Glaucoma Unit

The eye produces a unique fluid. When the produced fluid flows into the eye, an equal amount should drain out. The fluid drains out through an area called the drainage angle (this is the angle formed at the connection between the iris and the cornea). The balance of weight between the produced fluid and the fluid that drains out determines the pressure inside the eye, known as intraocular pressure (IOP). However, if the drainage angle does not function properly, fluid accumulates, causing the pressure inside the eye to rise and damaging the optic nerve.

If the drainage angle is blocked, fluid cannot flow out of the eye, causing the pressure to increase.

The optic nerve is composed of more than a million tiny nerve fibers, similar to an electrical cable made up of many small electrical wires. When these nerve fibers die, tiny blind spots develop in the field of vision. Initially, these blind spots are not noticeable until the majority of optic nerve fibers have already died. When all the fibers die, the eye becomes blind.

Open-Angle Glaucoma:
This is the most common type of glaucoma. It develops gradually when the eye does not drain fluids as it should (like a clogged drain). As a result, pressure inside the eye accumulates and begins to damage the optic nerve. This type of glaucoma is painless and does not initially cause changes in vision.

For some people, their optic nerves may be sensitive to normal eye pressure. This means that their risk of developing glaucoma is higher than usual. Regular eye examinations are important to detect early signs of damage to their optic nerve.

Closed-Angle Glaucoma (also called "Narrow-Angle Glaucoma" or "Angle-Closure Glaucoma"):

This type of glaucoma occurs when the iris is very close to the cornea, causing a small or narrow drainage angle. The iris can eventually block the drainage angle, similar to a lid covering a drain. When the drainage angle is completely blocked, eye pressure rises very quickly. This situation is called an acute angle-closure glaucoma attack. It is a true eye emergency, and urgent medical treatment is required. Immediate examination by an eye doctor or emergency eye care is necessary, as an increase in pressure can lead to irreversible damage and blindness in a short time.

1. Sudden blurry vision
2. Eye pain and around the eyes
3. Headache
4. Nausea or vomiting
5. Seeing halos or colorful rings around lights

Many people with angle-closure glaucoma develop it slowly. This condition is called chronic angle-closure glaucoma. There are no symptoms initially, so they may not be aware of it until the damage is severe or they have an attack.

Angle-closure glaucoma can lead to blindness if not treated promptly.

Open-Angle Glaucoma:

In open-angle glaucoma, there are no clear warning signs or symptoms in the early stages. As the disease progresses, blind spots develop in peripheral vision.

Most people with open-angle glaucoma don't notice any changes in their vision until the damage is quite severe. That's why glaucoma is called the "silent thief of sight." Regular eye exams can help your eye doctor detect this disease before you lose your vision. Your eye doctor can tell you how often you need to be checked.

Closed-Angle Glaucoma:

People at risk for closed-angle glaucoma typically don't show symptoms before an attack. Some early signs of an attack may include blurred vision, halos, mild headaches, or eye pain. People with these symptoms should be examined by their eye doctor as soon as possible. An attack of closed-angle glaucoma may include:

1. Severe eye or forehead pain
2. Redness of the eye
3. Decreased or blurry vision
4. Seeing halos or rainbows
5. Headache
6. Nausea
7. Vomiting

Normal-Tension Glaucoma:

People with "normal-tension glaucoma" have normal eye pressure but show signs of optic nerve damage from glaucoma, such as blind spots in their visual field.

For some people, there are no signs of damage, but they have elevated intraocular pressure (also called Ocular Hypertension or OHT). These patients are considered "suspects for glaucoma" and have a higher risk of developing glaucoma over time. Some individuals may be considered glaucoma suspects even if their eye pressure is within the normal range. For example, their eye doctor may notice something different in their optic nerve. Typically, glaucoma suspects do not exhibit symptoms, which is why they need careful monitoring by an eye doctor. The eye doctor can check for changes over time and initiate treatment if necessary.

Pigment Dispersion Syndrome (PDS) and Signs of Pigmentary Glaucoma:

Pigment Dispersion Syndrome (PDS) occurs when the lens rubs against the back of the iris, causing pigment dispersion in the eye chamber. Pigment can elevate intraocular pressure, leading to pigmentary glaucoma. Some people with PDS or pigmentary glaucoma may see halos or experience blurred vision after activities like running or playing basketball. If you notice these symptoms, seek an eye examination promptly.

