Glaucoma study

What is glaucoma?

Glaucoma represents a group of diseases with a characteristic feature the damage ofthe optic nerve, accompanied by visual disorders. According to the World Health Organization (WHO), glaucoma is the second most common cause of blindness worldwide (>8,000,000 people worldwide). Early diagnosis and regular follow-up are therefore vital.

What is intraocular pressure (IOP)?

Intraocular pressure (IOP) is determined by the balance between production and excretion of aqueous humor. The aqueous humor is produced by the ciliary body, a structure in continuation of the iris, and through the pupil, flows from the posterior to the anterior chamber. Fromthereitexits the eye through three (3) pathways:

  • Trabecularoutflow: through the trabeculum, a structure resembling a “colander” at the corner of the anterior chamber, into Schlemm’s canal, and then into the episcleral veins. This pathway is “pressure-sensitive” and accounts for about 90% of the drainage of the aqueous humor.
  • Uveoscleral outflow: through the ciliary muscle into the suprachoroidal space. It accounts for about 10% of the drainage of aqueous humor.

Iris: A small part of the aqueous outflows through the iris.

What is the role of intraocular pressure (IOP) in glaucoma?

High intraocular pressure (IOP) is the main modifiable risk factor for glaucoma damage. However, with the latest data, it has no role in the definition of the disease, as it has been shown that any level of IOP can increase the risk of glaucoma, depending on the other characteristics of the eye.

What are the categories of glaucoma?

There are several ways to classify glaucoma. For example, glaucoma can be congenital or acquired. Also, depending on the configuration of the angle of the anterior chamber, glaucoma can be of the open or closed angle type. Glaucoma is also classified as either primary or secondary, the latter being the result of some cause leading to an increase in intraocular pressure. (e.g. neovascular glaucoma, inflammatory glaucoma, etc.)

How is glaucoma diagnosed?

Our clinic provides the following services for the diagnosis and monitoring of glaucoma:

  • Measurement of visualacuity
  • Tonometry, i.e. measurement of intraocular pressure (IOP) with Goldmann flattening or pro bound tonometry (iCare)
  • Pachymetry (CCT), i.e. measurement of central corneal thickness, using ultrasound technology, OCT or Scheimpflugcamera
  • Gonioscopy, i.e. the assessment of the structures of the angle of the anterior chamber and grading of its amplitude
  • Assessment of anterior chamber angle by optical coherence tomography (OCT) and/or ultrasoundbiomicroscopy (UBM) in doubtful cases
  • Fundoscopy and fundus photography
  • Assessment and recording of optic nerve head and the peripapillary retinal nerve fiber layer (RNFL) with OCT
  • Screening of thevisual fields with the Humphrey Field Analyzer (HFA) and newer strategies such as Short Wavelength Automated Perimetry (SWAP) that have increased sensitivity to early glaucoma lesions

 In any case, the test is individualized, taking into account the medical history of the patients.

What is the treatment of glaucoma?

The goal of the available treatment options is to maintain visual function by reducing intraocular pressure to prevent further damage to the optic nerve and, by extension, the visual field.

 

The treatment of glaucoma is roughly divided into two (2) categories:

  • Pharmaceutical: mainly local treatment (eye drops), such as prostaglandin analogues, beta-blockers, α2-agonists, carbonic anhydrase inhibitors-CAIs (local and systemic), myotic, combined preparations and hyperosmotic agents (systemic)
  • Surgery: which includes both laser applications (e.g. SLT, iridotomy) and cyclodestructive procedures and surgeries of the type of trabeculectomy, valve implantation and newer MIGS (Minimal Residential Glaucoma Surgery)-minimally invasive glaucoma surgeries

Our clinic has Nd-Yaglaserfor SLT and iridotomies.

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