What is glaucoma?

Glaucoma is a condition affecting the optic nerve. The exact cause is still unknown. Often, a disruption in the fluid balance within the eye plays a role, leading to high internal eye pressure. This increased pressure pinches the blood supply to the optic nerve, causing gradual damage to its fibers. If the pressure remains high, the nerve fibers break down. As a result, parts of your field of vision can disappear without you even noticing.
In the early stages, glaucoma often doesn't cause any symptoms. Early detection is vital, as untreated glaucoma can lead to permanent damage to the optic nerve and, eventually, blindness. While eye pressure is often elevated, this isn't always the case. Glaucoma can also develop with normal or even low eye pressure. In these cases, poor blood flow to the optic nerve usually plays a part.

Types of glaucoma

The most common form of glaucoma is primary open-angle glaucoma. Glaucoma can also occur as a result of other eye problems, such as injuries, inflammations, tumors, blood vessel blockages, or other eye diseases and abnormalities. We call this secondary glaucoma. Acute (angle-closure) glaucoma is a condition characterized by sudden attacks of severely high eye pressure. This happens because the pathway to the drainage system for eye fluid becomes blocked: closure of the drainage angle. Acute glaucoma causes a red eye, is painful, and leads to significantly reduced vision due to a cloudy cornea.
In babies, children, and young adults, a congenital form of glaucoma is sometimes found. This is usually due to a birth defect in the development of the drainage system for internal eye fluid.

Symptoms of glaucoma

Glaucoma is often accompanied by the following symptoms:

• Pain in and around the eye

• Red and dull-looking eye

• Blurry vision

• Headache, nausea, vomiting

• Bumping into things more often or noticing surroundings less quickly

• Poor vision in the dark
  

What causes glaucoma?

The exact cause of glaucoma isn't yet fully understood by science, but several factors increase the risk. While high eye pressure doesn't automatically mean you'll develop the condition, it is a sign that you are at risk. It has been proven that genetics play a major role. If first- or second-degree family members have the disease, the chance of you developing it in your lifetime is up to 10 times higher. Age is also a determining factor, as older people are affected much more frequently. And if you are very nearsighted or farsighted, you also fall into this risk group.

Risk groups

When are you at risk of developing glaucoma?

• If you have high eye pressure

• If there is a family history of glaucoma

• If you are 40 years or older

• If you are very farsighted or nearsighted

Testing for glaucoma

The most important testing methods for glaucoma are:

• Eye pressure measurement: using the applanation method

• Ophthalmoscopy (examining the back of the eye)

• Field of vision test: perimetry with the Humphrey Field Analyser

• Gonioscopy (assessing the drainage angle).

• If glaucoma is suspected, at least these four tests will be performed. These same tests are usually carried out during regular check-ups once glaucoma has been diagnosed.

Treating glaucoma

With the right treatment, further damage to the optic nerve and your field of vision can be stopped or slowed down. Treatment is always aimed at lowering eye pressure. In the Netherlands, a protocol has been established for treating high eye pressure in primary open-angle glaucoma. This protocol outlines the preferred order of treatment:

• Initially, eye drops are prescribed

• Treatment usually begins with a beta-blocker

• If the pressure doesn't drop enough, the beta-blocker is replaced by a medication with a different active ingredient

• If this isn't effective enough, a combination of medications is used

• If medical treatment isn't effective enough, laser treatment or surgery follows, known as filtering surgery. Both procedures aim to improve the drainage of internal eye fluid

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