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Glaucoma is a complex eye disease characterized by damage to the optic nerve, which is responsible for transmitting visual signals from the eye to the brain. The key risk factor for this condition is an increase in intraocular pressure (IOP), which can gradually damage the optic nerve and cause irreversible vision loss over time.
Glaucoma is the primary cause of irreversible blindness globally. It typically occurs when there is excessive production or an obstruction to the outflow of aqueous humor, leading to an increase in intraocular pressure. This pressure increase within the eyeball can cause vascular damage and death of nerve fibers, resulting in a progressive decline in vision, starting from the peripheral visual field. If not treated promptly, glaucoma can lead to complete blindness.
The disease can take several clinical forms, broadly categorized as primary (with an unknown cause) and secondary (due to another condition like diabetic retinopathy or ischemic occlusion).
Glaucoma is diagnosed based on three factors: high eye pressure, deterioration of the optic nerve, and impairment of the visual field.
Apart from increased intraocular pressure, other risk factors associated with glaucoma include:
Previous eye trauma and prolonged use of corticosteroids can also contribute to causing or worsening glaucoma.
Secondary glaucoma refers to cases where other medical conditions cause or contribute to increased eye pressure, resulting in optic nerve damage and vision loss. It can be a result of severe eye injury, retinal thrombosis, hemorrhages, inflammatory conditions, tumors, and advanced cases of cataracts. Certain medications can also induce secondary glaucoma by increasing ocular tone.
Glaucoma is often referred to as the "silent thief of sight" because it typically progresses unnoticed without causing noticeable symptoms until the disease has reached an advanced stage. The damage to the optic nerve and the resultant vision loss at this stage are irreversible.
However, some signs that may indicate an increase in ocular tone include headache, disturbances, and alterations of the visual field (vision of halos around light sources, fixed and non-reactive pupil, rapid decline in visual acuity). In acute (angle-closure) glaucoma, spontaneous pain may suddenly appear around and inside the eyeball, intense enough to induce nausea and vomiting.
The consequences of glaucoma on vision are severe. The disease is characterized by a progressive alteration of the visual field, first in its most peripheral parts, then also in the central part, until it leads to complete blindness.
Glaucoma is diagnosed by an ophthalmologist based on an increase in intraocular pressure and a reduction in the visual field. These signs are also associated with particular alterations of the optic disc, visible by observing the ocular fundus with an ophthalmoscope. Other instrumental investigations, such as confocal laser ophthalmoscopy (CSLO), laser scanning polarimetry (SLP), and optical coherence tomography (OCT), allow the detailed study of the optic disc and measure the thickness of the nerve fibers around the papilla, evaluating thinning due to retinal cell loss.
The first choice treatment for glaucoma is generally pharmacological and involves the use of hypotonizing eye drops, to be instilled into the eye regularly and continuously, to maintain constant pressure over a 24-hour period.
When medications are no longer sufficient to control the flow and drainage of aqueous humor, surgical therapy for glaucoma is considered. Depending on the specific case, the ophthalmologist may indicate the use of laser or incisional surgery.
The objective of the operation is to stop the progression of the disease and reduce intraocular pressure, creating a further route for the outflow of aqueous humor.
While glaucoma is an insidious and sight-threatening disease, prevention is possible. Regular eye tests that allow for early detection of glaucoma involve the measurement of ocular tone (tonometry), which must be performed every two years after the age of 40. Tonometry also allows you to monitor changes in eye pressure over time and monitor the effectiveness of any treatment prescribed by the specialist.
In suspected cases, the doctor can further investigate by performing pachymetry (measurement of corneal thickness), a test of great importance in the evaluation and monitoring of patients with increased intraocular pressure, limiting the evolution of glaucomatous damage through timely medical intervention.