Understanding Glaucoma: Causes, Symptoms, and Treatments

Understanding Glaucoma: Causes, Symptoms, and Treatments

Glaucoma, or “green star”, is still a common cause of blindness in Germany. Anyone over 40 should, therefore, have their intraocular pressure and the condition of their optic nerve checked every two years. People with additional risk factors should have an annual screening because Only regular examinations by the ophthalmologist can detect the disease quickly.

Glaucoma: who is affected?

Glaucoma (glaucoma) is not a rare disease: there are around 1 million glaucoma patients in Germany, but only 600,000 know the diagnosis and are treated accordingly. A quarter of all blind people in Germany are blind due to glaucoma.

The frequency increases with age: while only around one per cent of 40-year-olds are affected, 18 per cent of 85-year-olds suffer from it.

The following risk factors  increase the likelihood of developing glaucoma:

Glaucoma: Initially, no symptoms

Glaucoma is the name given to a variety of eye diseases which – if not recognized and treated in time – lead to a sad result: they destroy the optic nerve.

What is fatal: Since glaucoma usually does not cause any symptoms at first, the person affected does not notice the insidious disease at first. If parts of the field of vision are blurred or dark, it is already too late, and the optic nerve has been damaged.

Regular check-ups at the ophthalmologist are crucial to detect glaucoma in good time.

development of glaucoma

The intraocular pressure plays a decisive role here: A certain pressure inside the eye is necessary to retain its spherical shape. The so-called aqueous humour maintains the pressure, which carries nutrients for the cornea and lens into the eye.

However, if the drainage of the aqueous humour is obstructed, the aqueous humour can no longer drain off – the intraocular pressure increases. Due to the pressure on the sensitive fibres of the optic nerve, it gradually dies.


Consequences of increased intraocular pressure

The result of excessive pressure inside the eye is loss of vision, and there is a risk of blindness in the long term. If there are defects or limitations in the field of vision, you simply no longer perceive certain areas – they are like a blind spot. However, the field of vision is at least as necessary for our orientation, especially in traffic, as central vision.

However, Increased intraocular pressure does not necessarily lead to the development of glaucoma.

Normal-tension glaucoma: IOP not increased

Glaucoma is not always accompanied by increased intraocular pressure. In so-called normal pressure glaucoma, the eye pressure is in the normal range, i.e. at a value of 21 mmHg or below. Other risk factors are decisive here, such as circulatory disorders.

Because the blood flow also influences the condition of the optic nerve. It has long been suspected that, in addition to eye pressure, pathological disorders of blood circulation are also responsible for glaucoma. These become noticeable outside the eye as chronically cold feet and hands.

Early detection of glaucoma

Only a glaucoma screening examination by an ophthalmologist can detect the disease in its early stages, measuring the intraocular pressure and examining the condition of the optic nerve. Damage to the optic nerve is decisive for diagnosing “glaucoma”.

The advantage of early detection of glaucoma: if detected early, eyesight can be saved through drug treatment.

From the age of 40, the check-up should be carried out every two years, and from the age of 60, every one to two years. Patients at risk should ideally do this annually.

The early detection of glaucoma does not damage the eye and costs the patient around 15 to 40 euros. The statutory health insurance companies usually do not cover the costs of early detection; it is a so-called iGeL examination (individual health service). Nevertheless, it is a worthwhile investment for the sake of health.


Diagnosis of Glaucoma: Typical Examinations

The ophthalmologist first takes a detailed medical history and checks possible risk factors. He examines the back of the eye to check the optic nerve and retina. He also measures the intraocular pressure after anaesthesia with a local anaesthetic. 

If glaucoma is suspected, the visual field is then determined. The visual field measurement gives the ophthalmologist precise information about the course of the glaucoma disease. Further investigations may also be required.

treatment of glaucoma

Well over nine per cent of glaucoma patients can be treated with eye drops. These often contain beta blockers or prostaglandins. The goal of lowering intraocular pressure can be achieved in two ways:

  • slow down the production of aqueous humor or
  • increase the outflow of aqueous humour.

In addition, the eye drops improve blood flow to the optic nerve and retina and are used in normal pressure glaucoma. Lowering blood pressure is often part of the therapy.

Timely therapy is crucial.

The most important thing is regular medication use according to the ophthalmologist’s instructions – even if you don’t notice any symptoms yourself. Almost none of the glaucoma patients who are diagnosed early go blind. In this way, the course of the disease can be delayed – however, glaucoma cannot be cured.

Patients who cannot be treated with medication can be treated with laser therapy or surgery.

Whether a patient with increased intraocular pressure should receive glaucoma prophylaxis must be decided on a case-by-case basis. One study showed that among untreated patients, ten per cent developed glaucoma in five years.


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