1.What is glaucoma?
Glaucoma is a serious eye disease that causes damage to the optic nerve and visual field defects because the intraocular pressure exceeds the level tolerated by the tissues in the eye, especially the optic nerve.
2. What are the dangers of glaucoma?
As already mentioned, glaucoma is a serious eye disease that causes optic nerve damage and visual field defects due to elevated intraocular pressure. As it most of the chronic glaucoma onset insidious, slow progress, often not detected, when the patient found abnormal vision, has reached the advanced stage of the disease, mainly manifested as serious damage to the visual field. Therefore, it is said that “glaucoma is the health killer of middle-aged and elderly people”.
3. What kind of visual field changes will occur in glaucoma?
When glaucoma progresses to a certain level, a characteristic visual field change, namely visual field defect, will occur. It arises from the death of one or several adjacent nerve fiber bundles, so the shape of the visual field defect corresponds to the alignment of the damaged nerve fiber bundle. Typical glaucomatous visual field defects include paracentral dark spots, arcuate or bowed dark spots, nasal staircases, and tubular or temporal visual islands. The tubular visual field or temporal visual island may remain in place for a considerable period of time, and vision may be suddenly lost as the disease progresses.
4. What are the predisposing factors for glaucoma?
① Age: Over the course of a person’s life, even a healthy eye will gradually become elevated. This is due to aging of the atrial fluid drainage system of the eye. For most patients with glaucoma, the rise in IOP begins between the ages of 40 and 50. Some patients also experience an increase in IOP at a much later age.
② Family background: It has long been recognized that children of glaucoma patients are more likely to develop glaucoma than the general population, but this does not mean that all children of glaucoma will develop the disease. Although it is true that genetic factors play a non-negligible role in the development of glaucoma, unfortunately there is still no direct evidence from current studies to explain this issue. There is no doubt that if there is one glaucoma patient in the family, it is important for the rest of the family to have regular eye exams. If there are multiple glaucoma patients in a family, it is best to start eye exams for other family members when they are 20 to 30 years old, and not later than 30 to 40 years old.
③ Race: Foreign research data show that different races have different types of glaucoma. ④ Myopia and hyperopia: People with hyperopia have a higher chance of acute closed-angle glaucoma, but with the same intraocular pressure, people with myopia are more likely to have glaucomatous optic nerve damage.
④ Other risk factors that may cause glaucomatous optic nerve damage are: hypertension, atherosclerosis, systemic hypotension and other factors that can cause vascular regulation disorders.
5.What types of glaucoma are there?
There are many ways to classify glaucoma, but our current textbooks classify glaucoma into primary, secondary and congenital according to the morphology of the anterior chamber angle, etiological mechanism and age of onset.
Primary glaucoma is divided into primary open-angle glaucoma and primary closed-angle glaucoma, while closed-angle glaucoma is divided into acute and chronic. Among them, acute closed-angle glaucoma is caused by the closure of the anterior chamber angle and the increase of intraocular pressure, the onset of age is more than 40 years old, especially in the 50-70 years old, more women than men, often for both eyes. This type of glaucoma has an acute onset and can cause permanent vision loss if left untreated, while most patients can recover their vision if treated promptly. Chronic closed-angle glaucoma and primary open-angle glaucoma also have an age of 40 years or older, and are not easily detected because of their insidious onset and slow progression, as well as the absence of symptoms and signs of acute attacks.
Secondary glaucoma is caused by certain eye diseases or systemic diseases, as well as trauma and long-term topical application of certain drugs (such as hormonal glaucoma).
Congenital glaucoma, also called developmental glaucoma, is glaucoma caused by a poorly developed atrial aqueous drainage system during fetal development.
6. How to achieve early diagnosis of glaucoma?
Early diagnosis of glaucoma is very important, but early diagnosis is actually very difficult to achieve because: ① the diagnosis of glaucoma is often only possible when the patient is seen; ② usually the early changes of the disease are not easily distinguished from normal variants and often require more frequent observation and follow-up to confirm or exclude the diagnosis.
Therefore, doctors recommend that: ① you should get an eye exam whenever you have visual problems; ② you should get an eye exam at age 40 even if you don’t have any symptoms or a family history of glaucoma; ③ you should get an eye exam as soon as possible when you have symptoms, a family history or other risk factors. Your ophthalmologist will quickly tell you if there is a possibility of glaucoma. If there are certain signs of the disease, your doctor will ask you to do some tests to confirm or rule out the disease, and if glaucoma is diagnosed, the next step needs to be to clarify the extent of the damage.
