glaucoma treatment:

What is glaucoma treatment?

glaucoma treatment

Glaucoma referred various ophthalmological diseases which, if not subjected to treatment, leading to a gradual death of optic nerve fibers and then destroy it - followed by the onset blindness.

The reasons for the withering away of the fibers of the optic nerve in glaucoma is still insufficiently studied ophthalmology. The danger of this disease lies in the fact that when there are no complaints. When begins to lose visual function, nerve damage often already severely progressed. While most patients can help eye drops, in some cases, surgery may be required to preserve residual visual ability.

In Germany, about 3 million people suffer from elevated intraocular pressure, is preceded by glaucoma, which affects about 800,000 people. The older the age, the more common disease. Since 40 years, glaucoma occurs in about 2.4% of the population, but with 75 years of age - at 7-8%.

The content of the article:

Glaucoma: Causes
Glaucoma: forms of the disease
Glaucoma: symptoms
Glaucoma: early diagnosis
Glaucoma Diagnosis
Glaucoma treatment without surgery
Surgery for Glaucoma
Glaucoma: Causes

As we have said, the exact causes of glaucoma are not yet installed. However, increased intraocular pressure, causing damage to the optic nerve, it is an important risk factor for this disease. Also, high blood pressure and limited blood supply (eg., Diabetes) may contribute to glaucoma. Besides, new ophthalmic research has shown that the cerebrospinal fluid surrounding the optic nerve can also be involved in the emergence of glaucoma; disorders of the immune system may also affect the appearance of the disease.

For a long time, increased intraocular pressure (> 22 mm Hg) to a certain extent it was considered the signature of glaucoma. Recently, however, it became evident that the elevated intraocular pressure though increasing the risk of damage to the optic nerve, however, it is not necessarily always accompanies the disease, that is, there are forms of glaucoma arising and without elevated intraocular pressure (so-called. Glaucoma with normal intraocular pressure). When elevated intraocular pressure enters into force the rule: the higher the intraocular pressure, the greater the risk of glaucoma. When intraocular pressure is 35 mm Hg, glaucoma risk is increased 5 times compared with the intraocular pressure of 23 mmHg

Glaucoma: other risk factors

In addition to elevated intraocular pressure and the elderly at higher risk for glaucoma are also at people who are blood relatives who already struck this disease. Another risk factor is strong myopia (at -5 diopters above). Also, black people are more prone to disease than light-skinned. In patients with diabetes increased the risk of glaucoma, if they have observed significant changes in the eyeball caused by diabetes. It is believed that the life habits, food, and profession do not constitute a risk factor for glaucoma. Nicotine only becomes a risk factor when glaucoma is already available because of nicotine it can progress.

There are several different forms of glaucoma. The most common so-called open-angle glaucoma. Besides it, in recent years, doctors attention captured glaucoma with normal intraocular pressure. One-third of cases of open-angle glaucoma belong to this form of the disease. As the name suggests, in this type of glaucoma, intraocular pressure remains normal and optic nerve damage is caused by disorders of the vascular system, which is usually manifested not only in the eye but also throughout the body. Rarer angle-closure glaucoma in which the intraocular pressure rises strongly.

The anomaly of development during the prenatal period of development can lead to a rare congenital glaucoma. If glaucoma occurs as a consequence of other diseases transferred, it is called secondary glaucoma. It may occur, for example, in severe inflammation of the eye, vascular occlusion, and accompanied by diabetes or occur after severe eye injuries. Open-angle glaucoma and glaucoma with normal intraocular pressure together constitute more than 90% of all cases of this disease.
Features congenital glaucoma

Congenital glaucoma is rare and often inherited. In contrast to the development of the disease in adults, there are early symptoms of congenital glaucoma. These include watery eyes, light sensitivity and exaggerated, sometimes turbid cornea. Congenital glaucoma can be treated only by surgery.

Glaucoma: symptoms, glaucoma treatment

Unfortunately, patients notice glaucoma at only after a portion of the optic nerve has already irreversibly affected. An indication of the presence of glaucoma can serve as a blind spot at the edges of the field of view, with time, more and more increasing. But they are often noticed too late because the other eye and the brain compensate for the first loss of this function. In the absence of curative measures, glaucoma can lead to blindness. The disease is often diagnosed too late and more because it is usually painless. Only with a rare form of angle-closure glaucoma in the eye pains, headaches and redness of eyes can serve as an indication that the organ of sight is not healthy and it is necessary to consult a surgeon-ophthalmologist.
Glaucoma: Prevention

In principle, every person can become ill with glaucoma, this time without noticing. Therefore, to protect against the development of the disease can only be preventive examinations by an ophthalmologist. Unfortunately, it is still too rare, because the public is not sufficiently informed about the dangers of glaucoma. Medical checkups acquire an even greater weight, if you remember, that the damage caused by glaucoma held even after the operation remain irreversible.

