What is glaucoma and how does it develop?
Glaucoma is a common eye disease that can lead to blindness if left untreated and is one of the leading causes of blindness.
Simply put, glaucoma is a serious eye disease in which the intraocular pressure rises intermittently or continuously to a level that exceeds the tolerance of the tissues in the eye, especially the optic nerve, causing damage to the optic nerve and visual field loss.
Glaucoma is a bilateral disease that can develop in both eyes at the same time, or in one eye first and then in both eyes.
Who is at risk for glaucoma?
1. Eye structure: People with a shallow anterior chamber are prone to have closed-angle glaucoma. Generally speaking, people with hyperopic or orthokeratology are more likely to have this anatomical structure than people with myopia.
2, age and gender: closed-angle glaucoma is mostly seen in women, the incidence is about 2-4 times that of men, the age of onset is more than 40 years old, especially in the 50-70 years old. There is no significant gender difference in simple open-angle glaucoma.
3, genetic factors: glaucoma is a polygenic hereditary lesion, with a family history, the incidence is much higher than those without a family history. Therefore, it is recommended that people with a family history of glaucoma should undergo regular glaucoma screening.
4. Refractive error: Patients with hyperopia are prone to closed-angle glaucoma because of their short eye axis. The incidence of open-angle glaucoma is higher in myopic patients.
5, bad habits: smoking and alcohol, irregular living, irregular diet, moodiness, and stubborn insomnia may become the cause of glaucoma.
6.Secondary glaucoma: Patients with cataract, diabetes and trauma should be alert to the occurrence of secondary glaucoma.
What are the early symptoms of glaucoma
Closed-angle glaucoma.
Early stage only: mild congestion of the eye, mild eye swelling and eye pain, or manifest as nasal root pain, migraine, reading difficulties, with iris vision (look at the incandescent light around the colored circle), often in the evening onset, relieved by sleep.
Acute attacks may include severe eye pain, blurred vision or even extreme loss of vision, ipsilateral migraine, orbital swelling, nausea and vomiting, and even systemic symptoms such as increased body temperature, rapid pulse or diarrhea. Some patients consult internal medicine or neurology due to the obvious systemic symptoms or even ignore the ocular symptoms, which may cause delayed treatment or even irreversible consequences.
In severe cases, complete blindness can occur in 24-48 hours during the acute attack. Therefore, when there is a headache, nausea and vomiting, especially blurred vision and colored circles around the lights, in addition to suspecting a cold and fever, one should also think that it may be an acute attack of glaucoma.
Open-angle glaucoma.
The onset of the disease is insidious, and there are usually no symptoms in the early stage When the lesion develops to a certain extent, a few people may experience mild eye distention, visual fatigue and headache, and vision is generally unaffected, while the visual field (i.e., the range of seeing things) gradually shrinks unconsciously.
What tests are needed to confirm the diagnosis of glaucoma?
1.Fundus examination: Glaucoma screening should be performed when there is a change in the shape of the optic papilla, with a cup-to-disc ratio >0.6 or a difference of cup-to-disc ratio >0.2 in both eyes.
2. IOP: IOP > 21 mmHg measured several times is considered elevated IOP. IOP measurement has non-contact IOP, pressure trapping IOP and pressure flattening IOP.
There are various measurement methods such as non-contact IOP, indentation IOP and pressure flattening IOP. The pressure flattening IOP measurement requires contact with the cornea, but the results are more reliable. If the IOP is not high in a single measurement, sometimes multiple measurements are needed, and if necessary, dark room, prone test and dilated pupil test may be performed to induce high IOP to assist in early diagnosis.
3, atrial angle examination: flashlight lateral illumination method can easily and roughly determine the depth of the anterior chamber, slit lamp method can early screen out the peripheral anterior chamber shallow people. For patients with apparently shallow anterior atria, detailed atrial horn structures usually need to be observed under ultrasound biomicroscopy and atrial horn microscopy to further clarify the diagnosis.
4. Visual field: If left untreated, the visual field will gradually shrink and eventually become blind as the glaucoma progresses. Because the patient’s vision is usually unaffected in the early stages, the narrowing of the visual field is often not easily detected, and when the visual field defect is apparent to the patient, it has usually progressed to a more serious degree. Because visual field damage in glaucoma is irreversible, and because the visual field is crucial in the diagnosis of glaucoma and in determining changes in the disease, patients with glaucoma and patients with suspected glaucoma should be monitored regularly and repeatedly for changes in the visual field.
5. Retinal nerve fiber layer examination: Studies have shown that defects in the retinal nerve fiber layer precede defects in the visual field, helping to diagnose glaucoma at an earlier stage, and because of the subjective nature of visual field examination, the reliability of the examination results sometimes varies greatly from one individual to another and from one examination to another. Therefore, fundus photography is also crucial in the early diagnosis of glaucoma as an objective test of optic nerve damage. In recent years, with the development of examination techniques, objective examinations such as OCT, HRT and GDx have played an increasingly important role in the early diagnosis of glaucoma. Subjective examination of the visual field together with objective examination of the retinal nerve fiber layer can improve the reliability of the examination results.
What are the common treatment methods?
