Diagnosis of glaucoma: at age 40, consult your ophthalmic every 2-3 years
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| WHAT IS THE GLAUCOMA? |
WHAT IS THE GLAUCOMA?
You may be suffering from glaucoma without your knowledge!
Glaucoma is often accompanied by no symptoms. Glaucoma is a disease of the eye that disrupts the functioning of the optic nerve. It is this latter which transmits to the brain the visual signals that make it possible to see.
Glaucoma is a disease that is slowly but gradually evolving. For most people with it, years will elapse before they see symptoms. Frequently, they do not even know that they are suffering from glaucoma before they begin to lose sight. In addition, vision loss associated with glaucoma is an irreversible phenomenon.
To protect yourself, take eye exams regularly. Ophthalmologists can detect and treat glaucoma before you have symptoms. If you are suffering from glaucoma, take appropriate treatment and have regular exams.
What is glaucoma?
Glaucoma is a disease of the eye that disrupts the functioning of the optic nerve. It is this latter which transmits to the brain the visual signals that make it possible to see. No one knows what causes the onset of glaucoma, but increasing pressure in the eye is one of the main risk factors.
When too high, eye pressure can damage the optic nerve. If this is the case, the signals sent by the optic nerve may not all reach the brain so the patient may not see all that his eye "sees". As a result, the visual field of the patient decreases and, without proper treatment, glaucoma may result in blindness.
Symptoms of Glaucoma
Tubular view
Most people with glaucoma do not even know they are suffering from it before they start to lose their sight. Fortunately, ophthalmologists are able to detect and treat glaucoma before the onset of the slightest symptoms.
Glaucoma is a disease that is slowly but gradually evolving. For most people who have it, it will take years for them to experience symptoms. Symptoms include a gradual narrowing of peripheral vision.
Vision loss is commonly referred to as "tubular vision". Unfortunately, loss of vision due to damage to the optic nerve is an irreversible phenomenon
The importance of intraocular pressure (IOP)
The eye is filled with fluids that contribute to maintaining a specific pressure in the organ. This is commonly referred to as "intraocular pressure," or IOP. Specialists can measure IOP easily and this is an important way to diagnose and treat glaucoma. Normally, IOP should be between 12 and 22 mm Hg (mercury).
IOP is generally measured with a tonometer. The test, called tonometry, is of paramount importance because high IOP is an important risk factor for glaucoma. However, high IOP is not always synonymous with glaucoma, nor does normal IOP mean that you will never have glaucoma.
The primary goal of glaucoma treatment is to control IOP. When it can be controlled, the risk of damage to the optic nerve diminishes, allowing patients to preserve their vision.
Causes of elevated IOP
The anterior section of the eye is filled with a liquid called aqueous humor. This substance is produced by the eye to irrigate its various structures. The aqueous humor is excreted through the eye through various channels. When these channels are obstructed, the aqueous humor remains trapped in the eye. The result is an increase in IOP, a major risk factor for the onset of glaucoma.
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Diagnosis of glaucoma: at age 40, consult your ophthalmic every 2-3 years
Article Content:
- Glaucoma
- SEE AS WELL
- Glaucoma: an insidious disease
- Glaucoma: Early essential screening
- Glaucoma: better understanding intraocular pressure
- Glaucoma: zoom on current treatments
- Diagnosis of glaucoma: at age 40, consult your ophthalmic every 2-3 years
Insidious and painless illness, glaucoma is still too often diagnosed with delay, when the visual field is already restricted. The French Society of Ophthalmology (SFO) recommends that people who have reached quarantine should consult their ophthalmologist every 2-3 years to find out if they have it.
In a context where these specialists are overwhelmed, proposing appointments at 6 months or even 1 year in certain French cities, it is difficult to believe that this recommendation will be followed. However, Dr. Eric Sellem, an ophthalmologist at the Kleber Ophthalmological Center in Lyon, and Professor Jean-Paul Renard, a university professor-hospital practitioner at the Val-de-Grâce Hospital in Paris, are confident.
