VIEW - Because glaucoma is the leading cause of blindness, associations and health professionals will travel across France to encourage screening. Eye disease can indeed be treated if it is taken care of in time.
06 Oct 2016 04: 15Julie Bernice and The sight is a precious sense and glaucoma can take it away. "In France alone, more than one million people are affected, but half of them are unaware of it," three associations alert in unison. The French Society of Glaucoma (SFG), the France-Glaucoma Association (AFG) and the National Union of the Blind and Visually Impaired (UNADEV), in partnership with Alcon Laboratories France - unite their strength to inform as many people as possible. Once installed, the disease can lead to blindness, but if it is detected in time, it can be treated.
"The alteration is slow, painless, with no discomfort at first"
"More than half of the French say they are unfamiliar with glaucoma (59%)," the associations say.
They take the figures from an international study. Now, this eye disease can make you blind if left untreated. How? It is often because of an elevation of the internal pressure of the eye that damages the optic nerve, which starts from the retina (behind the eye) and transports the images to the brain. Only then, when this nerve is damaged, the visual field is reduced little by little. But in 90% of cases, "the alteration is slow, painless, with no discernible discomfort at the beginning", says the site Ameli. Then in order not to lose sight, there is only one solution: to be detected.
They take the figures from an international study. Now, this eye disease can make you blind if left untreated. How? It is often because of an elevation of the internal pressure of the eye that damages the optic nerve, which starts from the retina (behind the eye) and transports the images to the brain. Only then, when this nerve is damaged, the visual field is reduced little by little. But in 90% of cases, "the alteration is slow, painless, with no discernible discomfort at the beginning", says the site Ameli. Then in order not to lose sight, there is only one solution: to be detected.
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Risk factors
As the disease develops without signs and pain, the diagnosis is often made during an ophthalmologic examination for another reason. But there are risk factors that should encourage vigilance:
- if you are over 40 years of age
- if a member of your family is suffering from glaucoma
- if you are myopic
- if you have high blood pressure, diabetes or sleep apnea
- if you are taking corticosteroids over time
How is screening done?
Glaucoma can be diagnosed through four examinations:
- the ophthalmologist observes the optical papilla (head of the optic nerve) by ophthalmoscopy (fundus of the eye) or optical coherence tomography (OCT)
- it measures the intraocular pressure by tonometry
- it examines the angle of flow of the intraocular fluid (or aqueous humor) by gonioscopy
- it makes an assessment of the visual field
In addition, radiological examinations can be carried out in addition.
When to get tested?
The free screening ball opens Thursday, October 6 at La Défense (Hauts-de-Seine). On the program: awareness of eye disease and the possibility of experiencing a person with glaucoma through interactive panels. The screening tour will then continue in the rest of the country. Among the dates to note:
-Lille (October 18 to 20)
-Rouen (from 25 to 27 October)
-Caen (15-17 November)
-Brest (November 22-24)
-Nantes (from 5 to 8 December)
-Bordeaux (December 12 to 16)
If you do not have the opportunity to go, consider consulting an eye care professional. "Although 8 out of 10 French people think it is important to consult their ophthalmologist annually, only 25% do so, compared to 46% of Americans," the associations said. This preventive gesture will allow you to preserve your vision for as long as possible.
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There are several types of glaucoma, the common feature of which is the progressive destruction of the fibers of the optic nerve. This destruction, long insidious and asymptomatic, results in a progressive loss of vision, first peripheral than central.
The main risk factor is an increase in intraocular pressure, but there are also forms of glaucoma at normal eye pressure.
There are two main mechanisms of glaucoma, with iridocorneal angle open (by far the most frequent) or with iridocorneal angle closed (or narrow). These two families of glaucoma have different treatments.
WHAT AGE CAN WE SUFFER FROM A GLAUCOMA?
glaucoma can occur at any age, but it is most often a disease of the second part of life. There are congenital forms, sometimes manifest from birth. There is often a familial and hereditary character: there are genes of glaucoma. Knowledge of family cases is, therefore, a particular risk factor, which justifies regular screening and surveillance.
HOW DOES A glaucoma BE TREATED?
Although some forms of glaucoma (congenital glaucoma, angle closure glaucoma) are most often surgically treated from the outset, adult open-angle chronic glaucoma is most commonly treated with various medical treatments (eye drops). These treatments can be used in combination, in order to combine their beneficial effects on eye tension and the preservation of visual function.
If they prove insufficient, or if they are poorly tolerated by the patient, surgical treatment, the laser of which may be the first step. The Sourdille clinic is particularly involved, alongside several French and international centers, in this surgical treatment, and in particular in the non-perforating surgery of the trabeculae.