7.What does an eye exam about glaucoma involve?
The first step is to check your vision. normal vision should be higher than 1.0. for glaucoma patients, there is a significant period of time when vision is normal. If there is a decrease in vision, it is important to find out the cause, such as whether there is refractive error, cataract, etc.
Step 2 is a slit lamp examination, which is used to examine the internal structure of the eye and to get a preliminary idea of the depth of the anterior chamber and the condition of the lens.
Step 3 is fundoscopy, which provides an understanding of the vitreous, retina and optic nerve papillae.
Step 4 is the measurement of intraocular pressure. The above 4 items are the basic examinations. If during this process any signs of glaucoma such as shallow anterior chamber, abnormal morphology of the optic nerve papillae or high intraocular pressure are found, further examinations should be performed.
Step 5 is the anterior chamber angle microscopy. After applying surface anesthetics, the anterior chamber angle microscope is placed on the surface of the eye to observe the width of the anterior chamber angle, whether there is a risk of atrial angle closure, and whether there are congenital abnormalities.
The sixth step is the optic disc morphology examination, which is a morphological examination of the optic nerve papillae by different instruments, usually called “glaucomatous optic disc analysis”, including fundus stereophotography, laser tomography imaging and other techniques, which can be used to understand the size and width of the optic disc rim, whether there are small lamellar or linear hemorrhages next to the optic disc, and whether the thickness of the optic The nerve fiber layer thickness is analyzed qualitatively and quantitatively for abnormal changes.
There are many different methods of visual field examination, and the most commonly used are various automatic quantitative visual field meters, which can be used to check the extent of visual field damage and compare the degree of visual function damage in each area.
Visual field examination and optic disc morphology are key tests in the diagnosis of glaucoma, and abnormalities in optic disc morphology often precede abnormal changes in the visual field. Other tests include color Doppler ultrasonography, visual electrophysiology, and contrast sensitivity testing, but none of these are currently required as tests for glaucoma.
8.Who is at risk for acute closed-angle glaucoma and under what circumstances?
Acute closed-angle glaucoma is more common in people aged 50-70 years, and more women than men. The incidence of this disease is higher in people with farsightedness, family history and age-related cataract expansion. Emotional excitement and anxiety can often be triggering factors, mostly in the evening, and climate change is sometimes a trigger for glaucoma attacks.
9.What are the clinical manifestations of acute closed-angle glaucoma?
Acute angle-closure glaucoma is clinically divided into six stages: the attack is characterized by red eyes and eye pain, blurred vision and iridopsia (the so-called “iridopsia” refers to the rainbow-like ring around the light source when looking at the light), cloudy cornea and loss of luster, dilated pupils, often accompanied by headache or migraine, nausea and vomiting, increased blood pressure, and often It is often misdiagnosed as hypertensive encephalopathy or gastrointestinal disease.
10. What should be done after acute closed-angle glaucoma attack?
A: Since most attacks of closed-angle glaucoma are triggered by emotional excitement, you should first control your emotions and order eye drops such as timothyroxine eye solution or pilocarpine eye solution to lower intraocular pressure as soon as the situation allows, and then go to the hospital for consultation. If you cannot tell whether it is indeed a glaucoma attack, please do not use any medication for the time being. Many people will have combined nausea and vomiting during acute closed-angle glaucoma attack, and patients will take belladonna and other drugs on their own, and such drugs will lead to aggravation of glaucoma condition and more serious consequences.
11.What kind of emergency medicine should be prepared in the family of glaucoma patients?
A: For patients with glaucoma, they should always have timothyroxine eye drops and pilocarpine eye drops at home, which are drugs to lower the intraocular pressure, and to control the elevated intraocular pressure as soon as possible by ordering the eye drops at the first time of the disease. It is worth mentioning that patients with bradycardia should not use timolacin eye drops, so they should explain to the doctor if they have bradycardia during the consultation.
12.What is the emergency treatment at home after acute closed-angle glaucoma occurs?