The goal of surgery for glaucoma may be available only saving more visual capability and prevention of blindness onset. Medical checkups include all inspections which are carried out for the diagnosis of the disease and are described below in the appropriate passage. Unfortunately, health insurance companies may not cover the cost of the survey data. She Sos AVL AAT about 20 euros.

This is especially important preventive care?

Medical checkups are especially important for people with risk factors for glaucoma. These include people older than 40 years, in a family that had already been cases Zabolev
In order to establish and confirm the "glaucoma" diagnosis is necessary to conduct several complementary measures.

Measurement of intraocular pressure

If you suspect glaucoma ophthalmologist first measures the intraocular pressure because it is one of the decisive factors for the development of glaucoma. However, one of the measures is not enough, because many types of the disease may remain undiagnosed: Glaucoma is often accompanied by violation of the outflow of aqueous humor with a consequent increase in intraocular pressure, but not always. If limited to only one method of examination - measurement of intraocular pressure, almost half of the glaucoma disease will not be revealed.

Survey slit lamp

Besides measuring the intraocular pressure of the eye examined by the so-called slit lamp. At the same time examining the eyes through a slit lamp acting as a microscope. It is possible that the doctor (ophthalmologist surgeon) before this medication drip into the eyes to cause mydriasis. Special beam path slit lamp light allows you to navigate through the optical eye incision. Thus it is possible to make an accurate assessment of the location and extent of changes in the various structures of the eye. In order to establish the presence of glaucoma special attention to areas in which the optic nerve extends beyond the eye (optic disc). Based on the examination with a slit lamp, a doctor can determine whether the optic nerve is damaged. If patients were to drip drops for pupil dilation, they are after the end of the survey a few hours can not drive a car.

Measurement of the visual field (perimetry)

Another method of confirming the diagnosis of glaucoma - the measurement of the field of view, the so-called perimetry. This method allows us to identify typical glaucoma visual field disturbances. Minor violations on the edges of the field of vision that patients may not notice, with the help of this survey can already be identified. However, be aware that violations in the field of vision often occur after a few years after the damage to the optic nerve, so the above examination with a slit lamp is needed.

Additional survey

These include measuring corneal thickness, three-dimensional measurement of the optic disc with the help of so-called retinotomografii (three-dimensional image of the optic nerve) and the so-called coherence tomography eyes. Retinotomografiya coherence tomography and the eye are important for follow-up of glaucoma.
Glaucoma treatment without surgery
Many patients with glaucoma can be helped by using eye drops (antiglaucomatous funds). In the past, we have been applied mainly beta-blockers, which, however, replaced by new and more specific drugs. Among the new antiglaucomatous agents is usually so-called alpha and prostaglandin antagonists. Both groups of substances called very effectively lower intraocular pressure. Another group of substances used - the so-called local action of carbonic anhydrase inhibitors, which, in addition to reducing the pressure, improve blood circulation disorders of the rear division of eyeball. Even if the angle-closure glaucoma is an urgent case, first attempt to lower intraocular pressure with the help of drugs. Only when that does not work, surgery to remove appointed glaucoma. Only with congenital glaucoma surgery is prescribed immediately. In secondary glaucoma should always be the parallel treatment of the underlying disease.

Surgery for Glaucoma, glaucoma treatment

If one glaucoma medication does not lead to sufficient reduction of intraocular pressure, glaucoma treatment to treat ophthalmic surgery.
Operation in glaucoma: technique

If the intraocular pressure in glaucoma can not be sufficiently reduced medication way, with the help of surgical intervention on the iris creates a pressure compensation between the front and rear cameras eye. In addition, glaucoma surgery prevents re-blockade with the outflow of aqueous humor: creates an artificial drainage for the aqueous humor to postoperative intraocular pressure could not rise again. Typically, glaucoma surgery is performed under local anesthesia and can be performed ambulant.

The arsenal of ophthalmic surgery has special techniques using a laser, reducing the intraocular pressure in glaucoma. However, their effect is often insignificant and short-lived.