This new approach, replacing or supplementing traditional interventions (trabeculectomy for example), has allowed us to reduce the number and frequency of complications of glaucoma surgery.
EXTERNAL CONSULTATION, AMBULATORY SURGERY OR HOSPITALIZATION?
The procedure is usually performed under local anesthesia and lasts about 30 minutes. Hospitalization of a few hours is usually sufficient. Sometimes a stay of 24 to 48 hours is required.
WHAT PRECAUTIONS SHOULD BE TAKEN AFTER THE INTERVENTION?
A partial and transient decrease in vision can be observed for a few days. A sensation of foreign body, associated with the presence of resorbable superficial sutures, is frequent, more generating than painful. The resumption of a normal life can be envisaged the next day or the day after the intervention. Local treatment with eye drops will be continued for at least one month. Any shock on the eye, any friction supported should obviously be avoided during the post-operative period.
DOES IT HAVE SIDE EFFECTS OR COMPLICATIONS?
As with any intraocular procedure, some complications may occur, even if they are infrequent. The presence of a slight hemorrhage of the operated eye, dilation of the pupil by the eye drops prescribed during the first days, the visual variations are most often of no consequence; Everything goes back to normal in a few days. But the existence of severe pain, not softened by the usual analgesics, must motivate an immediate call to the clinic, especially if accompanied by a decrease in vision.
WHAT ARE POSTOPERATORY CONTROLS?
Postoperative checks usually take place at 8-10 days, one month, three months and six months, and then become more spaced. They are intended to check for good healing, visual acuity, ocular tension and all the parameters of the visual function. These visits make it possible to observe the normalization of the tension and the stability of the vision. In the event of a secondary voltage rise, appropriate treatment will be undertaken.
CONCLUSION
What are, in conclusion, the keywords of glaucoma?
Screening: essential because chronic glaucoma is very insidious and because treatment does not recover lost vision;
Treatment: it does not recover lost vision, but it prevents further deterioration of vision. Treatment should, therefore, be started as early as possible, if possible before vision is impaired, and given at regular intervals;
Long-term monitoring: Chronic glaucoma is not cured because the cause (s) of the condition is not eliminated.
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New ways to treat glaucoma
The management of accelerated aging of the optic nerve could finally be simplified in the coming years.
The eyeball is an inextensible shell in which is permanently secreted a liquid: the aqueous humor. When all goes well, it is evacuated through a filter (the trabecular), so that a balance between secretion and evacuation is created. But at the slightest obstacle to the flow, it is mathematical: the pressure in the eye increases and the fibers of the optic nerve suffer from it: this is called glaucoma.
Problem: apart from the rare cases where this pressure increase is very sudden (acute glaucoma), nothing, absolutely nothing comes to alert you, because the initial visual loss is perfectly compensated by what remains of vision (a little likes 'You missed a pixel in a corner of your computer screen, where it is the least embarrassing). Glaucoma can, therefore, go unnoticed for a long time, unless a targeted ophthalmologic examination.
Then, when a fog and a veil appear before the eyes, it is because the optic nerve has already suffered well. These lesions will not be recoverable. Worse, if nothing is done, the evolution will be inexorably towards a reduction in vision, amputation of the visual field and ultimately loss of vision of the eye or, in the best of Case, the persistence of a small central island of vision, as if one was looking through a keyhole. It is all the more unfortunate that treatments exist ...
Daily drops
"The eye-drops, now indicated as the first intention, lower the tension which reigns in the eye. The laser, on the other hand, gives a certain permeability to the trabecular, by which the aqueous humor is normally evacuated: it is quite effective at the moment, but often the effect is transient. As for the surgery, it can, as the case may be, pierce the trabecular, install a drain or, what is new, install a small valve at its level that will open only when the pressure rises, "explains Dr. Valérie Dale, ophthalmologist attached to the CHU of Bordeaux. "If necessary, the other eye can be treated, but not at the same time (to avoid any infectious complications of both eyes). As for monitoring the tension in the eye, it's for life! ", She says.
Despite this arsenal, it is clear that many glaucomas are resistant. Among other causes: poor adherence to drugs. "To get good results, it is imperative to take every day its treatment. Surveys made by the presence of spies in the bottles have clearly shown that many "forgot" them or just took them before returning to their ophthalmologist, to have a good pressure that day (but this does not happen) Prevents the optic nerve from suffering), "warns Professor Frédéric Chiambaretta (Ophthalmology Department, Clermont-Ferrand University Hospital).
Medication Implants
This reluctance to follow treatment is explained. "Since glaucoma does not cause any discomfort at least in the first years the patients concerned are not very motivated to put on a daily basis drops that are sometimes responsible for immediate disturbing effects: red eyes, tingling, dizziness, The Pr Chiambaretta.