Primary angle-closure glaucoma: Once diagnosed, laser or surgical treatment should be preferred depending on the condition. In the acute phase, patients with high IOP should be treated with medications to lower IOP, such as topical IOP-lowering medications as prescribed by the doctor, such as Mao Guo Yunxin and Thimerosal, or systemic medications such as 20% mannitol and acetazolamide. If possible, laser peripheral iris perforation and laser peripheral iris shaping can be used to relieve pupillary block and promote opening of the atrial angle. If more than 50% of the atrial angle is open, iridotomy is still an option, otherwise, trabeculectomy and other filtration procedures should be chosen. Poor postoperative IOP control should be supplemented with medications.
Primary open angle glaucoma: the first choice of drug therapy, first with beta-blockers to inhibit atrial aqueous production, such as 0.5% thiamoxin, 0.25% Bethesda, etc.; unsatisfactory control of IOP plus the use of pupil constricting agents, such as 1% pilocarpine, etc., to widen the trabecular meshwork gap, to promote atrial aqueous drainage; through the single and combined use of two types of drugs still can not control IOP or can not tolerate, can be used 1% epinephrine, the drug can also This drug can also increase atrial fluid discharge. If drug therapy is ineffective or unsatisfactory, laser trabeculoplasty is recommended, which is often followed by drug therapy. If the IOP control is still unsatisfactory through the above treatment, surgery is the only option, commonly used surgery is trabeculectomy or other filtration surgery.
What should patients pay attention to in their daily life?
Who is prone to glaucoma attacks and under what circumstances?
First of all, patients with closed-angle glaucoma are prone to acute attacks. Especially in the evening when it is dark, when you are reading or working indoors and forget to turn on the lights, patients should go to the hospital promptly if they have severe eye pain, headache, extreme vision loss with iris vision, nausea and vomiting.
How to avoid acute glaucoma attacks in daily life?
Patients with closed-angle glaucoma, especially before treatment, should avoid working in a dark environment, keep a relaxed mood, eat regularly, sleep regularly, and try to avoid overeating and overexcitement and strain. For example, a large amount of water drawing in a short period of time may also cause an increase in IOP. Patients with secondary glaucoma should actively treat the primary disease.
Eye drops more drops all over the face flow, and less drops are afraid of no effect, how to drop eye drops better?
The correct method of eye drops: tilt your head slightly in front of the mirror, pull down your eyelids and look upwards, a drop of medicine into the conjunctival sac, gently close your eyes and gurgle, and do not forget to press the tear sac with your fingers.
What are the drugs in daily life that glaucoma patients should not use?
Anticholinergic drugs such as atropine, scopolamine, scopolamine, and red gutta percha have the effect of dilating the pupil, which can easily block atrial flow and increase intraocular pressure. These drugs should be used with caution by patients with glaucoma, especially those with closed-angle glaucoma.
Is it true that the more expensive the drug, the better it is? Why doesn’t the medicine that others use very well work for me? What is the best medicine?
There are many kinds of anti-glaucoma drugs, and the mechanism of action of each drug is different, and the efficacy of the drugs varies from person to person. For each glaucoma patient, the medication should be individualized and the most suitable type and dose of medication should be found under the guidance and testing of the doctor. Some drugs, such as bradykinin, although very common and effective, are not available for every glaucoma patient, and should be avoided for patients with asthma and bradycardia.
How long does it take to cure glaucoma? My eye pressure is well controlled, can I stop coming to the hospital?
However, as time goes by, the pressure rises again unnoticed, the channels once opened by laser re-close, and the drugs once sensitive are no longer effective. In this case, the patient needs to be detected in time by regular review and change of medication or further laser and surgical treatment to regain control of IOP.
Just like diabetes and hypertension, glaucoma is a lifelong disease that requires regular review even after surgical treatment. No medication or surgery can guarantee that the IOP will never rise again and the optic nerve will never be damaged.
Therefore, it is crucial for glaucoma patients to adhere to treatment and follow-up.
If glaucoma cannot be cured, why should I spend so much money and effort?
Although all treatments cannot reverse the natural course of glaucoma, good control of IOP can stabilize the disease or slow its progression in most cases. Just like skin gets older and older, no one stays young forever. The optic nerve in glaucoma patients also gets thinner and thinner, and once it’s damaged, you can’t expect it to grow back. So the sooner you treat it, the more optic nerve you can save and protect, just like the sooner you get a face mask the slower your skin will age. So we need to take care of our optic nerve just as carefully as we take care of our skin. Let us bask in the light for as long as we live.
Nowadays, there are a series of statements circulating on the Internet like “computer users who use computers for more than 8 hours a day are prone to glaucoma” and so on are they correct? How can I avoid it?
Glaucoma is mainly caused by increased atrial fluid production or obstructed drainage. Therefore, people with normal eye structure will not get glaucoma because they use computers more. However, for people who have a narrow atrial angle, especially middle-aged and elderly people, the crystal tends to swell and cause relative narrowing of the atrial angle. When they use computers, the light around them is usually dim in order to avoid backlighting, so that the pupil is easily dilated, making the atrial angle further narrowed and the atrial aqueous drainage poor. This, combined with long hours of work in front of the computer, mental tension and eye fatigue, may lead to vasoconstriction dysfunction, increased permeability, and increased secretion of atrial fluid, eventually leading to an increase in intraocular pressure. This condition can easily induce acute attacks in patients with closed-angle glaucoma. To avoid this, it is recommended that people with shallow atrial angles should avoid working in a dim environment, turn up the brightness of the display screen when using a computer, or turn on the indoor lighting. Combine work and rest at work to avoid overexertion and mental stress.