Chronic open-angle glaucoma

The iridocorneal angle is normal. The evolution is slow, there are no apparent symptoms, but the vision deteriorates progressively, so it has been called "The thief of sight."

This is the most common type of glaucoma. It occurs gradually, when the eye does not drain the fluid as it should (similar to a clogged drain). As a result, the eye pressure increases and begins to damage the optic nerve. This type of glaucoma is not painful and does not cause any change in vision at the beginning.

Some people may have optic nerves sensitive to normal eye pressure. This means that your risk of glaucoma is higher than normal. It is important to have frequent eye exams to detect early signs of optic damage.

Closed angle glaucoma

This type occurs when a person's iris is very close to the angle of drainage in the eye. The iris can block the drainage angle. This is similar to if there was a piece of paper on the drain that covered the sink. When the drainage angle is completely blocked, the eye pressure increases rapidly. This is called acute attack. It is a true eye emergency and you should call the ophthalmologist immediately; otherwise, you could go blind.

 These are the signs of an acute attack of angle-closure glaucoma:

• The vision suddenly becomes blurred
• You have severe pain in your eye
• Have headache
• You have a stomachache (nausea)
• Vomiting
• See rings or halos of rainbow colors around the lights

Many people with angle-closure glaucoma develop it slowly. This is called chronic angle-closure glaucoma. At first there are no symptoms, so they do not know they have it until the damage is severe or they suffer an attack.

What methods are used to detect glaucoma?

To diagnose glaucoma, it is necessary to evaluate the ocular pressure, but this is not the only factor to be taken into account: the optic nerve must also be studied, both from an anatomical and functional point of view.

I will explain each of the most important diagnoses.

• Pachymetry: This test is used to measure the thickness of the cornea and in this way correct the measurement errors of the ocular pressure given by the resistance differences between the thin corneas and the thick corneas.
• Gonioscopy : It measures the iridocorneal angle and allows the classification of glaucoma in its two classic forms, open angle or closed angle.
• High resolution ultrasound : allows to study the structure of the eye, the anterior chamber, the ciliary processes and the optic papilla.
• Biomicroscopy : uses a fundamental instrument called slit lamp, which allows to see the very enlarged details of the eye and examine the bottom of the eye and the optical disc in three dimensions with the help of special lenses.
• Applanation tonometer : allows to take the ocular tension in millimeters of mercury. Usually, it is incorporated into the slit lamp. The most used tonometer in the world is the Goldmann tonometer. There are tonometers that obviate the error factor of corneal thickness. There is the Pascal tonometer, which does not take into account the thickness of the cornea and in this way an intraocular pressure is obtained that is not affected by this parameter. Glaucoma perimetry: its purpose is to verify the amplitude of the visual field. At first, 

Patient care

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Patients with typical lesions of the optic nerve and campimetric defects compatible with glaucoma are treated independently of the intraocular pressure. The reduction of intraocular pressure is the only clinically proven treatment. For chronic glaucomas in adults and children, intraocular pressure should be reduced by at least 20 to 40% of the above values.

There are 3 methods available: medications, laser surgery and conventional surgery. The type of glaucoma determines the appropriate method or methods. The drugs and most of the laser interventions (trabeculoplasty) modify the secretion of aqueous humor and its drainage. Traditional surgery operations (eg, protected filtering procedures [trabeculectomy] or drainage device implants [bypass tubes]) establish a new drainage path between the anterior chamber and the subconjunctival space. Newer incisional surgeries try to improve trabecular or uveoscleral output without creating a full-thickness fistula.

Each of these procedures is very complex and extensive and I do not want to make a difficult publication for the understanding as I had stressed before. then I will only explain the surgery that until now is the best and the most used.

Both laser and traditional surgery are used to treat glaucoma. Laser trabeculoplasty is used to treat open-angle glaucoma. Argon or Nd: YAG is used in the laser that is applied to the trabecular network to stimulate the opening of the ducts and thus increase the flow of aqueous humor. Peripheral laser iridectomy is used in patients with angle-closure glaucoma. In it, the laser points to the iris to make an opening in it. This opens a new way by which the aqueous humor can pass from the posterior chamber to the anterior chamber.

Relevant information

There is no cure for glaucoma, but it can be controlled. Immediate treatment in the first stage can help protect vision loss.

Researchers from the United Kingdom discovered that the performance of sports activity seems to provide a long-term benefit, decreasing the incidence of low-pressure ocular perfusion (OPP), which is an important risk factor for glaucoma. OPP is a mathematical value that is calculated using the intraocular pressure of the eye and its systemic arterial pressure.

The results showed that participants who had performed moderate physical activity for approximately 15 years before the study had a 25% lower risk of developing low OPP that could favor glaucoma.

"It seems that OPP is largely determined by the state of the cardiovascular system, "said study author Paul J. Foster, MD, PhD, of the Institute of Ophthalmology at University College London." We can not comment on the cause, but there is definitely an association between a sedentary lifestyle and factors that increase the risk of developing glaucoma".

"Maintaining an active lifestyle seems to be effective in reducing the risk of developing glaucoma and many other serious health problems," concluded Dr. Foster.

In addition to regular exercise and maintaining an active lifestyle, you can also reduce the risk of glaucoma by avoiding smoking, maintaining a healthy weight and a healthy and varied diet.

conclusion

Glaucoma vision loss first affects the peripheral part of the field of vision. The loss of moderate or severe vision can be verified by the patient when evaluating his peripheral vision. This can be done by covering one of the eyes and examining the vision in the four corners of the visual field in terms of clarity and clarity, then the test is repeated with the other eye. Very often, the patient does not detect loss of vision until he suffers "tunnel vision". If the disease is not treated, the field of vision will close more and more, the central part will darken and eventually degenerate into total blindness in the affected eye.

Glaucoma is a disease in which the sequelae are irreversible, therefore, as first-level physicians we must be completely sure of the knowledge about the disease to help patients have a lesser impact on daily life since then, if there are sequelae, the patient must be sent to therapies so they can live with these sequels, as well as to help their family to understand the various pathologies that will derive from it, such as depression, as well as being a disease. It is estimated that around 70 million people have glaucoma, of which 10% suffer from bilateral blindness, it is important to refer them in time and know how to diagnose them.

Information reference

Video: glaucoma closed angle vs open angle

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