What is glaucoma?

Glaucoma is a disorder of the optic nerve. Its cause is still unknown. A disruption of the eye's fluid balance often plays a role. This leads to excessive pressure within the eye. This increased eye pressure constricts the optic nerve's blood supply, progressively damaging the optic nerve fibers. If the eye pressure remains too high, the nerve fibers are destroyed. This causes parts of the visual field to disappear without anyone noticing.
In its early stages, glaucoma often causes no symptoms. Early detection is crucial, as untreated glaucoma can lead to irreversible damage to the optic nerve and ultimately blindness. Intraocular pressure is often elevated, but this isn't always the case. Glaucoma can also develop with normal or even low intraocular pressure. Poor blood flow to the optic nerve often plays a role.

Types of glaucoma

The most common form of glaucoma is primary open-angle glaucoma. Glaucoma can also develop as a result of other eye problems: injuries, inflammation, tumors, blood vessel blockage, other eye diseases, or eye abnormalities. This is called secondary glaucoma. Acute (angle closure) glaucoma is a condition characterized by attacks of severely increased eye pressure. This occurs because the access to the eye's fluid drainage system is blocked: angle closure. Acute glaucoma causes a red eye, is painful, and significantly reduces vision due to a cloudy cornea.
Babies, children, and young adults sometimes develop a congenital form of glaucoma. This usually involves a congenital defect in the development of the drainage system for the internal fluid within the eye.

Symptoms of glaucoma

Glaucoma is often associated with the following symptoms:

• Pain in and around the eye

• Red and dull eye

• Blurred vision

• Headache, nausea, vomiting

• You bump into things more often and notice things around you less quickly

• Poor visibility in the dark
  

What causes glaucoma?

The cause of glaucoma is not yet fully understood by science. However, several factors do increase the risk. While elevated eye pressure doesn't automatically mean you'll develop the disease, it is a sign that you're at risk. It's now been shown that heredity plays a significant role. If first- or second-degree relatives have this disease, the chance of developing it in your lifetime is as much as 10 times higher. Age is also a determining factor. Older adults are much more likely to develop this disease. And if you suffer from severe nearsightedness or farsightedness, you also fall into this risk group.

Risk groups

When are you at risk of developing glaucoma?

• If you have increased eye pressure

• If glaucoma occurs in your family

• If you are 40 years or older

• If you are very farsighted or nearsighted

Glaucoma research

The main research methods for glaucoma are:

• Eye pressure measurement: eye pressure measurement using the applanation method

• Ophthalmology

• Visual field examination: perimetry with the Humphrey Field Analyser

• Gonioscopy (assessment of the chamber angle).

• If glaucoma is suspected, at least these four tests will be performed. Even if glaucoma has been diagnosed, these four tests will generally be performed during follow-up visits.

Treatment of glaucoma

With effective treatment, further damage to the optic nerve, and thus to the visual field, can be stopped or slowed. Treatment is always aimed at lowering eye pressure. In the Netherlands, a protocol has been developed for treating high eye pressure in open-angle glaucoma. This protocol outlines the order of preference for treatment:

• Initially, eye drops are prescribed

• You start with a beta blocker

• If the pressure drop is insufficient, the beta blocker is replaced by a drug with a different active substance

• If this has insufficient effect, a combination of resources is used

• If medication is insufficiently effective, laser treatment or surgery, known as filtering surgery, follows. Both procedures aim to improve the drainage of the internal eye fluid.

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