A: The onset of acute angle-closure glaucoma is often related to emotional excitement. Therefore, after the onset of the disease, family members should try to comfort the patient psychologically, so that the patient can actively cooperate with the doctor’s treatment, and after the condition is stabilized, regular psychological counseling should be carried out to avoid another onset. Glaucoma cannot be completely cured. Drugs and surgery are methods to control IOP, but not to cure it, so regular IOP and visual field examinations should be performed after the condition is stabilized. Family members of glaucoma patients should create a relaxing environment for the patient, encourage the patient to engage in some pleasant activities, avoid excessive fatigue and emotional excitement, eat a light diet, and avoid drinking large amounts of water at once. In addition, avoid constipation.
13.How to avoid the acute attack of glaucoma?
A: Early detection of glaucoma is the only way to avoid an acute attack of closed-angle glaucoma. The only way to detect glaucoma is to have regular eye examinations. people over 40 years old and people with glaucoma in their family should go to the hospital regularly for examinations to detect glaucoma at an early stage.
14. What are the signs of chronic glaucoma?
Primary open-angle glaucoma and chronic closed-angle glaucoma are both chronic glaucoma. The former usually has no symptoms in the early stage, but when the lesion develops to a certain extent, there may be mild eye distention, visual fatigue (such as soreness in the root of the nose and orbit) and headache. The latter sometimes has small attacks, manifested as mild eye swelling and headache, blurred vision, and occasionally rainbow phenomenon of looking at lights, mostly occurring in the evening and will soon relieve themselves, patients often think it is due to fatigue and neglect to consult the doctor.
15.What is congenital glaucoma?
Congenital glaucoma is caused by the abnormal development of atrial aqueous drainage system during fetal development, resulting in increased intraocular pressure, in which infantile glaucoma mostly develops within one year of age, manifesting as photophobia and tearing, corneal enlargement, and eventually blindness due to optic nerve atrophy if not treated in time; while juvenile glaucoma, generally develops after 6 years of age and before 30 years of age, with clinical manifestations similar to primary open angle glaucoma, such as Increased but fluctuating intraocular pressure. When adolescents develop rapidly progressive myopia, the possibility of glaucoma should be suspected.
16.Will my children definitely get glaucoma if their parents have glaucoma?
No. Glaucoma is a disease that runs in families, meaning that when there are glaucoma patients in the family, the chances of glaucoma occurring in members of the same family are higher than in other families, but it is not certain that children will have glaucoma if their parents have glaucoma.
17. How is glaucoma treated?
If glaucoma is diagnosed, it must be treated actively. In general, there are three main methods, namely medication, laser treatment and surgery. The order in which these methods are chosen varies from doctor to doctor, and different doctors will use different treatment plans depending on the type of glaucoma patient. Generally speaking, primary angle-closure glaucoma is mostly treated surgically, and early stage patients can also opt for laser iris peripheral resection. In the acute phase, the patient should be treated with medication and surgery should be performed after the IOP has decreased and the inflammatory response has subsided. Of course, when medication is not effective, surgery should be performed decisively. In primary open-angle glaucoma, the main treatment is medication, but another laser treatment, selective laser trabeculoplasty, is also available. Also when medication fails to stop the damage to the optic nerve, surgery is still needed.
18. How to choose the treatment plan?
Generally speaking, in the early stages of the disease when no visual field damage occurs, medication is sufficient, so in most cases, medication is used to lower the pressure. If the patient accepts the medication well and is able to lower the IOP sufficiently to stop the progression of the disease, medication is often continued. However, long-term drug therapy increases the risk of fibrosis and scarring of the filter follicles after antiglaucoma surgery, leading to a re-increase in postoperative IOP. In addition, patients may experience a loss of vision for a period of time after surgery. However, this loss of vision is exchanged for a long-term stable vision that is no longer impaired in the future.
19.Is it dangerous to have glaucoma surgery?
According to statistical data, surgical pressure reduction is more effective than drug treatment alone in protecting the visual field. However, any surgery has certain inherent risks, including some intraoperative or postoperative complications, etc. The effectiveness of the surgery and the degree of risk depend on the severity of the disease and the skill level of the surgeon. However, most patients have good results after surgery, with good control of intraocular pressure and preservation of visual function. There must be good communication between the surgeon and the patient as to whether or not to choose surgical treatment, and the surgeon will weigh the pros and cons of the disease and give the patient a recommendation. Of course the final decision is still in the hands of the patient.
20.How should patients with glaucoma take care of themselves?
