Questions and answers on Glaucoma

What is glaucoma ? Glaucoma is progressive damage of the optic nerve (the nerve of the eye), which connects the eye with the brain and gives us the sense of sight. Contrary to the popular belief, glaucoma is NOT the same thing as raised eye pressure. Many people with high pressure in the eye will never develop glaucoma and many people with normal pressure in the eye may have severe glaucoma. Eye pressure is a very important index for diagnosis and follow-up. Only examination by a specialised doctor and frequent follow-up can safely diagnose and properly treat glaucoma.

What are the symptoms in glaucoma ? Unfortunately glaucoma causes no symptoms unless the disease is so advanced that the patient notices drop of vision in one or both eyes. There are few exceptions related to some uncommon types of glaucoma. Contrary to the popular belief, glaucoma rarely causes headache or pain around the eyes. Visual loss in glaucoma is peripheral (vision to move around), whereas central vision is lost in the end. In more than 90% of glaucoma cases, diagnosis is made by a chance examination.

Who is at risk of developing glaucoma ? Glaucoma is much more common over 40 years of age. About 3% of the Greek population already have or will develop glaucoma. People at more risk are the ones with a relative having glaucoma, since the disease is in part hereditary. Increased risk is also related with high myopia, diabetes, people using any form of steroid treatment for extended periods and people belonging to certain races, such as the black race.

How is the diagnosis made ? It is very important to have a complete eye examination and particularly detailed examination of the optic nerve. In borderline cases it is very helpful to undertake special tests, such as optic nerve tomography. In any case, photographs of the optic nerve are taken and are very useful in monitoring the progress of the disease. Visual field examination is a means of mapping peripheral vision for each eye and is very useful in quantifying damage and stability after treatment.

Which is the modern treatment for glaucoma ? Irrespective of the cause, the only current treatment for glaucoma is reducing the pressure in the eye, so that no further damage happens to the optic nerve. There are three ways to achieve this:

• Eyedrops that must be used every day,
• Laser treatment,
• In cases where the two previous methods have failed to drop the eye pressure and damage to the nerve is progressive, it is necessary to have a glaucoma operation to avoid blindness.

Laser treatment for glaucoma (SLT laser) is the novel method of treatment and usually succeeds in reducing the eye pressure by 30% (the same as the most potent eyedrops). In everyday life, this means that many patients do not need to use drops everyday.

Dr George Kampougeris is specialised (fellowship) in diagnosis and medical and surgical treatment of glaucoma in Western Eye University Hospital of London, United Kingdom. He will discuss with you the diagnosis and also the best possible treatment and means of follow-up for your case.