Pseudoexfoliation Syndrome (PXF or PEX):

Pseudoexfoliation syndrome (PXF or PEX) is a systemic syndrome related to age, where a white fibrous material is found in the eye's anterior part, dispersed in the eye chamber, and obstructs the drainage system. The appearance of pseudoexfoliation deposits has a genetic component. This disease, similar to open-angle glaucoma, usually lacks symptoms, requiring regular eye check-ups for detection and monitoring.

Some individuals have a higher-than-average risk of developing glaucoma. The main risk factors include:

1. Age above 40
2. Family history of glaucoma
3. African, Hispanic, or Asian descent
4. High intraocular pressure
5. Nearsightedness or farsightedness
6. Previous eye injury (even in childhood)
7. Long-term use of steroid medications
8. Thin central corneal thickness
9. Systemic conditions such as diabetes, migraines, high blood pressure, compromised blood flow, or other health issues affecting the whole body

It is recommended to discuss your risk for glaucoma with an eye doctor. Individuals with more than one of these risk factors are at an even higher risk for glaucoma.

Diagnosing Glaucoma:

The only sure way to diagnose glaucoma is through a comprehensive eye examination. Checking intraocular pressure alone is not sufficient to detect glaucoma.

During a glaucoma examination, your eye doctor should:

1. Measure intraocular pressure
2. Examine the angle of drainage in the eye
3. Check the optic nerve for signs of damage
4. Assess peripheral (side) vision
5. Capture an image of the optic nerve or perform Optical Coherence Tomography (OCT) focused on the optic nerve
6. Measure corneal thickness

Glaucoma is known as the "silent thief of sight" because it typically has no symptoms in its early stages. In fact, half of the people with glaucoma may not be aware that they have the condition. Regular eye exams can help your eye doctor diagnose this disease before significant vision loss occurs. After the initial examination, your eye doctor will recommend how often you should undergo further testing.

There are two main types of laser treatments for glaucoma that aid in the drainage of fluid from the eye. These treatments are performed under local anesthesia with drops in outpatient clinics, without hospitalization.

Selective Laser Trabeculoplasty (SLT)

This treatment improves the function of the drainage angle, allowing the eye fluid to flow more easily, reducing intraocular pressure. Currently, the use of SLT laser is widely accepted as the first-line treatment for glaucoma, even before eye drops. Today, at Shaare Zedek Medical Center, there is an advanced device for performing Direct SLT, enabling precise and efficient treatment in just 2 seconds. Additionally, the use of the Direct SLT device allows the application of laser SLT for every glaucoma patient, either instead of or in addition to medications.

Peripheral Iridotomy

This treatment is designed for individuals suffering from angle-closure glaucoma. An eye doctor uses a laser to create a small hole in the iris. This hole assists in fluid flow to the drainage angle, preventing the development of acute glaucoma attacks.

1. Surgeries that enhance the natural drainage system's flow, such as KDB, GATT, i-stent, and Hydrus. In these surgeries, removal or implantation of a tiny device is performed to reduce resistance in the drainage system and allow unobstructed fluid flow into the drainage system.
   
   

2. Surgeries that bypass the natural drainage system, such as trabeculectomy, PRESERFLO, and glaucoma implants like Ahmed or Baerveldt.
   
   
   

3. Cataract surgery for certain individuals with narrow angles. Removing the eye's natural lens can relieve eye pressure. In cases with narrow angles, the iris and the lens are too close to each other. This condition can cause a relative blockage of the drainage angle (the opening of the drainage system). Removing the eye's natural lens in cataract surgery creates more space in the eye, widening the drainage angle, enlarging the drainage opening, and allowing more fluid to exit the eye, leading to a reduction in pressure.

Successful glaucoma treatment is a collaborative effort involving the patient, their support system, the eye care professional, and the family doctor. While the eye care professional may recommend a treatment plan, the responsibility for adhering to the treatment lies with the patient and their support system. The family doctor plays a crucial role in recording regular eye drops as part of the routine treatment and in periodically monitoring their use.

Once you start taking medication for glaucoma, your eye care professional will want to see you regularly. The frequency of these visits can vary based on the patient's treatment needs, ranging from every 3 to 12 months.