What is glaucoma?
Glaucoma is an eye condition in which there is progressive damage to the optic nerve.
Page contents
- What is glaucoma?
- How will I know if I have glaucoma? Are there symptoms?
- How quickly does glaucoma progress?
- What raises eye pressure?
- What should I avoid if I have high eye pressure?
- Which tests are done for a patient with glaucoma?
- How is glaucoma treated?
- Laser for glaucoma (SLT): when is it recommended?
- How much does surgery cost? Are prices affordable?
- The main types of glaucoma
- Who is at higher risk
- Acute glaucoma: when is it an emergency?
- Surgical options when eye drops are not enough
- How to use glaucoma eye drops correctly
- Living with glaucoma
- Glaucoma and cataract surgery
- Frequently Asked Questions about Glaucoma
Glaucoma is usually caused by raised pressure inside the eye. The pressure rises either because too much aqueous humour, a fluid the eye produces continuously, is being made, or because it is not draining away properly. When either of these factors is present, the pressure inside the eye increases and the optic nerve starts to be damaged.
The aqueous humour drains through a tissue called the trabecular meshwork, located where the cornea meets the iris at an angle. This area, which you will often hear referred to as the “angle”, is the area we must examine in anyone with raised eye pressure, because in some cases there are visible anatomical abnormalities responsible for the rise in pressure. The most common of these is narrowing of the angle, which leads to one of the best-known forms of glaucoma, angle-closure glaucoma.
There are, however, open-angle glaucomas in which there are findings in the angle of the eye. A typical example is pigmentary glaucoma, in which pigment granules released by friction between the iris and the lens are gradually deposited in the angle, progressively blocking it. A similar example is pseudoexfoliation glaucoma, in which friction of the lens capsule against the iris creates flakes that gradually block the angle. This type of glaucoma is part of an inherited syndrome called pseudoexfoliation syndrome, which also has other effects on the eye.
Finally, it is important to mention that there is also a form of glaucoma that is not linked to raised pressure, called normal-tension glaucoma. The exact cause of this condition is not fully known, but it has been associated with problems in blood circulation and blood pressure, mainly with episodes of a large drop in blood pressure.
Unfortunately, glaucoma is still one of the most common causes of blindness in people over 60. Fortunately, though, it is a condition that, particularly in people of Caucasian (European) descent, can be managed satisfactorily in most cases.
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An examination and clear advice on your case at our practice in Neo Psychiko.
How will I know if I have glaucoma? Are there symptoms?
Glaucoma affects peripheral vision, and this is why it takes a very long time to cause symptoms. Peripheral vision is the least used part of our vision, and because the other eye usually still has good peripheral vision, the patient has no symptoms. Unfortunately, it is therefore common that by the time the patient realises something is wrong, a large part of their visual field has already been lost.
To avoid this, all that is needed is a regular eye examination that includes measuring the intraocular pressure.
How quickly does glaucoma progress?
The rise in pressure is usually gradual, and beyond a certain point it becomes harmful to the optic nerve. This is usually a very slow process, and someone can have raised pressure for many months before developing glaucoma. This is why, in most cases, measuring the pressure once a year is enough. There are, of course, types of glaucoma such as angle-closure glaucoma, where the pressure rises very rapidly and to such a degree that it affects vision and needs urgent treatment. In these cases, however, the symptoms are such that they force the patient to seek medical help straight away, so the problem can be treated before there is significant damage to the optic nerve.
What raises eye pressure?
A clear fluid, the aqueous humour, is constantly produced inside the eye and drains through the angle of the anterior chamber. When drainage becomes difficult, the fluid builds up and the intraocular pressure rises. The most common reasons are:
- Wear of the drainage network with age, which is the mechanism behind open-angle glaucoma.
- A narrow or closed angle, where the iris mechanically blocks the fluid’s exit. This can cause a sudden and painful rise in pressure.
- Steroids (cortisone) in eye drops, inhalers, tablets or injections, mainly with long-term use and in people who are predisposed.
- Inflammation inside the eye, such as uveitis, and injuries, even years after the blow.
- Pseudoexfoliation and pigment dispersion, where microscopic material “clogs” the drainage network.
Family history, older age and high myopia also increase the risk. Raised pressure usually causes no symptoms at all, which is why it is only detected by measuring it in the clinic.
What should I avoid if I have high eye pressure?
Most people with high intraocular pressure or glaucoma lead a normal life. Some habits, however, are worth paying attention to:
- Stopping your drops without advice. The pressure rises again within a few days, without you noticing.
- Steroids without telling your ophthalmologist. If you are prescribed them in any form, mention that you have high eye pressure.