So it is all the challenge of current research: finding more acceptable alternatives. And the good news is that science is moving in this direction. The first formulations with a delayed form (requiring a single instillation of drops per day) are already available on the market. But researchers want to go even further, by developing implants placed inside the eye, in order to release their product for months.
Another pathway - the pathway of neuroprotection - is also being studied: indeed, when the nerve cells (those of the optic nerve) die, they secrete molecules toxic to their neighbors, resulting in a snowball effect. This local toxicity is therefore added to the initial problem of hypertension and a molecule is currently being tested with the hope of stopping this vicious circle.
"There are also drug forms better tolerated on trial, to decrease the secretion of aqueous humor or increase its evacuation, as well as attempts to decrease this secretion by laser treatment, acting directly on the cells that secrete it "Says Dr. Esther Blumen-Ohana, a hospital practitioner at the Quinze-Vingts National Ophthalmology Hospital in Paris. "Finally, in the short term, ophthalmologists are wondering about the opportunity to operate glaucoma earlier, whereas until now, surgery was reserved for cases refractory to drugs," says Professor Chiambaretta.
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Glaucoma
glaucoma is an ocular disease that can lead to total or partial blindness. Often, people who are affected do not know. Yet this disease is easy to detect by measuring eye strain. Treatments for glaucoma exist. What are the symptoms related to this condition?
Glaucoma screening, have you thought about it?
By Isabelle Durant on 04 October 2016
Screening for glaucoma, have you thought about it?
From 6 October to 16 December, a campaign to inform and raise awareness of glaucoma takes place throughout France.
What if you were a person with glaucoma? What does she see? How does the disease manifest itself? As part of World Sight Day to be held on October 13, a campaign to raise awareness of this vision disease, "Set Your Sights" is launched in France this week on the initiative of the French Society of Glaucoma Associated with the France-Glaucoma Association and the Una de (the National Union of the Blind and Visually Impaired).
Glaucoma can be treated if detected quickly. And this is the whole problem because it causes no disturbance of vision, the central vision being spared. No pain either ... When the disease is felt, it is often too late: linked to intraocular hyper-pressure due to obstruction of the aqueous humor (the intraocular fluid evacuation filter), Glaucoma damages the optic nerve, alters the visual field which can lead to irreversible blindness. Hence the importance of early detection and information campaigns. It aims to inform the general public about this eye disease as silent as little known and offers a free screening. The idea is to allow the experience of a person with glaucoma to be experienced. Interactive panels allow you to put yourself in the place of the one who no longer sees.
After a visit to the Paris region on October 6th and 7th in La Défense, this information and screening campaign will then take place in several cities in France such as Nantes, Brest, Lyon, Strasbourg, Grenoble ...
Some dates: in Lille (from 18 to 20 October); In Rouen (from 25 to 27 October); In Caen (from 15 to 17 November); In Brest (from 22 to 24 November); In Nantes (5 to 8 December); In Bordeaux (from 12 to 16 December).
To find out more: "Set your sights"
Today, one million French people are affected, half of whom are unaware of it, glaucoma being the leading cause of blindness in our country. However, if diagnosed early enough, it can be treated at an early stage. It is, therefore, important to mobilize and encourage screening as early as 45 years.
Alert signals:
An increase in eye tension than an alteration of the irreversible vision as well as modifications of the head of the optic nerve. However, excessive eye pressure is not always associated with glaucoma, which makes diagnosis difficult.
Screening at what age?
Beginning at age 45, or earlier if there is a family history or very high myopia. The examination consists of a measurement of the eye pressure and a background of the eye to check the condition of the optic nerve. The patient then assesses every six months with an ophthalmological examination and complementary examinations: visual field survey, computerized analysis of the optic nerve by tomography.
What treatments?
The treatment of glaucoma is based on a steady and prolonged reduction in intraocular pressure. Eye drops reduce it. Vasodilator drugs can also improve retinal blood flow. Laser surgery helps to restore the flow of hurting aqueous humor and preserve the remaining vision. In the past few months, ultrasound treatment has been proposed for people who have difficulty with eye drops. The technique is performed under local anesthesia.
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Glaucoma: when the peripheral field is reduced
Stopping glaucoma with ultrasound
Glaucoma: when the peripheral field is reduced
By Magali Quent, on 04 March 2016 modified on 05 October 2016
Glaucoma: when the peripheral field is reduced
From March 7th to 11th, the world glaucoma week takes place. Back on the causes, warning signs and treatments for this disease.
