there is a difference between the open angle glaucoma and the closed angle glaucoma.
People affected by pen angle glaucoma usually don’t recognize any symptom: this happens because the disease development is pretty slow and patients cannot notice the loss of vision in the peripheral field of vision. On the other hand, closed angle glaucoma symptoms are easy to spot because ocular pressure rises very quickly (this is why it is also called “acute”).
This symptoms may appear:
foggy vision, especially at night
halos around lights
migraines or pain around the eye
nausea and even vomit.
In the majority of cases, glaucoma has no symptoms though: this means that the average patient cannot realise there is a problem before it becomes too late.
When patients notice a loss in vision, glaucoma usually already reached a very advanced phase. Since there are no symptoms that can be spotted early on, especially for category at risk, it is of the uttermost importance to book ophthtalmologic exams on a regular basis.
Symptoms may vary depending on the kind of glaucoma.
Patients that have chronic glaucoma, usually cannot recognize symptoms: this happens because the disease develops pretty slowly and loss of vision in the peripheral field of vision is hard to notice.
People affected by acute glaucoma, usually develop a pretty serious sympyomatology, because endocular pressure rises very high. This symptoms may occur:
Open angle glaucoma
Open angle glaucoma: pathology with several factors that can happen more frequently as the age increases, usually above 40 years of age, and it’s caused by a drainage decrease of the camerular angle that leads to an increase of the endocular tone. This kind of glaucoma is usually characterized by an increase of the ocular pressure, measured with special tools by the ophthalmologist.There are several kinds and Dr Badalà has the most advanced glaucoma diagnostics techniques (pascal tonometer, DGX, HRT II, OCT) and published several texts on the matter.
Open angle glaucoma with normal tension: in the latest decades, we witnessed the increase of the occurences of this disease, that is even more underhand than the previous one, because a standard check of the ocular pressure is totally non effective and even misleading. In fact ocular pressure usually stays within the normal range. Only a specific exam, performed by an ophthalmologist, can spot the disease.
Pseudoexfoliative glaucoma: it is a kind of open angle glaucoma but it is characterised by fibrillar deposits that block the camerular angle and its drainage channel, causing a strong increase of the endocular tone, along with a quickened glaucoma form.
Pigment glaucoma: its a form of open angle glaucoma: it usually occurs in nearsighted patients, especially male ones, and it is caused by the abrasion of the iris pigment that blocks the trabeculate, with a consequent increase of the endocular tone.
Closed angle glaucoma
Acute closed angle glaucoma: the acute blockage of the camerular angle is characterized by a strong and unexpected increase of the endocular tone, usually paired with reddening and strong pain in the affected eye. Often other more general symptoms appear, such as nausea and symptoms similar to the ones of a myocardial infarction or abdominal problems. It is important to prevent this kind of glaucoma with a treatment called laser Iridotomy, to be performed on suitable eyes.
Neovascular glaucoma: in this form of glaucoma, the camerular angle is blocked by neo-formed pathological vessels, after several circulatory problems (arterial or venous).
Congenit glaucoma: it is diagnosed when the glaucoma appears right after birth or during the very first years of the child, after a malformation of the camerular angle. In this cases the disease becomes noticeable because of an excessive enlargement of the ocular bulb, because the ocular walls of a child cannot sustain the increased endocular pressure.
Which is the difference between open and closed angle glaucoma?
The main difference is that the open angle glaucoma is considered to be a chronic disease, while the closed angle glaucoma in an acute disease.
Open angle glaucoma has no symptoms, while the closed angle glaucoma shows strong pain, nausea, vomit. The eye has a specific pressure, determined by the production of the acqueous humor at the ciliary body level. The acqueous humor is expelled through channels present in the camerular angle: if it is closed, the humor cannot go out and there is a significant increase in the ocular pressure, along with acute pain.
Evaluation of the optic nerve papilla: with a biomicroscopic exam, the ophthalmologist can understand if the optic nerve has any alteration that could lead to glaucoma. If that is the case, a photographic documentation of the optic nerve is made, to be used as a comparison for future reference.
Evaluation of the optic nerve fibers: since the diminished depth of the optic nerve fibers represent the most clear symptom of a glaucoma, it is important to measure their depth with a polarimetry, using a Laser scanner like the GDX or via OCT
Measuring the endocular pressure: Measuring the endocular pressure: the measurement of the endocular pressure is no longer considered a valid criteria to spot glaucoma early on, and this is because there is an increasing number of glaucomas with standard pressure. This is why measuring the endocular pressure is useful to check variations of the endocular tone, both on healthy and ill patients.
In this context it is more and more important measuring the corneal depth with a ultrasonographic pachymetry, that significantly improves the meaning of an isolated measurement of the endocular tone.