The term glaucoma includes a large group of diseases that are characterized by:

an increase in intraocular pressure (IOP)

lesion of the optic nerve head, as well as retinal ganglion cells

narrowing of the field of view

Glaucoma can occur regardless of age but is most common in elderly or senile.

Glaucoma is considered one of the major causes of irreversible blindness in the world according to the World Health Organization (WHO).

Intraocular fluid path and its outflow

Intraocular fluid (the IOF) plays an important role in supporting the intraocular pressure. It is one of the sources of supply of intraocular structures (lens, cornea, trabecular apparatus, vitreous body).

Produced IOF processes of the ciliary body, which is located behind the iris, and going back into the eyes of the camera. Further, most of the liquid, washing the lens, flows away through the pupil into the anterior chamber enters and passes through the ocular drainage system (Schlemm's canal and trabecular), which is in the zone of the front chamber Gali Noy angle. Because the drainage system IOF eye falls into putting out collectors (graduates), and then in the superficial veins of the sclera.

In this way, it flows away about 85% of the intraocular fluid, but there is another way of outflow, which flows off about 15%.

IOF may go out of his eyes, seeping through the stroma of the ciliary body and sclera in the veins of the choroid and sclera. This path is called the use scleral outflow.

There is a balance between production IOF and its outflow. In the case of violation of this balance varies the level of intraocular pressure, which is a prerequisite for the development of glaucoma.

The causes and mechanisms of development of glaucoma

Glaucoma is a multifactorial disease, which is necessary for the development of a number of reasons (risk factors):

heredity

the individual anatomical structure of the eye or abnormal

pathology of the cardiovascular, nervous and endocrine systems.

Various combinations of these risk factors glaucoma trigger mechanism, which can be represented as steps:

strengthening the development of intraocular fluid and/or a deterioration of its outflow from the cavity of the eyeball;

an increase in intraocular pressure (IOP) above tolerance (tolerance) to the optic nerve;

ischemia (blood disorder) and hypoxia (lack of oxygen), the head of the optic nerve;

development of glaucomatous optic neuropathy followed

atrophy (loss of) the optic nerve.

The forms of glaucoma

There are the following main types (forms) of glaucoma: 

congenital glaucoma:

early primary congenital glaucoma,

infantile congenital glaucoma,

juvenile glaucoma,

concomitant congenital glaucoma

Primary glaucoma of adults:

Primary open-angle glaucoma (POAG)

multifactorial disease associated with involutional and age-related changes in the eye)

primary angle-closure glaucoma (PZUG)

(The main cause of the disease - the closure of the anterior chamber angle, where is the drainage system of the eye, the root of the iris)

secondary glaucoma in adults:

(A consequence of other ocular or systemic diseases in which there is involvement of the actors involved in the production or outflow IOF)

symptoms of glaucoma

Mostly glaucoma is asymptomatic, and the patient noted decreased vision when already 50% of the fibers of the optic nerve is damaged irreversibly.

Non-specific symptoms of glaucoma are:

blurred vision

pain

mulligrubs

a feeling of heaviness in the eyes

narrowing of the field of view

blurred vision in the dark

"Iridescent circles" before the eyes when looking at the light source

Nonspecific these symptoms are called because they can be characterized by other ophthalmic diseases.

In form-closure glaucoma and acute attack occurs, symptoms are pronounced: sharp pain in the eye, headache, redness of the eyes, nausea, vomiting.

But with the appearance of any of the symptoms should immediately seek medical advice listed above.

Diagnosing glaucoma:

To put a glaucoma diagnosis and determine the method of glaucoma treatment is necessary to conduct a thorough diagnostic evaluation, which should include:

viscometry (visual acuity)

refractometry (determination of the optical power of the eye - refraction)

perimetry (definition of peripheral vision)

tonometry (determination of intraocular pressure)

biometrics (identification of anterior chamber depth, lens thickness, the length of the eye)

biomicroscopy ( a study of tissue and eye media with the help of a slit lamp)

gonioscopy ( the study of the structure of the anterior chamber angle)

ophthalmoscopy (fundus study assessing the state of the optic nerve and retina)

glaucoma Treatment

Conservative treatment of glaucoma includes drugs that decrease the production of intraocular fluid and/or improve its flow, hemodynamic (blood flow improvers) and neuroprotective (protects nerve fibers) drugs.