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Glaucoma is a range of conditions, where the common feature is damage to the optic nerve; the optic nerve connects the eyes back to the brain, taking the visual information from the eyes to the brain.
In glaucoma, the optic nerve becomes damaged and therefore the vision can be affected. One of the problems with glaucoma is a lot of the damage can take place before the patient becomes aware of it, so it’s very important to have your eyes checked regularly as you get older, especially if you have a family history of glaucoma.
If anyone suspects you may have glaucoma, it does need to be followed up.
There are a few risk factors for glaucoma and the main one is getting older. The second risk factor is a family history; there are some other risk factors, too but these are less common.
The trouble with glaucoma is that when the damage has taken place, you can’t reverse it.
Often, patients don’t have any symptoms; the condition is picked up at the opticians. One of three things could trigger a concern by the optician: either the shape or appearance of the optic nerve looks like the patient may have glaucoma. Or the pressure inside the eye is higher than it normally would be. Or possibly an abnormality is picked up on a visual field test, which measures your peripheral vision.
Most patients would normally be tested for glaucoma in their routine optician appointment. What happens usually is the optician has a concern and will send the patient to hospital; we will then be able to assess whether it looks like they do or don’t have glaucoma.
One of the most important measurements that’s taken is the pressure inside the eye – and it’s very clear: the higher the pressure becomes, the greater the risk of glaucoma. Lowering the pressure inside the eye reduces the risk of glaucoma developing or getting worse.
Sometimes, the patient has pressure that is high, but it doesn’t cause damage. In other patients the pressure may not be particularly high, but it can still cause damage. Eye pressure is an especially important measurement, but it’s not the only thing to look at. There are several scans and tests you can do when the patient comes to the hospital to help diagnose and monitor glaucoma.
Often, the patient won’t notice any symptoms, but if they have severe or advanced glaucoma, they may notice a significant change to their vision, usually missing or blank patches. Sometimes, in acute (sudden onset) glaucoma, they get pain, the eye goes red and the vision is lost, but that is rare.
Most forms of glaucoma are chronic (long-term), and the patient may not know they have it.
With regards to the management of glaucoma, it’s about preventing any further damage. The thing that can be adjusted is the pressure inside the eye – and nearly all forms of glaucoma treatment are aimed at reducing the eye pressure.
Essentially, there are three ways to bring the eye pressure down. The first is to use some eye drops, the second is to use a laser, and the third is to do surgery.
Usually, the first thing to do is the eye drops or laser. If those aren’t providing enough treatment, patients may need to have the surgery.
The surgery involves creating a little ‘trap door’ – a valve, to release the pressure from inside the eye. It’s an operation, often while the patient is awake under a local anaesthetic as a day case.
After surgery, the eye may be sore, ‘scratchy’ or watery for a while and the vision may be a bit blurred. There will be some eye drops to use, and patients will be followed up in clinic to see whether the surgery has done the job in terms of bringing the pressure down.