Generality
Glaucoma is a subtle disease that affects the eye, slowly destroying sight. In Italy about two million people suffer from it, most of whom are unaware of being affected. Very often, in fact, glaucoma does not cause any symptoms and we he realizes its presence only when his sight is compromised. Fortunately, an early diagnosis, combined with the right therapies, is able to block its evolution, minimizing damage to sight.
Causes
The silent thief of sight
The term glaucoma identifies a heterogeneous group of diseases characterized by an increase in intraocular pressure.
When these natural pathways are obstructed and the ratio between aqueous humor produced and that eliminated increases, the pressure inside the bulb increases exceeding the normal 14-16 mmHg. If this pressure increase is significant or lasts for a long time it can damage the optic nerve, a sort of electrical connection that transmits visual information directly to the brain.
Epidemiology
Glaucoma mainly affects the over 40s and its incidence, higher than in the north, increases with increasing age (over 60 the risk of glaucoma is double, over 70 it increases up to five times).
Risk factors
The chances of developing glaucoma increase in the presence of certain diseases (ocular hypertension, myopia and diabetes), migraine, previous eye trauma, prolonged use of certain drugs (such as cortisone) and in case of familiarity with the disease.
Symptoms and Complications
Injury to nerve fibers leads to a progressive narrowing of the visual field, typical of advanced stage glaucoma. The damage to vision is in fact progressive and, since it initially affects only lateral vision, it goes unnoticed until a large part of vision is lost.
Types of Glaucoma
Doctors make a first important distinction between the various forms of glaucoma by separating those with an open angle from those with a narrow angle.
- In the first case the onset of the disease is slow and progressive due to an alteration of the outflow systems of the aqueous humor which progresses slowly.
- In the case of narrow-angle glaucoma, a less common form than the previous one, the disease manifests itself suddenly. The obstruction to the outflow is more abrupt and severe, so much so as to trigger symptoms such as eye pain, nausea, vomiting, blurred vision and halos around to the lights.
There are also other minor forms, with different characteristics and therapeutic options (congenital glaucoma and pigmetary glaucoma).
Prevention
ALL FORMS (except congenital glaucoma) ARE PREVENTABLE
When it comes to glaucoma, we cannot fail to speak of early prevention. A simple eye examination can in fact block or otherwise limit the progression of the disease before major damage occurs.
For this reason, after forty "years (35 for people at risk), it is advisable to undergo at least one medical examination of the eyes every two years.
Care and treatment
If glaucoma is recognized and treated in time, the person can retain their sight for the rest of their life. Current therapeutic options allow in fact to control the disease avoiding the worsening of glaucoma. Unfortunately, however, all these "cures" are not effective to the point of restoring lost sight.
By keeping the therapy and controls constant over time, it is however possible to establish a long and painless coexistence with the disease.
Medicines
See also: Glaucoma - Drugs for the treatment of Glaucoma
The first approach is pharmacological, generally based on the use of eye drops (beta blockers and prostaglandins). The first are very efficient as they lower ocular pressure by 20-25%; however, they are contraindicated in the case of asthma and heart disease, including arrhythmias and atrioventricular blocks.
Prostaglandins are perhaps the most powerful drug currently to lower eye pressure without incurring the side effects of pilocarpine, a drug still very valid but which, by tightening the pupil, tends to further reduce the visual field.
Surgery
When drug treatment fails to adequately reduce intraocular pressure it is possible to resort to surgery. Also in this case there are different techniques based on the type of glaucoma and the characteristics of the patient.
The intervention can make use of modern lasers capable of correcting the problem on an outpatient basis. When their use is contraindicated or inadequate to the type and stage of glaucoma, the traditional surgical technique is used. The intervention allows in most cases to significantly reduce the pressure inside the eye. In this way the pressure drop allows the temporary abandonment or in any case the reduction of drug therapy.
Like all surgical interventions, however, this type of operation is not without complications, albeit rare. For this reason, surgery is generally reserved for cases where there are no other alternatives.
