Chronic glaucoma (also known as open angle glaucoma) is the most common chronic ophthalmological condition, and also one of the most common causes of treatable blindness in the world.
Chronic glaucoma is optic nerve damage associated with (in most patients) high intraocular pressure, amongst other things. Optic nerve damage has to be confirmed with visual field checks and other special techniques, such as the Heidelberg Retina Tomograph (HRT) or with Optical Coherence Tomography (OCT) as high intraocular pressure alone does not constitute glaucoma.
Chronic glaucoma is more likely if there is family history of glaucoma and in patients over 40. The disease usually affects both eyes, and to differing degrees. It is asymptomatic until the last stages of the disease.
Secondary glaucoma are even less common. They have obvious reasons for the rise. Those can be traumas, abnormal blood vessels growth inside the eye or the iris rubbing against the lens that lies close behind it.
In all cases of glaucoma an individualised treatment plan is necessary and is based on good clinical evidence.
The first step of the treatment is conservative, by using different drops to decrease the intraocular pressure. There are many different types of drops and different combinations that can be tried.
If the medical glaucoma treatment is not enough to keep the disease under control, some patients can benefit from a laser treatment (selective laser trabeculoplasty).
If the disease is progressing despite the medical treatments (not all the patients are suitable for laser), the last step is surgical treatment. The operations are varied; the surgeon will decide the best technique for each patient.
An ophthalmic surgeon can perform an operation called a trabeculectomy. Here, they make a small trap door in one of the layers of the eye to drain off higher pressure fluid. A surgeon commonly treats acute glaucoma by making a small laser hole in the iris to allow the fluid of the eye to drain fully.
The glaucoma treatment aims to reduce that pressure in the eye, even if it is within the normal range at the time it is diagnosed.
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