Primary open-angle glaucoma affects 1.7 million French
Diagnosis glaucoma Primary open angle glaucoma (GPAO), which accounts for 90% of all glaucoma, affects 1.7 million French people. Among them, half are unaware that they are reached, according to projections of two new European and international studies, the results of which are contained in the 2014 report of the SFO. Among people over 60, 35% have a severe form, but only 30% are detected.
Illness insidious par excellence, glaucoma is painless. The sight does not diminish, it is the visual field which is gradually restricted; But this shrinkage, long compensated by the brain, is generally so progressive that the affected person usually realizes it only at an advanced stage when the optic nerve is already affected.
"Without treatment, it is blindness, absolute blackness," warns Professor Jean-Paul Renard, university professor-hospital practitioner at the hospital of Val-de-Grâce in Paris, and rapporteur of the report SFO 2014.
Glaucoma, a pathology with multiple risk factors
Glaucoma is a degenerative neuropathy that affects the optic nerve, gradually destroying ganglion cells in the retina. Its main risk factor is elevated intraocular pressure. Screening is therefore based on regular monitoring of this pressure, combined with observation of the fundus of the eye and the visual field.
Other risk factors include high myopia, age, ethnicity, but also vascular factors (arterial hypertension, arteriosclerosis, certain treatments that may cause ocular hypertension, ie increased The interior of the eye), and sleep apnea, quotes Dr. Eric Sellem, the ophthalmologist at the Kleber Ophthalmological Center in Lyon. Epistemic factors (mainly environmental factors: tobacco, pollution, food, pesticides) are also implicated in genetic predispositions (the same as those predisposing to coronary artery disease).
Diagnosis of glaucoma: an appointment every 2-3 years at the ophthalmic
He, therefore, recommends to everyone, from the quarantine, to go to his ophthalmologist every 2-3 years for a control visit. Advice to follow even more if there are family cases. "For novice glaucoma under normal pressure, difficult to detect, an interrogation and the search for risk factors can help the ophthalmologist," said Professor Renard.
But how do you do regular eye pressure checks when it is so difficult to get an appointment with the ophthalmologist? "Already, there is no urgency for glaucoma screening, so this is not really a problem," reassures the specialist. "Moreover, the medical demographics of ophthalmologists should not be so deficient as that in The years ahead, "he said.
Screening for glaucoma is based on several simple and painless tests:
Measurement of ocular pressure using a tonometer: the ophthalmologist can use a contactless method without eye drops, by sending a jet of air into the eye, or, on the contrary, By means of a plastic cone affixed to the eye after the installation of an anesthetic eye drops.
Examination of the fundus of the eye by an ophthalmoscope; The doctor can thus detect the presence or absence of lesions on the optic nerve.
Once the diagnosis is made, the ophthalmologist can perform two other examinations, one that evaluates the visual field and the other that examines the iridocorneal angle (gonioscopy), in order to clarify the nature of glaucoma and its condition Advancement.
Glaucoma: three possible treatments
The treatment may be medical (eye drops), physical or surgical, depending on the nature of glaucoma, its severity and the age of the patient.
MEDICAL TREATMENT
New galenic formulas have appeared in the eye drops market, which offers sustained release products without preservatives, says Dr. Sellem. Unlike "classic" eye drops, which must be installed at a fixed time, several times a day, these new products require only one daily dose, two or three drops per day. A simplification that should improve adherence to treatment.
PHYSICAL TREATMENT
In some cases, laser treatment may be preferable especially in the case of the pathology of the ocular surface. But its effect is not final, it is necessary to renew the treatment every 3-4 years. "The laser makes it possible to postpone surgery and to combine it with a cataract surgery in elderly patients," explains Professor Renard.
Another approach is the ultrasound technique. The latter act on the ciliary body, which produces the aqueous humor, decreasing this production in order to reduce the intraocular pressure. The treatment is outpatient (no hospitalization) and has a success rate of 60% to 1 year, says the doctor. Very often, a treatment with college should be resumed a few months after. Its cost, twice as high as the laser, limits for the moment its use to certain "privileged" centers of ophthalmology, able to invest in the machines and pass the cost on to its patients. But this thriving technique should be democratized in the future, predicts Dr. Sellem.