- Medicines with anticholinergic effects, such as some antihistamines, decongestants and antidepressants, when you have a narrow angle. If the patient leaflet mentions a contraindication in glaucoma, ask whether it applies to your type.
- Head-down positions for a long time, such as some yoga poses, and lifting very heavy weights while holding your breath.
- Drinking a large amount of fluid in one go. It is better to drink water in smaller amounts throughout the day.
- Smoking, which reduces the blood supply to the optic nerve.
On the other hand, moderate aerobic exercise, such as walking, is beneficial, and coffee in sensible amounts does not seem to have a significant effect in most patients. Regular monitoring with pressure measurement, visual field testing and optical coherence tomography (OCT) of the optic nerve shows whether the treatment is working well enough.
Which tests are done for a patient with glaucoma?
As mentioned above, the most important tool for diagnosing glaucoma is regular measurement of the eye pressure. In addition, there is a test that checks the patient’s visual field, which is very useful for monitoring how the condition is progressing. In recent years, a machine called optical coherence tomography (OCT) has made a major contribution to both diagnosis and monitoring. It measures the cell layer and the optic nerve fibres that are damaged in glaucoma, so it can measure the thickness of these layers and compare them with the normal average. The software of these machines also produces maps that make the results much easier to read, so that even patients themselves, with a little familiarity, can see whether there is deterioration or stability. Another advantage of this test is that it can detect changes very early, even before they become visible on fundoscopy, and it is objective, meaning it does not depend on the patient’s ability to respond.
Book an appointment with the doctor
An examination and clear advice on your case at our practice in Neo Psychiko.
How is glaucoma treated?
The most common glaucoma treatment is eye drops that lower the pressure in the eyes. Newer eye drops are highly effective with few side effects and are usually enough to stabilise the condition. A common problem in treatment is poor adherence, when for whatever reason the treatment is not taken as recommended. The best results are seen in people who do not miss their treatment even for a single day.
An additional, very useful and relatively new treatment for glaucoma is a laser applied to the trabecular meshwork, which delivers energy to the area and helps it drain better. Its advantages are that it is non-invasive and can be repeated several times. Its main drawback is that its effect gradually wears off, and there is a risk of the pressure being raised for a period, especially in people who are not very consistent about attending their pressure check appointments.
Finally, there are cases where the pressure is not at a satisfactory level even though we are using all the available eye drops. In these cases we consider surgery. This is done either by placing a valve that drains the excess fluid, or by creating a new drainage channel with an operation called trabeculectomy. These operations are not painful, and the recovery period is short and needs only a little care. They reduce or eliminate the need for eye drops for a long time.
Laser for glaucoma (SLT): when is it recommended?
Selective laser trabeculoplasty (SLT) targets the eye’s drainage network and makes it easier for fluid to leave the eye, lowering the intraocular pressure. It is mainly recommended for:
- open-angle glaucoma and ocular hypertension, as a first treatment or together with drops,
- patients who find it hard to use eye drops every day or do not tolerate them,
- glaucoma caused by pseudoexfoliation or pigment dispersion, depending on the case.
It is not suitable for angle-closure glaucoma, where a different type of laser, iridotomy, is used. SLT is done in the clinic with anaesthetic drops and takes a few minutes. Afterwards there may be mild discomfort or blurring for a few hours, and the pressure is checked again over the following weeks.
The result varies from person to person and may wear off over the years, in which case the procedure can be repeated. SLT does not cure glaucoma permanently, so regular monitoring continues as normal.
How much does surgery cost? Are prices affordable?
The cost of surgery is affordable. For more information about prices, please contact the doctor.
The main types of glaucoma
Glaucoma is not a single condition but a group of conditions with a common outcome: gradual damage to the optic nerve. The type determines how it is monitored and treated.
- Primary open-angle glaucoma: the most common type. The angle through which the aqueous humour drains is open but works less efficiently. It progresses slowly and without symptoms for years.
- Angle-closure glaucoma: the angle is narrow and can close, either gradually or suddenly. It is more common in long-sighted people, older people and women.
- Normal-tension glaucoma: the optic nerve is damaged even though the pressure measures within normal levels. Here, the blood supply to the nerve also plays a part.
- Secondary glaucomas: caused by another condition, such as pseudoexfoliation syndrome, pigment dispersion, eye inflammation, injuries or long-term use of steroids in eye drops, tablets or inhalers.
- Congenital and childhood glaucoma: rare, it appears in babies and children with large, cloudy eyes, watering and sensitivity to light. It needs urgent treatment.
