Status: 07/03/2023 08:29 a.m
Glaucoma, also known as glaucoma, is one of the most common diseases of the optic nerve. Eye drops, laser procedures, and surgeries can help. Initially, those affected usually hardly feel any symptoms.
Glaucoma is the most common cause of permanent blindness in Germany. Excessive intraocular pressure is considered to be the cause of the continuous loss of nerve fibers and increasing visual field defects. Normal intraocular pressure is between 10 and 21 millimeters of mercury (mmHg).
Causes of glaucoma
In the front part of the eye, which is filled with liquid, fresh aqueous humor is constantly being produced – a kind of nutrient solution that supplies the lens. The water passes through the pupil into the anterior chamber of the eye, where the trabecular meshwork is located. The trabecular meshwork consists of many small canals that conduct the aqueous humor out of the eye into what is known as Schlemm’s canal. The aqueous humor leaves the eye through this and flows outwards, where it is absorbed into the bloodstream. This keeps the pressure in the eye constant. If the outflow through the trabecular meshwork is disturbed or if too much fluid is produced, the aqueous humor builds up. This increases the pressure in the eye and on the optic nerve: the nerve slowly dies and the eye becomes blind.
Further information
5 Min
How can glaucoma be recognized and which treatment is the right one? Prof. Maren Klemm gives tips. 5 mins
Symptoms: eye pain or headache
In the beginning, a glaucoma usually causes hardly any symptoms, as it progresses, visual field defects (scotomas), eye pain or headaches occur. Acute glaucoma, also known as a glaucoma attack, has symptoms such as sudden visual disturbances, hardening of the eyeball, severe headache and eye pain, red eyes and nausea.
Glaucoma: treatment for glaucoma
To prevent vision loss, glaucoma must be detected and treated as early as possible. It is treacherous that those affected feel nothing of glaucoma. It only becomes apparent when examined by an ophthalmologist. From the age of 40, the intraocular pressure should therefore be checked every three years, in the case of glaucoma in the family from the age of 35 and at shorter intervals. The risk is also increased with diabetes and eye injuries, so the doctor should check the eye more often.
Diagnosis: Examinations for the early detection of glaucoma
The early detection examination includes:
an eye test, the measurement of the intraocular pressure (tonometry), a reflection of the back of the eye to detect damage to the retina or the optic nerve head.
However, healthy people have to pay for the early detection examination themselves as a so-called individual health service (IGeL). Only when the diagnosis of glaucoma has been made will the health insurance companies cover the costs for the examinations that are due.
Eye drops or surgery for glaucoma
If the intraocular pressure is greatly increased but the optic nerve has not yet been damaged, pressure-reducing eye drops are used. They’re low-risk and effective, but they can also cause side effects like irritated, dry eyes. Affected people sometimes have to drip several times a day.
If the pressure-reducing drops are not sufficient, a relatively complex operation, the so-called trabeculectomy, can help, which restores the drainage via a small conjunctival opening and an incision in the dermis. However, the cut in the dermis can lead to scarring.
Glaucoma-Operation with Stent
In some people, tiny tubes (“stents”) can lower the pressure in the eye, eliminating the cause of the glaucoma. Under local anesthetic, the ophthalmologist uses an instrument to insert one or two stents into the angle of the anterior chamber of the eye, between the lens and the cornea, through a tiny opening in the conjunctiva. The aqueous humor can drain there. An incision in the sclera is not required, the procedure is shorter and less invasive, sufferers do not have red eyes and recover more quickly.
Mini stent is not suitable for everyone
A mini stent is suitable for people whose glaucoma is not yet very advanced and whose intraocular pressure is less than 30 millimeters of mercury (mmHg). Because there is almost no bleeding during the procedure, the procedure is also suitable for older patients who are taking blood-thinning medication. In addition, the insertion of the stents can be easily combined with an operation against cataracts.
Because there is little risk of damaging the lens, the procedure is best for people who already wear an artificial lens. However, the stents do not solve the problem for everyone affected.
More than half of the patients treated so far manage without eye drops after the procedure, others only need a single type of drop. If the mini-stent operation is unsuccessful, there is still a trabeculectomy (see above).
Laser intervention can delay or replace drops
Laser therapy is an alternative to drop therapy for glaucoma. There are various laser procedures that can gently complement or even replace drop therapy. One of them is the so-called selective laser trabeculoplasty (SLT). Extremely short laser impulses with high energy are used, which only affect melanin-containing pigment cells of the trabecular meshwork. Unlike other laser procedures, SLT does not result in heat-related damage to the trabecular meshwork. The body’s own healing process of the cells cleans and widens the meshwork of the trabecular meshwork, thus restoring the drainage of the aqueous humor.
The painless procedure is suitable for those affected with mild glaucoma and an open chamber angle and can save them the drip for a certain time or delay it. However, the effect usually only lasts for a certain amount of time, and the procedure can be repeated several times. Regular checks are important.
Post-op treatment is important
Careful follow-up treatment is important after glaucoma surgery, otherwise the conjunctiva will quickly grow back together. Nevertheless, in most cases the interventions have to be repeated after some time because the success is not permanent.
Implanted chip to bring additional security
In order to maintain the long-term success of the operation, it is important to check the intraocular pressure regularly. A new type of chip implanted in the eye could make this easier in the future. The ring-shaped, very flat chip is inserted into the so-called sulcus in front of the lens and controlled by an external reader. First, the reader uses induction to transmit the current required for the measurement to the chip, which then measures the intraocular pressure and transmits the value to the reader. In this way, those affected can easily measure their intraocular pressure themselves at any time. They feel nothing of the measurement process itself, nor of the chip. This chip can also be used to detect pressure peaks over the course of the day that would otherwise remain undetected. In such a case, those affected can counteract this with eye drops, as instructed by the ophthalmologist.
Special case of normal pressure glaucoma
Some people with glaucoma do not have increased intraocular pressure compared to the general population. Nevertheless, the typical damage to the eye can occur. The cause has not yet been fully clarified. Experts suspect that the blood flow to the optic nerve could be disturbed by strongly fluctuating blood pressure (primary vascular dysregulation). It is not uncommon for those affected to react particularly sensitively to internal and external stimuli that affect the circulatory system. Like other types of glaucoma, normal-tension glaucoma is treated with eye drops that lower the pressure in the eye.
experts on the subject
Ophthalmology Clinic and Polyclinic
University Hospital Hamburg-Eppendorf
Martinistraße 52
20246 Hamburg
(040) 74 10-533 05
Old Market 1-2
24103 How
(0431) 530 110 10
Chief Physician at the Sulzbach Eye Clinic
Knappschaftsklinikum Saar GmbH
At the clinic 10
66280 Sulzbach
(06897) 574-1121
ophthalmologist
Market 1
23552 Luebeck
(0451) 31 700 600
Chief Physician of the Eye Clinic
Rübenkamp 220
22291 Hamburg
(040) 18 18-82 28 31
Markische Strasse 61
44141 Dortmund
www.bundesverband-glaukom.de
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Visit | 04.07.2023 | 8:15 p.m