GLAUCOMA

Many people with glaucoma are unaware of the condition until it has already caused significant vision loss. However, when symptoms do occur, they can include:

• Increased Intraocular Pressure: Glaucoma often leads to increased pressure within the eye (intraocular pressure or IOP). This elevated pressure may cause eye discomfort or pain, which can be a symptom of acute angle-closure glaucoma.

• Blind Spots: Glaucoma can cause the development of blind spots in the peripheral (side) vision. Initially, these blind spots may be small and go unnoticed by the affected individual. Over time, if left untreated, these blind spots can expand and impair peripheral vision.

• Headaches: Some people with glaucoma, especially those with increased intraocular pressure, may experience intense headaches or eye discomfort.

• Tunnel Vision: In advanced stages of glaucoma, tunnel vision can occur, where the field of vision narrows significantly, leaving only a small central area of clear vision.

• Redness of the Eyes: Elevated intraocular pressure can sometimes lead to redness of the eyes, which may be accompanied by eye pain or discomfort.

Main types of glaucoma include: 

• Primary Open-Angle Glaucoma (POAG): Primary Open-Angle Glaucoma (POAG) is the most common type of glaucoma, and it develops gradually over time. In this condition, the drainage angle of the eye remains open, but the fluid (aqueous humour) does not flow out properly, leading to increased intraocular pressure (IOP). POAG typically progresses silently without early symptoms, and if left untreated, it can cause permanent vision loss.

• Angle-Closure Glaucoma (ACG): Angle-Closure Glaucoma (ACG), also known as closed-angle or narrow-angle glaucoma, is characterised by a sudden increase in intraocular pressure due to a blocked or closed drainage angle of the eye. ACG may present with acute symptoms, including severe eye pain, headache, blurred vision, halos around lights, and nausea. This condition requires immediate medical attention to prevent vision loss and alleviate symptoms.

• Normal-Tension Glaucoma (NTG): Normal-Tension Glaucoma (NTG) is a type of glaucoma where damage to the optic nerve occurs despite having intraocular pressure within the normal range. The exact cause of NTG is not well understood, but it may be related to poor blood flow to the optic nerve or increased susceptibility of the optic nerve to pressure changes. Regular eye exams are essential to detect and manage NTG.

• Congenital Glaucoma: Congenital Glaucoma is present at birth or develops in infancy. It is caused by an abnormal development of the eye's drainage system, leading to increased intraocular pressure. Infants with congenital glaucoma may exhibit signs such as excessive tearing, light sensitivity, and enlarged eyes due to increased eye size. Early detection and prompt treatment are crucial to prevent vision loss and promote healthy eye development.

• Secondary Glaucoma: Secondary Glaucoma occurs because of other eye conditions or factors, such as eye injury, inflammation, tumours, cataracts, or certain medications. Increased intraocular pressure is a secondary effect of the underlying condition. Treatment of the underlying cause is necessary to manage secondary glaucoma effectively.

• Pigmentary Glaucoma: Pigmentary Glaucoma occurs when pigment granules from the iris block the drainage angle, leading to increased intraocular pressure. It is more common in young, near-sighted adults. Proper management of pigmentary glaucoma is essential to prevent vision loss and complications associated with high intraocular pressure.

• Exfoliation Glaucoma: Exfoliation Glaucoma is caused by the build-up of extracellular material in the eye, particularly on the lens and drainage angle. This material may block the drainage of fluid, leading to increased intraocular pressure. Early detection and treatment are important in managing exfoliation glaucoma.

• Traumatic Glaucoma: Traumatic Glaucoma results from an eye injury that damages the drainage system or causes inflammation, leading to increased intraocular pressure. Prompt medical attention and appropriate management of the eye injury are crucial in preventing vision loss and complications associated with traumatic glaucoma.

The causes of glaucoma can vary depending on the type of glaucoma:

Primary Open-Angle Glaucoma (POAG):

• Genetic Predisposition: Family history of glaucoma can increase the risk.

• Age: POAG is more common in individuals over the age of 60.

• Ethnicity: Certain ethnic groups, such as African Americans, have a higher risk.

• Elevated Intraocular Pressure (IOP): High IOP is a significant risk factor.

Angle-Closure Glaucoma:

• Eye Anatomy: Narrow angles between the iris and cornea can predispose individuals to angle-closure glaucoma.

