What is the difference between cataracts and glaucoma?

Cataracts and glaucoma are two different diseases, but the general perception is that their gravity is comparable – both are feared because of the possible loss of vision. Cataract is the progressive clouding of the lens until it becomes completely opaque, while glaucoma is the progressive atrophy of the optic nerve.

In the course of cataracts, we are dealing with degeneration of one element of the eye structure – the lens. In the course of glaucoma, the nerve fibers responsible for the transmission of visual impressions to the brain degenerate. Both diseases cause visual impairment and gradual loss of vision. The most feared is that it will be a permanent loss.

Cataracts – first symptoms

Symptoms that strongly require diagnosis for cataracts include:

• Difficulties in properly judging distances,
• Deterioration of vision after dark or in a dark room, but also the frequent impression that we see better on cloudy days,
• Unpleasant glare from intense light sources, such as when driving at night,
• difficulty distinguishing colors
• Seeing objects “as through a dirty glass” or “as through a fog.”

These symptoms can appear at any age. If we are replacing our glasses and the ophthalmologist/optometrist is having trouble selecting the optimal correction because we keep missing something, and we are experiencing at least one of the aforementioned symptoms, it is necessary to have an examination to determine what condition the lenses of our eyes are in.

Untreated cataracts and risk of glaucoma attack

Cataract does not attack suddenly, it develops in stages: from a slight opacity occurring only at the periphery of the lens, through an advanced, immature cataract, to the form in which the opacity of the lens is already complete. The progressive opacity of the lens is accompanied by changes in its structure: from being flexible, soft and thin, it becomes rigid, hard and thick. “Stretching” in the eye thus causes compression of blood vessels, an increase in intraocular pressure and can contribute to an attack of glaucoma.

Glaucoma – symptoms that must be responded to immediately

The symptoms of glaucoma can go unnoticed for a long time, although some patients recognize in retrospect that in the early stages of the neurodegenerative process they felt, among other things:

• photophobia,
• watery eyes,
• Darkness when looking at the light,
• difficulty seeing in the dark.

When glaucoma progresses to the acute phase, we may also experience other discomforts that we do not associate with eye problems, such as nausea, abdominal pain, vomiting or headaches.

The most common is primary open angle glaucoma, which (85-90% of cases), which develops bilaterally. The damage to the optic nerve is then caused by such factors as elevated intraocular pressure, age over 40, myopia over 4 diopters or thin corneas. The presence of glaucoma in close relatives (especially parents) is an additional aggravating factor.

A sudden acute attack of glaucoma, caused by a sudden increase in pressure in the eye and manifested by very severe pain in the eye and head, nausea, vomiting, an unpleasant sensation that the eyeball is hard as a stone and a series of symptoms associated with visual disturbances can appear in the course of another variety of the disease – glaucoma with a closing angle. Such an attack in a very short time can lead to atrophy of retinal nerve fibers and blindness, so medical intervention must be immediate!

Are visual field losses in cataract and glaucoma patients the same?

In the course of cataracts, the opacity often appears first in the central part of the lens, causing blurry, fuzzy vision when reading or observing distant objects. If the lens clouds first in the peripheral part, we may not experience any vision problems for a long time!

In the course of glaucoma, central vision is preserved for a very long time, while defects localize to the periphery of the visual field, which gradually narrows and we eventually have what is known as lunette vision.

Cataract treatment

Cataracts cannot be inhibited or cured pharmacologically. One solution is surgical intervention.

We can opt for:

• Cataract phacoemulsification – is a method of removing cataracts using an ultrasonic tip and implanting an artificial intraocular lens.

• Cataract femtoemulsification – is surgery with a high-precision femtosecond laser. It’s a method that involves making micro-incisions (called ports) in the cornea and removing the cloudy lens through them and then inserting a new lens.

Glaucoma treatment

Glaucoma is progressive in nature, and at present we do not know of a treatment that can either completely halt its progression or reverse permanent vision loss. However, the earlier glaucoma is diagnosed, the better the chance of slowing its progression and preserving vision. Regular diagnostic examinations – at least once every two years for healthy people, and once a year for those with a family history or at risk – are an absolute minimum.

In addition to pharmacological treatment, glaucoma is treated:

• Traditional surgery procedures (trabeculectomy, canaloplasty)
• Laser surgery procedures (selective laser trabeculoplasty SLT, micropulse laser trabeculoplasty (MLT), laser iridectomy, laser iridoplasty),
• diathermy (point heating of tissues with a strong electromagnetic field) or selective freezing of relevant sections of eye tissues to improve outflow of aqueous fluid from the eye, which lowers the pressure in the eye and slows the course of the disease.