Glaucoma: A Culprit for Loss of Sight

Glaucoma is a disorder characterized by damage in the optic nerve, the major nerve for vision. This nerve is the one responsible for receiving impulses from the retina and transmitting these to the brain to be recognized as a vision. Therefore, damage to this nerve will greatly affect the persons vision. This disease, once left untreated may eventually lead to irreversible loss of sight. In fact, it has been the leading cause of blindness in the United States.

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Normally, the eye produces aqueous humor that is balanced by factors like secretion rate, flow resistance and resorption resistance. But once one of these factors is impaired, the balance between the aqueous production and aqueous outflow will also be disrupted. When this happens, aqueous humor will be trapped causing an increase in the intraocular pressure that will eventually damage the optic disk that precedes visual field loss.

Two of the major types of glaucoma are the following:

    1. Open-angle Glaucoma

This type of glaucoma occurs more frequently than other types of glaucoma. It usually results from an impaired trabecular meshwork of the eye when it inefficiently drains aqueous humor. As fluid accumulates in the internal environment of the eyes, intraocular pressure rises causing damage to the optic nerve. This in turn can cause gradual visual loss. This type of glaucoma silently performs it's dirty job before the person can detect it's presence. Symptoms will not be seen until there is an optimum damage to the optic nerve already.

    1. Angle-closure Glaucoma

Unlike the first type of glaucoma, this type is rare but it's presence is clearly visible. Symptoms will be seen right away when the intraocular pressure rises. This happens when the iris suddenly blocks the drainage angle of the eye. This is a medical emergency and should be treated immediately by healthcare personnel. Asian people and those with hyperopia have greater risk in developing this type of glaucoma and therefore should avoid medications and products that would further increase their risk in developing the disorder.

Symptoms of Glaucoma

Open-angle glaucoma is generally asymptomatic. Meaning to say, symptoms would not be seen until later on in the course of the disease when there is already optimum damage to the optic nerve. The first observable symptom for this type of glaucoma is the loss of peripheral vision, or what you call tunnel vision wherein the person can only see things in front of him and neglects the things beside him. Seeing large blank spots is the evidence that the optic nerve of that person has been damaged extensively. However, symptoms for angle-closure glaucoma occur suddenly and acutely. It includes sudden eye pain, blurring of vision, nausea, vomiting, seeing halos, eye redness and headaches. Eyes of a patient with glaucoma appear red. The cornea may appear hazy even to the naked eye of an observer. Also, when being assessed, pupils of glaucoma patients are non-reactive to light and accommodation.

Diagnostic Tests used to detect Glaucoma

An ophthalmologist or an eye expert will be assessing you to detect presence of glaucoma. It is important to have your eyes regularly checked especially for those who are experiencing the symptoms mentioned above or if there is a high risk in developing such disorder. This way, you'll get to detect it presence earlier and treat it before it even gets worse. Total loss of vision will be prevented thereby protecting the persons totality. Here are some painless diagnostic exams that an ophthalmologist might perform.

    1. Tonometry

Tonometry is the most common diagnostic test used in detecting presence of glaucoma. It is generally done to measure the intraocular pressure with the use of an instrument called a tonometer. Normally, it must range from 10-21 mmHg. But a rare type of glaucoma, the normal-tension glaucoma, may fall in the normal range despite the disease progression.

    1. Pachymetry

Pachymetry, on the other hand, is done to assess corneal thickness. A probe called a pachymeter is smoothly placed on the cornea for measurement. This is done because corneal thickness has an effect to intraocular pressure readings.

    1. Goniocopy

By using a mirrored lens, the ophthalmologist will assess the eyes drainage angle to determine the type of glaucoma that a person has. If there is inefficiency in the trabecular meshwork, then it is diagnosed as open-angle glaucoma; and if there is blockage on the drainage angle, then it would be considered as angle-closure glaucoma.

    1. Opthalmoscopy

With the aid of an opthalmoscope, the physician will be able to view the interior part of the eye. The pupils will be dilated with the use of an eye drop for better visualization. A patient with glaucoma will have evidences of cupping or optic nerve changes, which is an indication of optic nerve damage. Cupping of the nerve will result to blank spot in the persons visual field.

    1. Visual Field Testing

This test intends to determine presence of the blank spots mentioned earlier. It is done with the aid of a bowl-shaped device called a perimeter. During the test, the persons one eye is covered while flashes of light will be flashed from various locations unto the examined eye. The person being examined must press the button whenever he or she sees the light. The test must be done every 6-12 months to monitor changes and detect the development of disease early on.

Treatment for Glaucoma

Treatment for glaucoma highly depends on it's type, extent and response. Here are some of it's most common treatments.

    1. Medical Intervention

Eye drops have been the gold standard for treatment of glaucoma for years. It works either by decreasing the production of aqueous humor or by increasing it's outflow. Here are several types of eye drops prescribed by physicians:

    1. Beta-adrenergic antagonists

It effectively reduces production of aqueous humor. However, it brings about side effects such as worsening of asthma and emphysema, as well as bradycardia and hypotension. Brand names of these medications are the following: Timolol, Carteolol and Metipranolol. But another brand under this classification is the Betaxolol, which concentrates it's effect on the eyes only, hence decreasing systemic side effects.

    1. Prostaglandin analogs

This works by increasing aqueous humor outflow. It has replaced Timolol as the most common drug prescribed for glaucoma simply because it causes fewer systemic side effects. However, as compared with other eye drops, this type causes more redness of the eyes. Also, it changes the color of the iris and thickens eyelashes. It includes medication such as Xalatan, Travatan and Lumigan.

    1. Adrenergic agonists

These are adrenaline-like drugs that function both in decreasing fluid production and in increasing it's outflow. It includes medications such as Alphagan, Propine, Apraclonidine and Epinephrine.

    1. Miotics

These parasympathomimetic agents constrict pupils and acts by increasing fluid outflow from the eyes. It includes drugs such as Pilocarpine and Demecarium.

    1. Surgical Intervention

 

    1. Laser trabeculoplasty

This surgery is performed to treat open-angle glaucoma. It has two types Argon Laser Trabeculoplast (ALT) and Selective Laser Trabeculoplasty (SLT). In ALT, it stimulates the trabecular meshwork to perform it's function efficiently by creating evenly spaced minute burns onto the area. While in SLT, it creates intact mesh-like drainage canals, which surrounds the iris, by using different frequencies of laser.

    1. Laser iridotomy

This surgery is performed for patients with angle-closure glaucoma and for those with a very narrow drainage angles. A tiny hole is created into the upper part of the iris to improve the outflow of the aqueous humor. This hole is concealed by the upper lid.

    1. Trabeculectomy

In this surgery, there are two things to be done. First is a flap on the sclera (the eyes white part) and second is a bleb under the conjunctiva (covering of the white part of the eye). Once created, fluid will now drain through the flap going to the bleb, where it will be reabsorbed by the blood vessels surrounding the eye.

Treatment for glaucoma depends on the patient condition. It is best to consult your doctor for suggestions. Also, once treated, remember to have a regular check up with your doctor, to carefully monitor your condition and disease control.

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Posted in Dentistry Post Date 08/29/2018


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