What is Glaucoma?

Popularly known as glaucoma, it occurs when increased intraocular pressure damages the optic nerve cells. When optic nerve cells die, it can lead to permanent vision loss. At the beginning of the disease, there are no symptoms. As the disease progresses, it affects the optic nerve. The optic nerve is like an electrical cable containing numerous fibers. These fibers transmit images from different areas to the brain. As the nerve is damaged, the visual field deteriorates. Many patients only notice glaucoma in the advanced stages, when significant vision loss occurs. Once glaucoma develops, reversal or cure is impossible. Therefore, early diagnosis is crucial.

Are There Different Types?

Glaucoma has different classifications. When classified by age, it can be classified as congenital, childhood, and adult. Additionally, glaucoma can be classified according to its mechanism of development, such as the widening or narrowing of the anterior chamber angle where the fluid is expelled. These types of glaucoma can be divided into open-angle and narrow-angle glaucoma.

Are Eye Pressure and Glaucoma the Same Thing?

Glaucoma is no longer diagnosed with high eye pressure, as it was 20 years ago. Today, the criterion of high intraocular pressure has been removed from the definition of glaucoma. This is because the optic nerve can be damaged even without elevated intraocular pressure (normal-tension glaucoma). Therefore, the popular belief that "eye pressure equals glaucoma" is incorrect.

What Are the Symptoms?

Symptoms vary depending on whether glaucoma is open-angle or narrow-angle. Open-angle glaucoma is an insidious disease. Because intraocular pressure rises slowly in patients, optic nerve damage progresses slowly. Therefore, patients experience little to no pain. The narrow-angle type develops more suddenly, causing vision loss, severe pain, and bloodshot eyes.

How Is It Diagnosed?

First, the patient's intraocular pressure is measured. Damage to the optic nerve is determined by performing tests that evaluate this nerve from both a structural and functional perspective. The oldest method for assessing optic nerve damage is the visual field test. Optic nerve tomography and retinal tomography are newer and more advanced diagnostic methods. The most difficult aspect of glaucoma is that once the field of vision narrows, it is unfortunately impossible to expand it again. Therefore, diagnosing chronic simple glaucoma is crucial for preventing the progression of optic nerve damage. Otherwise, it is impossible to reverse the damage that has already developed.

Who Should Get Checked?

Glaucoma can occur in anyone, at any age. Anyone can develop glaucoma, especially after the age of 35. However, those with a family history of glaucoma, diabetes, and myopia are at higher risk. Therefore, everyone aged 35 and older should have an eye exam, and those at risk should have an annual eye exam.

Who's at Risk?

The most significant risk group is those with a first-degree relative, such as a mother, father, or sibling, who has glaucoma. Under normal circumstances, approximately 2 percent of people aged 40 and over are at risk of developing glaucoma. If a first-degree relative has glaucoma, this risk increases approximately sixfold. If the patient is nearsighted or diabetic, the risk doubles.

What are the Treatment Options?

Glaucoma treatment is divided into three main categories: medication, laser, and surgery. Open-angle glaucoma is usually treated with eye drops. In some cases, oral pills are also recommended. However, these medications can be used for extended periods due to their high side effects. Oral pills can also be used to prevent optic nerve damage in patients with very high intraocular pressure who must wait several days before surgery.

How Common is It in Turkey?

While reliable data isn't readily available, hospital records indicate that there are approximately 100,000 glaucoma patients diagnosed in Turkey. However, we know that there are approximately 400,000 glaucoma patients in our country. This means that diagnosed glaucoma accounts for approximately 25 percent of all cases. This figure is around 55 percent in Western Europe and the United States. Ministries of health in the United States and Europe are conducting special screening programs for this disease and are working to raise public awareness.

How Is It Treated?

First, we lower the patient's eye pressure by either reducing the production of aqueous humor in the eye or increasing its outflow. There are medications for both. These medications are taken at regular intervals every day and are required for life. If, despite medication, the patient's eye pressure persists and the visual field narrows, meaning the optic nerve damage is progressive, surgery is the treatment of choice. The surgery involves creating an incision in the white part of the eye. This hole, which is too small to be seen from the outside, allows the excess fluid inside the eye to drain from there.