Seeking an ophthalmologist in Barcelona to treat your glaucoma?
Glaucoma is a chronic eye disease that affects 1 to 2% of people over 40. About 10% of people over 70 suffer from it. It is also the second leading cause of blindness in Europe, after age-related macular degeneration (AMD).
If you suffer from glaucoma or would like to be screened, do not hesitate to make an appointment with one of our ophthalmologists.
What is glaucoma?
Glaucoma is a chronic disease caused by an increase in intraocular pressure that gradually destroys the fibres of the optic nerve.
Glaucoma is most often a problem with the emptying of the aqueous humor, one of the fluids in the eye. The internal pressure then increases, suddenly and intensely in the case of acute glaucoma, very gradually if the glaucoma is chronic.
The different types of glaucoma
There are two types of glaucoma.
Chronic open-angle glaucoma
Primary open-angle glaucoma (POAG) is a form of glaucoma where the trabeculum has lost its permeability. Its management is specific and does not lead to a cure. It is the most common form of glaucoma.
Chronic angle-closure glaucoma
Angle closure glaucoma is a particular form of secondary glaucoma. Much less frequent in France than chronic open-angle glaucoma, it is secondary to a malformation that causes the iridocorneal angle to close. Most often it is a case of an eye that is too short (small as in hyperopia) or of an abnormal insertion of the iris.
Glaucoma remains completely asymptomatic for most of its course.
In the advanced stages, however, glaucoma may be accompanied by the following symptoms:
- Sudden blurred vision
- Red eye
- Eye pain
- Seeing coloured halos around lights
- Extreme sensitivity to light
- A dilated pupil
- Nausea and vomiting.
What causes glaucoma?
Glaucoma is caused by an increase in pressure in the eye. This increase in pressure is the result of a blockage in the filter that removes intraocular fluid, also known as the aqueous humour. This filter, called the trabeculum, gradually becomes blocked in some people, no longer allowing sufficient passage of the aqueous humour that is constantly produced inside the eye.
Glaucoma can also be the result of the iris coming together in front of the trabeculum (acute glaucoma), or of the existence of an abnormal and impermeable membrane in front of this trabeculum from birth (congenital glaucoma).
It is also important to know that glaucoma generally occurs from the age of 40 onwards and its frequency increases with age. Also, people with dark skin, mainly people of African origin, have a higher risk of developing glaucoma, which often appears earlier.
How can glaucoma be diagnosed?
Glaucoma is often diagnosed late, during a consultation for another eye problem: age-related presbyopia, the onset of cataract, glasses replacement, etc.
Several examinations can be proposed to detect glaucoma.
Measurement of intraocular pressure
Intraocular pressure is measured with a tonometer. Normally the intraocular pressure is 15-16 mmHg. Ocular hypertonia is defined as a pressure higher than 21 mmHg.
The level of IOP is a major risk factor for the development and progression of glaucoma.
Measuring the thickness of the cornea
Measuring the thickness of the cornea is essential to establish the true intraocular pressure: a thin cornea tends to distort the measurement of intraocular pressure (by underestimating it). Conversely, a thick cornea can make a normal pressure appear high.
The fundus examination allows us to observe the retina and the starting point of the optic nerve, looking for signs of damage to the optic fibres.
Evaluation of the visual field
This examination highlights the impact of the damage to the optic nerve and its progression. Glaucoma is characterised by a progressive and irreversible damage to the visual field, initially peripheral (on the sides and near the nose) and for a long time unnoticed.
If it is not possible to restore lost vision, it is possible to stop the progression of glaucoma and vision loss by reducing intraocular pressure.
Several treatments can be offered to the patient depending on the progress of the disease.
Treatment with eye drops
The treatment of glaucoma is based on the regular administration of eye drops (prostaglandins, beta blockers, carbonic anhydrase inhibitors, etc.). These drops reduce intraocular pressure by reducing the secretion of aqueous humour or by facilitating its elimination.
They must be applied at regular times, for life and without interruption.
Laser treatment may be necessary as a first line treatment but is most often prescribed when drug treatment no longer works.
Laser trabeculoplasty involves selective photocoagulation of the iridocorneal angle, which results in improved aqueous humor flow through the trabeculum.
If glaucoma is resistant to previous treatments and vision continues to deteriorate, surgery may be considered. The most commonly used surgical technique is trabeculectomy.
The surgical procedure involves creating a new outlet for the aqueous humour to maintain normal pressure in the eye.
Dr. Rob van der Veen