SURGICAL TREATMENT
Remains the surgery. Again, this technique does not guarantee success in 100% of cases. Its choice must, therefore, be discussed with the patient, depending on the progress of his glaucoma, his ocular characteristics, the risks of the operation, etc. It is generally reserved for patients resistant to medical treatment and laser, and in whom the disease continues to evolve.
But to avoid getting there, only one solution consult your ophthalmologist every 2-3 years as soon as you turn 40 years old.
Dossier realized in collaboration with Professor Christophe Baudouin, head of department III at the Center Hospitalier National d'Ophtalmologie of Quinze-Vingts in Paris and of the ophthalmology department of the Ambroise Paré Hospital (92). Director of Research at the Institute of Vision, Inserm-UPMC U 968. UMR CNRS 7210 - January 2013.
Glaucoma is a disease of the eye associated with the progressive destruction of the optic nerve, most often caused by too much pressure inside the eye. This pathology is the second leading cause of blindness in developed countries. To date, treatments have stopped its development but they do not restore vision when the disease is already evolved. Early detection of glaucoma is, therefore, essential.
Glaucoma is an ocular disease associated with the progressive destruction of the optic nerve under the influence of several factors. The most frequent of these factors is ocular hypertonia, that is to say, an excessive pressure inside the eye. The visual impairment caused by the disease first affects the periphery of the visual field, then progressively extends towards its center. Glaucoma is often diagnosed at a very advanced stage when central vision is threatened. The visual handicap is then irreversible.
The eye pressure involved
© Inserm, Frédérique Kotlikoff
Ocular hypertension most often the cause of the disease is caused by a problem of evacuation of the intraocular fluid which feeds the lens and the cornea. This liquid, called "aqueous humor," normally flows through a filter called "trabecula".
In most cases of glaucoma, an alteration of the trabeculae of genetic origin hinders the flow of the aqueous humor. This is called open-angle glaucoma. It is the most frequent form of the disease, of slow evolution. The filter retains the intraocular fluid, the pressure rises and spreads throughout the ocular sphere. It sounds on the optic nerve by progressively destroying the nerve cells that constitute it.
Glaucomatous trabecular: major depletion of trabecular cells (propidium iodide). The green coloring is due to the autofluorescence of the elastic constitutive of the trabecular meshes.
© C. Baudouin
Glaucomatous trabecular: major depletion of trabecular cells (propidium iodide). The green coloring is due to the autofluorescence of the elastic constitutive of the trabecular meshes.
Less often, it is the anatomy of the eye that is altered. The access of the aqueous humor to the trabecular can then be difficult, if not impossible. The same phenomenon of ocular hypertonia occurs but we speak in these cases of closed-angle glaucoma. This can be suddenly manifested by nocturnal, painful and very destructive attacks requiring urgent treatment.
Nevertheless, seizures are often less violent, resulting in little or no pain. They destroy the optic nerve in an insidious, rapid and irreversible way. These glaucomas are particularly aggressive.
In rare cases, glaucoma is not related to ocular hypertension. Glaucoma with a neurological or vascular component, at normal eye pressure, can cause similar damage.
Frequent disease, especially after 40 years
Glaucoma is the second leading cause of blindness in developed countries after age-related macular degeneration. The disease can occur at any age, including at birth. However, its frequency increases with the years, especially after 40 years. Glaucoma affects 1 to 2% of the population over 40 years of age and about 10% after 70 years. Approximately 800,000 people are treated in France but 400,000 to 500,000 people would suffer from the disease without knowing it.
An indispensable screening
The destruction of the optic nerve is usually asymptomatic. The visual deficit becomes really troublesome when the disease is already very advanced. It is then irreversible. Both eyes are not always reached in the same way and somewhat compensate each other, delaying the diagnosis.
Photographic appearance of the optic disc during glaucoma
© C. Baudouin
Photographic appearance of the optic disc during glaucoma
Functional impairment can be avoided by long-term, well-medicated drug therapy, provided it is started before the destruction of nerve cells. The whole issue is therefore based on the early detection of the disease.