A: Glaucoma patients should be careful to avoid mood swings. Glaucoma patients often have a “glaucoma personality”, and mood swings are the main cause of glaucoma attacks, so it is very important for glaucoma patients to adjust their mood and be cheerful. In terms of diet, just pay attention to a balanced diet, there is no need for special attention. When visiting a doctor for other diseases, you should take the initiative to tell your doctor about your glaucoma history, because there are some drugs that glaucoma patients cannot use.
21. What should glaucoma patients pay attention to in their daily life?
Although glaucoma is a serious eye disease that can cause blindness, after timely and effective treatment, as long as the patient does not have severe visual field defects, he or she can drive a car and lead a normal life as normal people. Since there is a relationship between changes in intraocular pressure and the size of the pupil, patients with glaucoma should try to avoid activities in dim light, such as watching movies in the cinema, watching TV at home without turning on the lights, etc. When having an eye exam, inform your doctor that you are a glaucoma patient and decide whether to do a dilated pupil exam at your discretion.
In addition, patients with glaucoma who suffer from other systemic diseases should avoid using atropine-like and nitroglycerin-like drugs to prevent triggering glaucoma.
In terms of diet, less oily and high-fat foods should be consumed. It must be emphasized that patients with glaucoma must strictly follow the treatment protocol and regular checkups.
The last thing to pay attention to is regular rechecking of IOP (when IOP is stable, it can usually be measured once a month) and visual field (when IOP is stable and visual field is stable, it can usually be measured once every six months or once a year).
22. Can glaucoma patients drink beverages?
Foreign investigations have concluded that within one hour after drinking coffee or tea, there will be a mild increase in intraocular pressure, but the magnitude of this increase is small and will not have a major impact on glaucoma. Therefore glaucoma patients can drink these beverages. It is generally accepted that patients with glaucoma do not need to limit their daily fluid intake, but they should not drink large amounts of water in a short period of time. For example, after drinking 1 liter of water in a few minutes, it can cause a rapid increase in intraocular pressure and induce glaucoma. So glaucoma patients should remember not to drink a lot of water in a short period of time.
23. Do glaucoma patients have to quit smoking and drinking?
Moderate alcohol consumption has a protective effect on the cardiovascular system, and also for glaucoma patients, even if they drink alcohol every day, they do not have to worry about causing damage to their eyes. In acute closed-angle glaucoma, large amounts of alcohol can even lower intraocular pressure for several hours. However, long-term smokers with glaucoma are more likely to have their IOP rise and progress further.
24. What leisure sports can glaucoma patients participate in?
For glaucoma, regular physical activity is as important as proper rest and adequate sleep. Sports can lower IOP to a certain extent, but for patients who already have visual field defects, it is important to be aware of their vision status before playing sports. For example, when playing tennis, a patient with visual field loss may not be able to see the tennis ball being hit at him; when riding a bicycle, he may not be aware of the danger that is approaching him because of his visual field loss. This is very dangerous. Similarly, patients with optic nerve damage are not suitable for diving.
Sauna bathing does not have a negative effect on glaucoma patients. Generally speaking high altitude flights do not cause damage to glaucoma patients, but those who fly frequently and have severe glaucoma should consult their ophthalmologist frequently for routine checkups. Playing a musical instrument can cause a temporary increase in intraocular pressure, so glaucoma patients who like to play a musical instrument need to consult an ophthalmologist for their help.
25. Can glaucoma patients wear corneal contact lenses?
Wearing contact lenses will not have an effect on eye pressure. Even glaucoma patients wearing contact lenses can reduce the dose of medication that will lower their eye pressure because some of the medication can be stored underneath the contact lens, creating a storehouse that can slowly release the medication and improve its utilization. However, it is important to remember that some IOP-lowering medications can reduce the sensitivity of the corneal surface and can easily damage the cornea when wearing contact lenses. In short, glaucoma patients who need to wear contact lenses for a long time must do so under the guidance of an ophthalmologist.
26.Does pregnancy have an effect on glaucoma?
Since sex hormones play a role in adjusting IOP, generally speaking, IOP decreases during pregnancy and increases moderately after menopause in women. In addition, chronic glaucoma is a slowly progressive disease. In order not to affect the fetus, medication can be temporarily discontinued during pregnancy or, under the guidance of a physician, an IOP-lowering drug that has no adverse effects on the mother and fetus can be chosen.