With Professor Thanh Hoang-Xuan, head of the ophthalmology department of the American Hospital of Neuilly, and Dr. Catherine Albou-Ganem, surgeon and ophthalmologist, co-founder of the Clinique de la vision, in Paris.
The frequency increases with age. It results from an excess of pressure inside the globe exerted by a liquid called aqueous humor. Normally, this liquid is renewed. But if it does not evacuate properly, it stagnates and the eye pressure climbs, gradually destroying the fibers of the optic nerve ...
The irreversible damage to the peripheral visual field gradually restricts vision to the central zone, sometimes to blindness.
• The warning signs
Up to an advanced stage, glaucoma does not cause pain or disturbances of vision because central vision is long preserved and peripheral visual deficit often compensated by the other eye. And when the discomfort appears, the damage is already very important.
Only an early assessment can detect the problem and save the optic nerve.
• Prevention
It goes through a screening from the age of 45, or even earlier if there is a family history or very high myopia. The aim is to measure the ocular pressure (tonometer), to check the state of the optic nerve (the fundus of the eye) and possibly to test the visual field and the thickness of the nerve layers of the retina (OCT). Preventing glaucoma also means limiting aggravating or triggering factors: sleep apnea, circulatory blood disorders, prolonged use of cortisone.
• Treatments: eye drops, laser, surgery, ultrasound
Rare, congenital glaucoma can only be treated by surgery. Acute (closed-angle) glaucoma, which is less rare, manifests itself in severe pain and sudden visual loss, requiring rapid intervention, laser or surgery. Chronic (open-angle) glaucoma, the most frequent, has four types of treatment.
Hypnotizing eye drops: A daily installation of this first-line treatment for life prevents the aggravation of the disease by decreasing the production of aqueous humor. If the visual field continues to deteriorate, it is necessary to pass laser or surgery.
The laser: In a few sessions, its impacts widen the channel of an evacuation of the aqueous humor. The decrease in pressure makes it possible to lighten the installation of an improperly tolerated eye drops but the results are rarely stable.
Surgery: When the disease continues to evolve, the operation, under local anesthesia, consists of making a micro-orifice to facilitate the evacuation of the aqueous humor and preserve the remaining vision. Excellent results in 75% of cases. The remaining 25% must resume daily installation or be reoperated.
Ultrasound: This technique (cyclo coagulation circular), used for 18 months in some centers, consists of partially cauterizing the glands secreting the aqueous humor, in 2min, under local anesthesia. This gesture, which slows down the evolution of glaucoma, is for the time being reserved for severe forms resistant to laser and surgery.
• And tomorrow?
The development of better-tolerated drugs continues. And as it will probably never be possible to perform an optic nerve graft, the future also involves improving early detection means.
By Agnès Duperrin modified on October 15, 2015
Stopping glaucoma with ultrasound
Focus on glaucoma treatments, including novelties and a focused ultrasound technique to better address the problem.
Glaucoma is linked to an intra-ocular hyper-pressure which, over time, damages the optic nerve and diminishes the visual field very gradually. It leads, in extreme cases, to blindness.
This is due to the poor evacuation of the aqueous humor, which circulates continuously in the eye. Very often, the disease is detected only late, when the damage is already significant. "This painless disease is still common: 400 000 people are unaware of being affected in France, but any visual loss is irremediable." Early detection is essential to start the treatment without waiting and to keep the sight ", insists Professor Philippe Denis, Of glaucoma.
• Current treatments
It is possible to slow down the disease with daily eye drops. They are not always well supported (dry eyes, tears, itching ...), require a certain manual dexterity and a good treatment. New eye drops limiting preservatives are better tolerated. Another option: a laser or surgical treatment, rarely definitive. The objective is to accelerate the evacuation of excess liquid or to limit its production.
• The new technique
Developed by EyeTechCare, it uses highly focused ultrasound to reduce fluid production and restore a new intraocular balance. Its name: UC3 for "cycle coagulation circular by ultrasound". It combines the advantage of being effective for a long time (the recoil is twelve months with a very good tolerance) and to require a unique a priori gesture. "However, it would be perfectly possible to re-enter or revert to a conventional treatment," says Dietrich Wolf, general manager of the small Lyon-based company.
First reserved for glaucoma not controlled by eye drops and surgery, ultrasound technique is available more widely since early 2015 for people tolerant eye drops, including before any surgical recourse.
• In practice
The intervention, a soft coagulation of the ciliary body ( the gland that produces the aqueous humor), is performed in a session under local anesthesia. It is supported by the Health Insurance and offered in specialized centers of glaucoma in Paris, Lyon, Limoges, Nantes, Rouen, Lille, Saint-Jean-de-Luz, Biarritz, Toulouse, nd Grenoble.
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