Due to the often silent nature of the disease and its frequency in the general population, systematic and regular screening is recommended from the age of 40, especially in at-risk families (some of whom have developed the disease).
This screening is based on the measurement of the ocular pressure which must be less than 20 mmHg (the average being 15 mmHg) and on the analysis of the optic disc during a fundus eye. The optic papilla tends to become hollow and to atrophy in the event of destruction of the nerve fibers.
What are the risk factors?
Approximately 30% of glaucoma is hereditary and screening should be strengthened in families with a history of glaucoma. Furthermore, increased age, very high myopia, hypertension, diabetes, sleep apnea or prolonged intake of corticosteroids can increase the risk of glaucoma.
A more or less rapid evolution
Open-angle glaucoma, the most frequent, evolves slowly. It generally takes several years or even decades before the occurrence of a disabling visual deficit or even simply felt. Closed-angle glaucoma evolves much more rapidly and can lead to sequelae after a few months or even weeks if the intraocular pressure is very high, beyond 40 mmHg.
Optic nerve damage can be prevented by a long-term, well-attended, early-onset treatment. When intraocular pressure is moderate, drug therapy can normalize and protect nerve cells in the vast majority of cases.
Several classes of drugs can be used and possibly associated with one another: prostaglandins or beta-blockers. These drugs are most often administered as eye drops and must be taken for life.
In a case of treatment failure, poor tolerance or very high intraocular pressure, laser or surgery are interesting alternatives. The laser stimulates the trabecular cells under the impulse of light energy and increases the flow of the aqueous humor. The surgery consists in releasing the trabecular under local anesthesia.
The disease can be monitored by drug monotherapy in about half of patients with chronic glaucoma. In others, it is necessary to combine several medications and to use laser and/or surgery to stop the progression of the disease.
To date, no treatment can restore vision when the optic nerve is affected.
Research progresses
"See" glaucoma
The Clinical Investigation Center of the Quinze-Vingts Hospital (Paris) benefits from the latest technologies in medical imaging. More and more efficient tools allow the observation of the different structures of the eye. Laser scanning, for example, offers the possibility of observing an obstructed trabeculae. The adaptive optic allows to see the head of the optic nerve and to discern the loss of some nerve fibers on the 1.5 million that counts an optic nerve.
These technologies facilitate diagnosis by allowing the early detection of the destruction of nerve cells before the onset of visual impairment. They also provide information on the mechanisms of the disease. Recently, for example, doctors at the Clinical Investigation Center have found that the pores through which the nerve fibers pass to the optic nerve are disorganized in people with glaucoma. It remains to be seen whether these alterations constitute risk factors for the disease or early signs of impairment.
Improve tolerance to available treatments
Drugs are most often effective in lowering intraocular pressure but are most often accompanied by adverse effects associated with the presence of preservatives to delay the contamination of the solution after opening. These components cause a risk of inflammation, redness and dry eyes. Recent toxicological studies have made it possible to identify the substances in question and to test new ones to enable manufacturers to propose better-tolerated eye drops, especially among those based on prostaglandins.
A new therapeutic class under evaluation
Maintenance of a normal ganglion cell network after treatment with CXCR3 antagonist
© C. Baudouin
Maintenance of a normal ganglion cell network after treatment with CXCR3 antagonist
A team from Inserm recently showed that glaucoma is associated with local inflammation induced by a particular molecule.
By blocking the action of this molecule in rats with ocular hypertonia, the researchers succeeded in restoring the normal flow of aqueous humor, decreasing the intraocular pressure and protecting the visual function of these animals.
These very promising results pave the way for the evaluation of a new treatment in humans.
Repair the optic nerve
The treatment of glaucoma is now based on the lowering of the intraocular pressure, but it does not yet make it possible to preserve or repair directly the optic nerve. Several research teams are working in this direction. They have already shown experimentally that some molecules have a neuroprotective potential. Among these molecules, alpha-2 agonists, which stimulate protective molecules and promote the secretion of neurotrophic factors, are already marketed as antiglaucomatous eye drops. Glutamate receptor antagonists are also very promising, but demonstration of their clinical efficacy has not yet been made.
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