Neglecting glaucoma may cause blindness

Many consider "Glaucoma" the most severe eye disease, especially among the elderly where it is a leading cause of blindness. Glaucoma earned its name (translated as “blue waterfalls” in Greek) because the patient will often see blue halos from sources of light, which indicates to him/her the presence of blue water inside the eye. ”Arabs Today," met with an ophthalmology specialist and head of the Eye Hospital in Gaza, Dr. Amr Abu Omara to discuss the disease: Q:  First of all could you define the eye disease glaucoma for us? A: Glaucoma is a disease of the optic nerve (which carries the images we see to the brain), and it results in high intraocular pressure. This pressure causes tissue damage of the optic nerve fibers leading to partial loss of the visual field. I would like to point out that the lack of early diagnosis and treatment of the disease is a serious matter that would cause complete damage to the optic nerve, and thus patients’ blindness. Q: What causes the disease? A: The reason behind the infection glaucoma is the imbalance between the amounts of liquid water that is produced by the eye, and the ability of special channels in the eye to drain this fluid. The consequence of this imbalance is the gathering of fluid pressure within the eye, and the internal tissues including the optic nerve. There are several reasons leading to the inability of the eye to drain.   For example, a blockage or inflammation in the channels responsible for discharge, leading to narrowed channels. In addition, some eye injuries may lead to damage in the tissues of the channels. Q: Who are the people at risk from glaucoma? A: The disease affects adults and children alike, especially those who are most vulnerable to infection, such as those suffering from diseases like foresight and small corneas. Inflammation of the iris also leads to high intraocular pressure, especially among the elderly.  They are at a high risk of getting infected with the disease, as they are five times more likely to get it than any other age group. In addition, the presence of a genetic history of glaucoma in the family increases the likelihood of getting the disease by a large percentage. For example, if a mother is infected, her child's risk of inheriting the disease increases about six or seven times compared to people who do not have a family history of it. It is important to note that the increase in intraocular pressure alone does not necessarily mean the presence of glaucoma; the doctor will take various things into consideration in order to identify the chance of infection from other issues such as myopia, previous injuries, as well as a previous severe anemia. Q:  The forms of glaucoma vary, what are the main ones? A: The disease takes more than one form- chronic, open-angle glaucoma is the more common form that usually appears after the age of sixty, when the drainage angle becomes less efficient within the eye, leading to an increase of intraocular pressure, impacting the optic nerve in a non-painful form. In this case, the patient feels a pain in their field of vision, and in some cases lack of clarity of vision in one part of the visual field is noticed. If the patient continues without treatment, his/her ability to see will be limited to a small circular area. The second form of the disease is called “acute closed-angle glaucoma”.  It is relatively less common, and usually affects people who have narrow-front angle of their eyes or people with foresight. The most important characteristic of this disease is the sudden high intraocular pressure, due to a complete blockage of water drainage, and thus a lack of clear vision and intense pain in the eye. This may lead to headaches, nausea and vomiting as well as seeing the colours of the rainbow from light sources. The appearance of these symptoms requires an immediate visit to the doctor because this type of glaucoma leads to loss of vision if not treated quickly, as well as the possibility of injuring the other eye. The other type of closed-angle glaucoma is called “chronic glaucoma”, and occurs with a gradual clogging of the corner of the eye without pain. This kind affects people from African or Asian origins. Some kinds of these diseases might be congenital, where a child is born with it or infected during his/her early years because it was passed down from the parents. A child will have several symptoms when they are infected with this kind of disease; the pupils will appear bigger as a result of the enlargement of the cornea's size in addition to the loss of the brightness and transparency of the cornea. In this case, the child will need filtration for the liquid of the eye so that they have the ability to focus. The fifth type of glaucoma is “secondary glaucoma”, coming from pre-standing issues such as repeated iris inflammation, maturation of white water, prolonged use of cortisone components, blockage of blood vessels in the retina, internal tumors of the eye, and late stages of diabetic retinopathy. Q:  Tell us about the mechanism for diagnosing the disease. A: Regular screening with a specialist oculist is the best way to detect the presence of glaucoma in its early stages. If the existence of the disease is suspected, it is diagnosed by measuring the internal intraocular pressure through a special method called "Tonometry" measurement. In addition, the physician measures the field of vision for both eyes, and explores the drainage angle within the eye and examination of the optic nerve to assess the presence of any damage caused by the high pressure on the nerve fibers. It is important to repeat the tests on a regular basis to see the evolution of the damage caused by glaucoma to the optic nerve with the passage of time. Q: How is glaucoma treated? A: The damage done to the optic nerve cannot be cured - all medicines and surgical operations are done to stop deterioration and prevent further damage only. Eyedrops can be used for treatment, given a few times a day with some types of pills that help to alleviate intraocular pressure by reducing the secretion of watery fluid within the eye, or by improving the performance of the drainage angle. I must stress that the presence of some side effects of the medications; the patient might feel tingling, redness of the eye, blurred vision, headaches and change of the heart rate when using eye drops, as well as numbness of the fingers of the hands and feet, and bloody stools or constipation when taking some pills. In some cases, surgery is undergone, which makes some minor burns to the eye resulting in tissue contraction and the expansion of others. Surgery is considered the best treatment in most cases of severe and congenital glaucoma that do not respond to drugs; surgical processes works on building a new drainage channel for the flow of liquid water and thus lower the intraocular pressure. Q: How can a laser be used for the treatment of eye glaucoma? A: The use of a laser might be effective in various types of a glaucoma infection; for example it can be used in the case of open-angle glaucoma by expanding the drainage angle in order to maintain normal intraocular pressure. In case of infection with closed-angel glaucoma, the laser will be used to create a hole in the iris to improve the flow of liquid water to the drainage angle. Q: If you want to provide tips especially for patients with glaucoma or "blue water", what would you say? A: A patient suffering from glaucoma must be well aware that the medication is not a temporary remedy, rather they must continue to take it constantly and regularly as long as the doctor recommends. Stopping taking the drugs would lead to the rise of the intraocular pressure again. The patient must be aware that the primary goal of treatment is to maintain the level of intraocular pressure and thus maintain sight. The treatment will not necessarily improve sight ability, so it is important to stick with the treatment even if there is not a clear improvement, or increased visual acuity. Finally, the patient must notify their doctor as soon as any noticeable symptoms or side effects appear as a result of taking certain types of drugs, in anticipation of complications that might have an impact on the patient's health.