GLAUCOMA is becoming an increasingly important cause of blindness, as the world’s population increases. According to reports from the World Health Organization (WHO), glaucoma is now the second leading cause of blindness globally, after cataracts.

“Glaucoma however presents perhaps an even greater public health challenge than cataracts because the blindness it causes is irreversible”, the report says.

As a global body, WHO officials are looking into ways to address the problems caused by glaucoma which until 2002, was the third leading cause of blindness.

Something has to be done, especially in Africa as it will be essential to train hundreds of eye doctors”, says WHO’s Director of Chronic Diseases and Health Promotion, Dr. Robert Beaglehole.

What is Glaucoma?

Glaucoma is the general term for a group of similar diseases. In primary open angle glaucoma, the channels that drain fluid within the eye become blocked, causing the pressure within the eye to rise.

It refers to a buildup of pressure within the eye that causes damage to the optic nerve.

The front part of the eye contains a clear fluid, the aqueous humor. This fluid nourishes the eye and gives it its shape. The eye constantly produces this fluid and drains it away through a drainage system.

If a person has glaucoma, the fluid drains too slowly out of the eye. When this happens, fluid builds up, and pressure inside the eye rises.

If a person does not manage this pressure, it may damage the optic nerve and other parts of the eye, leading to vision loss.

Glaucoma usually affects both eyes, although it may affect one eye more severely than the other.

Causes and risk factors of Glaucoma

Experts do not know exactly what causes glaucoma, but some health conditions increase the risk.

If a person has primary glaucoma, there is no identifiable cause. If they have secondary glaucoma there is an underlying cause, such as a tumor, diabetes, hypothyroidism, an advanced cataract, or inflammation.

Risk factors for glaucoma include the following:

For Whites, being over 60 years old

For Black and Hispanic people, being over 40 years old

Having diabetes or another underlying health condition

A family history of glaucoma

Having an eye injury or condition

Previous eye surgery

Severe myopia (shortsightedness)

Taking corticosteroid medication, especially as eye drops

High blood pressure

Genetic factors, which can lead to childhood glaucoma

Types of Glaucoma

There are several types of glaucoma, including:

Open-angle glaucoma

Closed-angle glaucoma

Low-tension glaucoma

Pigmentary glaucoma

Open-angle glaucoma

Also known as chronic glaucoma, this is the most common type. It develops slowly, and a person may not notice any symptoms, even if slight vision loss occurs.

Many people with this type of glaucoma do not seek medical help until permanent damage has already occurred.

Closed-angle glaucoma

This is also known as acute angle-closure glaucoma. It can start suddenly with pain and rapid vision loss.

As the symptoms are noticeable, the individual will usually seek medical help, resulting in prompt treatment. This can prevent permanent damage.

Low-tension glaucoma

This is a rarer form of glaucoma in which eye pressure is not higher than the normal range but still causes damage that affects the optic nerve.

Experts know little about this condition, but it might be due to reduced blood supply to the optic nerve.

Pigmentary glaucoma

This is a type of open-angle glaucoma that typically develops during early or middle adulthood.

It involves changes in the pigment cells that give color to the iris. In pigmentary glaucoma, the pigment cells disperse throughout the eye.

If the cells build up in the channels that drain fluid from the eye, they can upset the normal flow of fluids in the eye. This can lead to a rise in eye pressure.

Childhood glaucoma

In rare cases, glaucoma can affect children due to genetic factors. The child may have:

Unusually large eyes

Cloudiness in the cornea

Sensitivity to light

It is important to note that medication and surgery can help prevent vision loss.

Symptoms of Glaucoma

The symptoms of the two most common types of glaucoma are different.

Open-angle glaucoma

Symptoms develop slowly, and a person may not notice them until the later stages.

They include: gradual loss of peripheral vision, usually in both eyes and tunnel vision.

Closed-angle glaucoma

The symptoms of acute glaucoma appear suddenly and include:

Eye pain, usually severe

Blurred vision

Nausea and possibly vomiting

Seeing halo-like glows around lights

Red eyes

Sudden, unexpected vision problems, especially in poor lighting

Diagnosis of Glaucoma

Ophthalmologists regularly check for glaucoma as part of a routine eye test. They can use several diagnostic tests:

Opthalmoscopy

The eye doctor puts drops into the eye to widen the pupil, then examines the inside of the eye using a special light and magnifying glass.

Perimetry

The doctor carries out a visual field test to check the person’s peripheral (side) vision. The person looks straight ahead while the doctor presents a light spot in different places around the edge of their vision. This helps create a map of what the person can see.

Tonometry

After using eye drops to numb the eye, the doctor measures the pressure in the eye with a device that either touches the cornea (applanation) or uses a puff of air.

Gonioscopy

The doctor uses eye drops to numb the eyes, then places a type of contact lens on the eye. The lens has a mirror that that can show if the angle between the iris and the cornea is normal, too wide (open), or too narrow (closed).

Pachymetry

The doctor places a probe on the front of the eye to measure the thickness of the cornea. The doctor will take this into account when they assess all the results, as corneal thickness can affect eye pressure readings.

Treatment of Glaucoma

Treatment aims to improve the flow of fluid from the eye, reduce fluid production, or both.

There are several ways to do this:

Eye drops

Most people will use eye drops as initial treatment. These either reduce the amount of fluid the eye makes or improve drainage.

It is essential to follow a healthcare professional’s instructions carefully for the best results and to prevent adverse effects.

Possible Adverse effects include:

Stinging

Redness of eyes

Change in eye color or skin around the eye

Headaches

Dry mouth.

Occasionally, retinal detachments or difficulty in breathing may occur.

If the adverse effects persist, the doctor may change the dose or recommend a different option.

Surgery

If drugs do not help, or if the person cannot tolerate them, a doctor may recommend surgery.

Surgery usually aims to reduce the pressure inside the eye. Possible interventions include:

Trabeculoplasty: The surgeon uses a laser beam to unblock clogged drainage canals, making it easier for fluid to drain out.

Filtering surgery: If laser surgery does not help, the surgeon may open channels in the eye to improve fluid drainage.

Drainage implant: This may help if glaucoma occurs in children or as a result of another health condition. The surgeon inserts a small silicone tube into the eye to improve drainage.

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