• Age: Older adults are more susceptible.

• Hyperopia (Farsightedness): People with hyperopia have a higher risk.

• Family History: A family history of angle-closure glaucoma may increase the risk.

Normal-Tension Glaucoma (NTG):

The exact cause is not well understood, but it can be related to:

• Abnormal blood flow to the optic nerve.

• Increased susceptibility of the optic nerve to damage even at normal eye pressure.

Secondary Glaucoma:

• Eye Injury: Trauma to the eye can lead to secondary glaucoma.

• Eye Surgery: Some eye surgeries, such as cataract surgery, can trigger secondary glaucoma.

• Medications: Certain medications, particularly corticosteroids, can increase the risk.

• Eye Conditions: Conditions like uveitis or pigment dispersion syndrome can lead to secondary glaucoma.

Congenital Glaucoma:

• Genetic Factors: Congenital glaucoma can be inherited.

• Abnormal Eye Development: Structural abnormalities in the eye's drainage system from birth can cause this condition.

• Pseudoexfoliative Glaucoma (PXG) and Pigmentary Glaucoma (PG): These types of glaucoma are often associated with the shedding of certain eye-related materials within the eye, leading to increased eye pressure and damage to the optic nerve.

The medical treatment of glaucoma primarily focuses on reducing intraocular pressure (IOP), which is a major risk factor for glaucoma-related damage to the optic nerve. Here are some common medical treatments and interventions for glaucoma:

• Medications (Eye Drops):

Prostaglandin Analogs (e.g., Xalatan, Lumigan, Travatan): These eye drops increase the drainage of aqueous humour, reducing IOP.

Beta-Blockers (e.g., Betimol, Timoptic): These eye drops decrease aqueous humour production.

Alpha Agonists (e.g., Alphagan, Iopidine): These drops reduce aqueous humour production and increase drainage.

Carbonic Anhydrase Inhibitors (e.g., Trusopt, Azopt): These drops reduce aqueous humour production.

Rho Kinase Inhibitors (e.g., Rhopressa, Rocklatan): These drops reduce IOP by targeting the trabecular meshwork's stiffness and resistance.

• Laser Peripheral Iridotomy (LPI): LPI is a procedure used to treat angle-closure glaucoma. It involves creating a small hole in the peripheral iris to improve the drainage of aqueous humour from the anterior chamber of the eye.

• Selective Laser Trabeculoplasty (SLT): SLT is used to treat open-angle glaucoma. It involves using laser technology to target and stimulate the trabecular meshwork, which helps improve aqueous humour drainage.

• Glaucoma Surgery: 

Trabeculectomy: This surgical procedure creates a new drainage channel for aqueous humour to lower IOP.

Tube Shunt Surgery: A small tube is inserted into the eye to divert excess fluid and reduce IOP.

Minimally Invasive Glaucoma Surgery (MIGS): Various MIGS procedures aim to lower IOP through less invasive techniques, such as using microstents or shunts.

Adopting a healthy lifestyle can contribute to overall eye health and may help manage glaucoma symptoms. Here are some natural strategies to consider:

• Diet: Eating a well-balanced diet with foods rich in antioxidants, such as fruits and vegetables, can support eye health. Antioxidants may help protect the optic nerve from damage.

• Regular Exercise: Engaging in regular physical activity can help maintain healthy blood flow to the eyes and reduce intraocular pressure (IOP). Consult your healthcare provider for suitable exercises.

• Caffeine Intake: Limiting caffeine intake, especially before eye examinations, may help prevent temporary increases in IOP.

• Smoking Cessation: Smoking is a known risk factor for glaucoma and can worsen the condition. Quitting smoking can have a positive impact on eye health.

• Stress Reduction: Chronic stress can contribute to elevated IOP. Stress-reduction techniques such as meditation, deep breathing exercises, and yoga may help manage stress.

• Acupuncture: Some people find acupuncture helpful in reducing stress and promoting overall well-being. It may be worth discussing with a qualified acupuncturist.

• UV Protection: Protect your eyes from harmful ultraviolet (UV) rays by wearing sunglasses with proper UV protection, especially when outdoors.

• Sleep Position: Elevating your head slightly during sleep may help reduce IOP, particularly in individuals with certain types of glaucoma. Consult your eye specialist for guidance on this.