Be Clear On Glaucoma

Glaucoma is one of the world’s most common causes of blindness. Primary open angle glaucoma affects an estimated half a million people in England. VISUfarma gives us the facts.

What is glaucoma?

Glaucoma is a progressive condition where retinal ganglion cells (RGCs)—nerve cells in the eyes forming part of the optic nerve—begin to degenerate, leading to loss of vision and eventually blindness. RGCs play a key role in transmitting visual information from our eyes to the brain, enabling us to see. In glaucoma, these cells begin to die, which leads to loss of vision.

The reason for why this degeneration happens is not fully understood. Glaucoma usually affects both eyes but may be worse in one eye. Globally, glaucoma affects an estimated 70 million people, 10 percent of whom are blind. This makes glaucoma the leading cause of irreversible blindness worldwide.

How is glaucoma linked to abnormally high pressure in the eye?

The degeneration of RGCs, which leads to the visual loss in glaucoma, is attributed to abnormally raised pressure in the eye, called intraocular pressure (IOP). The reason for this rise in pressure is due to a build-up of the fluid that flows through the eye, often because the fluid can’t drain away as it should. This increased pressure causes damage to the retinal ganglion cells causing the cells to die.

But research has demonstrated that this is only part of the story. Elevated IOP is still considered one of the biggest risk factors for developing glaucoma, but it is no longer part of the official definition. RGC death and resultant glaucoma is not fully understood. Once the RGC nerve cells die, they cannot be replaced, which is why the vision loss in glaucoma is permanent and why protecting these cells from damage is so important. Reducing IOP is the current standard for treating glaucoma. However, though essential in almost all glaucoma management plans, reducing IOP does not completely stop disease progression. One study found that over 20 percent of patients continued to experience loss of vision after treatment, putting them at risk of blindness. Recently, new research has focused on the energy in the RGCs and how supporting this, alongside IOP lowering drops, can further help slow disease progression.

What are the different types of glaucoma?

There are several different types of glaucoma:

Open angle glaucoma—This is the most common type of glaucoma, accounting for an estimated 80 percent of glaucomas. It develops slowly over a number of years.

Acute angle closure glaucoma—an uncommon type of glaucoma with a rapid onset. It is thought to be caused by the drainage in the eye becoming suddenly blocked, which can raise the pressure inside the eye very quickly.

Secondary glaucoma—this occurs when there is a pre-existing eye condition, such as inflammation of the eye (uveitis).

Childhood glaucoma (congenital glaucoma)—a rare type of glaucoma in young children, caused by an abnormality of the eye.

What are the risk factors of glaucoma?

There are several risk factors that make someone more likely to develop glaucoma:

  • High pressure in the eye, called intraocular pressure (IOP)
  • Being over 40 years of age
  • Having a family history of glaucoma
  • Being of African descent
  • Having a thinner central cornea
  • Having diabetes
  • Long term use of medicines known as corticosteroids
  • Mitochondrial dysfunction

What are the symptoms associated with glaucoma?

The most common form of glaucoma, primary open angle glaucoma, typically develops over time and is asymptomatic—there are no symptoms, which make it difficult to diagnose. Symptoms of vision loss may only present in the late stages of the disease when irreversible damage has already occurred.

Symptoms of vision loss are likely to start at the edges of the visual field and include blurred vision and halos of light. Glaucoma is best treated in the early stages of the disease when it is detectable only by clinical examination. For this reason, it is important to have regular eye checks with a healthcare professional, especially if you are in a high risk-category for developing glaucoma.

Very occasionally, glaucoma can develop suddenly with the following symptoms. If you develop symptoms suddenly you should go to your nearest A&E department as it may require immediate treatment.

  • Intense eye pain
  • Nausea and vomiting
  • A red eye
  • A headache
  • Tenderness around the eyes
  • Seeing rings around lights
  • Blurred vision

How is glaucoma diagnosed?

Because glaucoma doesn’t usually have symptoms, it is most likely to be first noticed during a routine eye test. If glaucoma is suspected, an optometrist may perform a test to confirm the diagnosis or refer you to an eye doctor. There are many tests that can be used, including:

  • A test to measure the pressure in the eye.
  • Examining the front of the eye to check if the draining system is blocked, which can increase pressure in the eye.
  • A test to check the edges of the visual field, since this is the first area of vision to be affected by glaucoma.
  • An assessment of the optic nerve, which connects the eye to the brain and becomes damaged in glaucoma.

Once confirmed, a specialist eye doctor will assess the extent of the damage, possible causes, and best treatment options.

How often should a person with glaucoma see a specialist?

According to guidelines from the National Institute for Health and Care Excellence (NICE), a person with glaucoma should be regularly monitored for the rest of their life. The number of visits to a specialist (in less severe cases an optician or a GP) may vary depending on the severity, risk of progression and type of glaucoma, ranging from once a month to every two years.

What are the different treatment options for glaucoma?

Treating glaucoma is essential to prevent irreversible damage and blindness, so it is important to adhere to treatment schedules and attend regular appointments.

Glaucoma treatments aim to reduce the pressure in the eye. Usually, this involves application of eye drops multiple times day. Treating glaucoma will not reverse any vision loss that has already occurred but it may prevent it from getting worse. In some cases, when eye drops haven’t worked, laser treatment or surgery may be advised.

How can reducing IOP help to prevent the progression of glaucoma?

By reducing the IOP, more of the nutrients can reach the RGCs enabling them to survive and function correctly. To date, all available glaucoma treatments work by reducing IOP. This has proven to be effective but does not, in many cases, fully stop disease progression in all patients.

What else can a patient do alongside glaucoma treatment to help their vision and eye health?

Always follow the treatment schedule prescribed by a healthcare professional and attend regular eye checks. In addition to prescribed medications, add-on treatments are also available which may work alongside the prescribed treatment and offer beneficial effects.

Coqun, an add-on glaucoma treatment by VISUfarma, contains an antioxidant called coenzyme Q10 (CoQ10). CoQ10 is found naturally in the body and has protective effects in the eye but the amount decreases as we age. Topical CoQ10, used alongside IOP lowering drops, may further help to protect the RGCs from dying. COQUN® eye drops contain CoQ1O and are a new add-on treatment to antihypertensive glaucoma therapy.

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