What is Glaucoma?

Glaucoma is a disease of the optic nerve that can cause permanent vision loss. Glaucoma is the second most common cause of permanent vision loss in the world. Glaucoma may develop at any age from birth. A fluid called aqueous humor is constantly produced in the eye and excreted out of the eye. When the balance between production and excretion is disrupted, intraocular pressure increases.

Intraocular pressure is not always high in glaucoma. It should not be forgotten that glaucoma can develop or progress even when intraocular pressure is at normal levels.

Glaucoma Symptoms

Glaucoma is an insidious and progressive eye disease. In glaucoma patients, the damage to the optic nerve may not cause any complaints until it reaches a certain level. Patients are usually diagnosed during a routine eye examination. Glaucoma may show its first symptoms in advanced stages with visual field disorders and narrowing. Glaucoma can also be seen in newborn babies and may present with opacification of the cornea, light sensitivity, and epiphora.

Although the normal value of intraocular pressure is accepted as 9-21 mm-Hg, the normal value range of pressure may vary from person to person. Factors such as the patient’s corneal thickness, the type of device used for measurement, whether the measurement is taken in the morning or evening, and whether the patient has exerted effort before the measurement may affect intraocular pressure measurement. All these factors are taken into consideration by ophthalmologists during the examination and the intraocular pressure value is interpreted specifically for each patient.

Considering that glaucoma is an insidious disease and that the majority of patients do not know they have glaucoma, the importance of routine eye examinations is much better understood. Patients with risk factors are advised to have an eye examination at least once a year.

Glaucoma Risk Factors

• High intraocular pressure
• Being over 40 years of age
• Having a thin corneal thickness
• Glaucoma history in the family
• Race
• High myopia or hyperopia  
• Long-term corticosteroid use
• Eye trauma

Glaucoma Examination

• Determining the level of visual acuity
• Measurement of intraocular pressure and measurement of corneal thickness
• Detailed eye examination of anterior and posterior segment of the eye
• Measurement and evaluation of the thickness of the retinal nerve fiber layer
• Examination and evaluation of the visual field
• Additional examinations may be performed depending on the glaucoma type

Glaucoma Treatment

The basis of glaucoma treatment is early diagnosis and compliance with treatment. Early diagnosis and treatment in glaucoma are extremely important for the preservation of vision and visual field and can prevent permanent vision loss. When diagnosis and treatment are delayed, it is not possible to repair the damaged optic nerve or restore the visual field lost. The treatment of glaucoma varies depending on the type and course of glaucoma, but can be performed medically or surgically.

Medical Treatment

The aim of medical treatment is to reduce the intraocular pressure to a value that the optic nerve damage does not progress. In order to reduce intraocular pressure, the production of the fluid called aqueous humor in the eye should be reduced or its outflow from the eye should be increased. 

In medical treatment, the aim is to reach the desired target intraocular pressure with the minimum number of medications and drops, but some patients may need to use 2 or 3 medications in combination.

In medical treatment, the patient’s compliance with the medication regimen is a as important as the effectiveness of the medications. If the treatment regimen is not followed, it is not possible to achieve the desired effect.

Surgical Treatment

In patients, who cannot reach the desired target intraocular pressure with medical treatment or have problems with medication use, desired target intraocular pressure can be achieved with surgical treatment. There are many surgical options, and the type of surgical procedure. Type of surgery is determined according to the type of glaucoma disease and the patient’s age and needs.

Glaucoma Surgery Process

Before Surgery

• Unless your doctor tells you otherwise, you do not need to stop your daily medications
• You do not need to stay in the hospital
• Since glaucoma surgery is generally performed with local anesthesia, fasting is not required before surgery.
• If the surgery is to be performed with general anesthesia, tests related to general anesthesia are performed before surgery.

Surgery Day

• Application of local anesthesia around the eye
• The average duration of surgery varies according to the type of surgery (30 – 45 minutes)
• The patient does not feel any pain during surgery.

After Surgery

• Eye drops will be used for 1 month after surgery.
• Temporary low or high intraocular pressure may be encountered in the early period after surgery. This is an expected situation and additional treatments may be started.
• There are control examinations on the 1st day, 3rd day, 1st week and 1st month after surgery. Additional control examinations may be performed if needed.
• Swimming in the sea or pool, heavy lifting and heavy sports activities are restricted until full recovery is achieved in the surgical area.