Glaucoma – causes, symptoms, prognosis

It is estimated that by 2020 the number of glaucoma patients worldwide will rise to about 80 million, and the disease will cause total blindness in about 11.2 million people. Glaucoma is a disease of the optic nerve that involves its progressive atrophy (known as glaucomatous neuropathy). The disease is 4 times more common in siblings of sufferers and 2 times more common in their offspring compared to the population without a family history.

Since atrophic changes in the optic nerve are irreversible, all people at risk should be under constant eye care.

NOTE: Although intraocular pressure remains the main modifiable risk factor for the onset and development of glaucoma, in some people even pressures within the statistical limits of normal can gradually damage the optic nerve, and elevated intraocular pressure is not always going to lead to the disease.

Contrary to popular belief, glaucoma is not exclusively a disease of the elderly, those with a family history of glaucoma and those dealing with a variety of comorbidities. Indeed, there is congenital glaucoma: childhood glaucoma, juvenile glaucoma, adult glaucoma and also secondary glaucoma in the course of other eye diseases.

We can say that congenital glaucoma reveals itself as:

• Infantile glaucoma (from birth to 3.-4 years of age),
• Primary childhood glaucoma (from over 4 to 10 years of age),
• Primary juvenile glaucoma (from over 10 to 35 years of age)

Primary glaucoma develops without an identified cause, while secondary glaucoma develops in the course of other eye diseases associated with diabetes, cataracts, inflammation, cancer or trauma, among others.

Classical division of glaucoma types

Depending on the structure of the anterior segment of the eye (the glaucoma angle), glaucoma is divided into: open angle glaucoma and closing angle glaucoma.

Open-angle glaucoma

We speak of it when the so-called “aqueous fluid” produced constantly in the eye leaves the eyeball at a place called the isthmus angle. If it hits some obstacles there and does not find an outlet, it accumulates in the eye, causing intraocular pressure to rise, which leads to pressure on the nerve fibers and causes atrophy of the optic nerve.

Primary open angle glaucoma is the most common form of glaucoma (85-90% of cases), developing bilaterally. Damage to the optic nerve most often follows such factors as elevated intraocular pressure, age over 40, the presence of glaucoma in close relatives (especially parents), myopia of more than 4 diopters or a thin cornea.

In open-angle glaucoma, there may be a case of normalpressure/no pressure glaucoma(JNC). In this form of the disease, it is characteristic that there is not always an increase in intraocular pressure. JNC is more often diagnosed in people over the age of 50 and in women. Diagnosed individuals may have thin corneas, myopia, a tendency to freeze their arms and legs, migraine and also low blood pressure, sleep apnea, increased blood clotting or thyroid disease.

Secondary open angle glaucoma is characterized by significantly elevated intraocular pressure, which occurs due to the deposition of abnormal proteinaceous material or pigment deposits within the retina, beading and blocking its orifices. This form of the disease is sometimes more aggressive than JNC and is associated with large fluctuations in intraocular pressure. A very large amount of pigment (pigmentary glaucoma), elements of the exfoliated lens capsule (PEX) or adhesions formed as a result of past inflammation of the eye appear in the retinal angle.

Risk factors for open-angle glaucoma include:

• positive family history
• elevated intraocular pressure
• myopia
• hypertension
• nocturnal drops in blood pressure and low diastolic perfusion pressure (the difference between diastolic blood pressure and intraocular pressure)
• migraines
• Vasoconstrictive symptoms (cold feet and hands)
• diabetes
• Fat metabolism disorders (hypercholesterolemia and hyperlipidemia)
• thin corneas

Closing-angle glaucoma (SCG)

This type of glaucoma is diagnosed in 10-15% of patients. The structure of the anterior segment of the eye can lead to a sudden closure of the outflow of aqueous fluid through a thick, convex iris or a large, bulging lens. Such a sudden attack of glaucoma is sometimes the result of a sudden increase in pressure in the eye caused by tremendous stress or rapid dilation of the pupil. This can then lead to closure of the angle of descent, which, combined with a sudden and rapid increase in intraocular pressure, can lead to atrophy of the retinal nerve fibers and blindness in a very short time. In the case of an acute glaucoma attack, medical intervention must be immediate!

A chronic form of the disease – with an insidious and asymptomatic course – is also possible.

Risk factors for angle-closure glaucoma include:

• positive family history
• race
• structure of the eye
• hyperopia
• Fat metabolism disorders (hypercholesterolemia and hyperlipidemia)
• diabetes

Chronic glaucoma doesn’t hurt!

The only effective way to stop or slow glaucoma is early detection and appropriate treatment. The earlier the disease is recognized, the better the chance of stopping its progression and preserving vision.

In healthy people, the only way to prevent vision loss due to glaucoma is to have regular diagnostic tests (at least once every 2 years), while those with a family history of glaucoma or who are in other risk groups should get tested at least once a year.

It is worth remembering that the chronic form of glaucoma, which develops insidiously and asymptomatically, does not hurt. Severe, unremitting pain in the eye and head is characteristic only of an acute glaucoma attack and affects 1-2% of patients with glaucoma. Eye pain may also accompany severe forms of secondary glaucoma, for example, in the course of diabetes. You can find a package of examinations performed in the diagnosis of glaucoma at the SwissLaser Clinic here.