Who is at higher risk
Screening is especially important for people in high-risk groups:
- age over 40, with the risk increasing every decade
- a family history of glaucoma in parents or siblings
- high myopia or high hyperopia
- diabetes and high blood pressure or, conversely, very low blood pressure and migraines
- a thin cornea, as shown by pachymetry
- long-term use of medicines containing steroids
- a previous eye injury
If you belong to one of these groups, we recommend a full check-up with pressure measurement, a fundus examination and, where needed, visual fields and an OCT of the optic nerve.
Acute glaucoma: when is it an emergency?
In acute angle-closure glaucoma, the pressure rises suddenly to very high levels within a few hours. The symptoms are severe:
- intense eye pain and headache, usually on one side
- a red eye and sudden blurring of vision
- coloured haloes around lights
- nausea or vomiting
This is an emergency that needs immediate eye care, because very high pressure can permanently damage the optic nerve within a few hours. Treatment includes medication to bring the pressure down quickly, followed by laser iridotomy.
Do you have a family history of glaucoma?
Screening detects glaucoma before vision is lost. Book a full eye examination in Neo Psychiko, Athens.
Surgical options when eye drops are not enough
In most patients, glaucoma is controlled with eye drops or laser. When the pressure stays high or the damage progresses, there are surgical options:
- Minimally invasive glaucoma surgery: tiny devices or techniques that make it easier for the fluid to drain. They are often combined with cataract surgery and have a quick recovery.
- Trabeculectomy: the classic operation that creates a new drainage route. It offers a significant reduction in pressure and is used in more advanced cases.
- Glaucoma drainage devices (valves): small devices placed in complex or secondary glaucomas.
The choice depends on the type and stage of glaucoma, the target pressure and the patient’s general health.
How to use glaucoma eye drops correctly
Treatment only works when the eye drops are put in correctly and every day. Some practical tips:
- Wash your hands and tilt your head slightly back.
- Gently pull down the lower eyelid and put one drop into the small “pocket” this creates, without the tip touching the eye.
- Close your eyes for one to two minutes and press lightly on the inner corner of the eye. This keeps the medicine in the eye for longer and means less of it is absorbed into the body.
- If you use two different eye drops, wait at least 5 minutes between them.
- Link the dose to a fixed daily habit, such as brushing your teeth, so you do not forget it.
If you notice redness, stinging, a change in the colour of the iris or eyelids, tiredness or shortness of breath, tell your ophthalmologist. Do not stop the treatment on your own, because the pressure can rise without you noticing.
Living with glaucoma
With early diagnosis and proper monitoring, most patients with glaucoma keep useful vision for the rest of their lives. Regular exercise such as walking is beneficial, while prolonged upside-down positions are best avoided. Coffee in moderation is not a problem for most people. Most important of all is keeping your follow-up appointments, because that is the only way to confirm that the pressure is on target and that the optic nerve remains stable.
Dr. Vasileios Skouteris monitors patients with glaucoma at his clinic in Neo Psychiko, Athens, using modern diagnostic equipment. To book an appointment, call 210 677 0007.
Glaucoma and cataract surgery
Many patients with glaucoma will at some point also need cataract surgery. The two conditions often occur together, because both become more common with age. In angle-closure glaucoma, removing the lens “opens up” the space inside the eye and can lower the pressure significantly. In some patients with open-angle glaucoma, cataract surgery is combined at the same time with a minimally invasive glaucoma procedure. Planning is done carefully, with pressure checks before and after.
Frequently Asked Questions about Glaucoma
What raises the pressure in my eyes?
The pressure rises when the fluid inside the eye does not drain properly, usually because of age-related wear of the drainage network or a narrow angle. Other causes include long-term steroid use, inflammation, injuries and certain syndromes such as pseudoexfoliation. Family history and high myopia increase the risk.
Can glaucoma be cured?
The damage glaucoma has already caused to the optic nerve cannot be reversed. However, the disease can be controlled very effectively with eye drops, laser or surgery, so that its progression stops or slows down. With early diagnosis and regular monitoring, most patients keep useful vision for the rest of their lives.
Is there a new treatment for glaucoma?
In recent years, selective laser trabeculoplasty (SLT) has been used more and more often as a first treatment. There are also minimally invasive glaucoma surgery techniques (MIGS), often combined with cataract surgery, as well as sustained-release drug implants. The right choice depends on the type and stage of glaucoma.
How often should I have my eye pressure checked?
After the age of 40, a full eye examination with pressure measurement is recommended every 1-2 years, and more often if there is a family history of glaucoma, high myopia, diabetes or steroid use. People who already have glaucoma or high eye pressure are monitored at intervals set by the ophthalmologist, usually every 3-6 months.
Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO