Glaucoma
What
is Glaucoma
Glaucoma is a group of conditions
where the pressure inside the eye causes damage to the optic nerve, resulting in
reduced vision.
Most people with glaucoma are
unaware of any problems; your vision may seem normal and there is no pain. This
is because the centre of the vision, which you use for detail is not affected
until the most advanced stages of the disease. Instead you may lose peripheral
patches of vision without you knowing.
Glaucoma cannot be cured but it is
possible to control the disease in most cases by drops or, in some cases,
surgery. Without treatment patients usually lose vision gradually over the
course of many months or several years. Once lost, it is not possible to restore
the vision.
The aim of treatment is to minimise
any further damage to your vision and to help you keep useful vision for as long
as possible.
Because glaucoma is a condition
which can deteriorate without you noticing changes to your vision, it is
important to attend for regular review, where any problems can be picked up
early and treatment given accordingly.
Some patients have high pressure in
the eye but never develop any glaucoma damage. These are called ocular
hypertensives. As it is impossible to tell who will go on to develop damage and
who will not, all patients with high eye pressure need to have their eyes
checked on a regular basis.
For other patients they may have
some feature that makes one suspect glaucoma but there is not enough evidence to
require long-term medication. These patients require monitoring over a life
time.
How we treat Glaucoma
Glaucoma cannot
be cured but it can be controlled.
What happens at each visit?
At each visit we
will assess:-
·
your vision
·
your eye pressure (tonometry)
·
your optic nerve (the seeing nerve)
In addition we
may carry out the following:-
·
perimetry -assessment of your side vision or peripheral field of vision
·
photographs and/or a scan of the optic nerve.
You should follow
the recommended treatment and attend the main consultant clinic on a regular
basis until your condition is stabilised. Your treatment may need to be changed
a few times before this stability is achieved.
Throughout this
period you will remain under the direct supervision of your consultant until
they are sure that your disease is under control.
For many people,
once the glaucoma is under control, treatment can remain unchanged for many
years. However you still need regular reviews to monitor your condition. This is
done in the Stable Glaucoma Service by a specially trained team of optometrists
and nurses.
Medication (eye drops)
The first choice of treatment
usually for glaucoma is eye drops. These drops lower the pressure inside the eye
and so reduce the chance of further damage to the optic nerve and your vision.
As the high pressure is caused by an
imbalance between how much fluid you make in your eye and how quickly you can
drain it away, eye drops that lower the pressure, work in different ways. Some
reduce how much fluid you make and others help you to drain it away faster.
It is important to use all your
drops as directed. Failure to take glaucoma medication regularly can cause large
changes in your eye pressure which have been shown to be just as bad as a
constant high pressure.
All medications have known side
effects, but not everyone will experience them. If you are experiencing problems
with your drops please let one of the Glaucoma team know and we shall try to
provide an alternative.
You will be provided with a separate
information sheet about your drops which will tell you how the drug works, how
often to use it and the common side effects to expect in some cases.
Laser and surgical treatment
In some cases eye
drops are not enough to control your pressure. We then have to consider laser
treatment or surgery. The consultant will discuss this with you in detail should
this become necessary.
Treatment for your
Glaucoma
You will find
information on your medications on the sheets provided. Each sheet provides
information on how your drops work, how often to use them and how to keep them
fresh. Most people have no problems using eye drops. Common side effects are
also listed so you know what to look out for if you do have problems.
When taking more
than one drop, please allow at least 10 minutes between each drop so that the
first one has a chance to sink in before you instil the other one.
Some words you might
hear
1. IOP
–This stands for Intra-Ocular Pressure (pressure inside the eye). The eye
is constantly producing a clear fluid which nourishes the inside of the eye
(aqueous humor), and this can be measured. The balance between how quick the
fluid is made and drains away determines the Intra-ocular pressure.
Some people may
have high pressure but do not experience the changes associated with glaucoma.
This is called ocular hypertension. This may need treatment in some cases
and always needs to be watched in case any glaucoma damage occurs.
Some people may
have some changes in the eye or vision that looks like glaucoma but may not be.
These people are called glaucoma suspects. They need to be watched in
case the change gets worse
High tension
glaucoma
occurs when the eye pressure is above normal limits and there are the changes in
the eye associated with glaucoma. This almost always needs treatment.
Normal tension
glaucoma
is when the eye pressure is within normal limits but the eye and vision has the
changes associated with glaucoma. This often needs treatment.
In all these
conditions the aim of treatment is to stop the pressure causing damage at the
back of the eye and retaining vision.
2.
Perimetry or visual fields-This is a special test which looks at how much
you can see around the edges of your vision. In glaucoma you can lose this
vision without realising it. Changes in your visual fields may mean a change in
treatment is required. This would be discussed with you.
3. HRT-This
stands for Heidelberg Retinal Tomography. This is a state of the art
camera which takes digital photographs of the optic nerve (the part of the eye
which is damaged in glaucoma). It is painless. Usually no dilating drops are
needed. It produces instant pictures and with the aid of computer technology
will help to decide how your condition is doing.
Common questions answered
These are some of
the commonly asked questions. If you have any queries at all, please ask when
you attend the hospital or contact a member of the Glaucoma team. (See your
glaucoma service for contact details at the end of this booklet)
Will I go blind?
The majority of
people with glaucoma do not go blind. In the United Kingdom around 95% of those
diagnosed with early glaucoma, will retain useful sight for life with treatment.
Most damage is done prior to diagnosis. If the condition goes untreated there is
a big risk of reduction in vision. 13% of people on the blind register have some
form of glaucoma.
What about my family?
As glaucoma can
run in families, any parent, siblings and children over the age of 40 should be
checked by an optometrist. The test is simple and painless. Where a first degree
relative has glaucoma, the test is free to those over 40. Just tell your
optometrist that you have a family member with the disease. People from families
with glaucoma should be tested from the age of 35 if the disease was diagnosed
earlier in the family. In general you are four times more likely to develop
glaucoma if some one in
the family
already has the condition. This is more so if two or more family members are
affected.
Is there any other treatment?
Some people may
need surgery or laser treatment to help control their glaucoma. For the majority
of people their condition is successfully managed with drops.
What if I forget to put my drops in?
Do not panic if
you forget to put in your drops. As soon as you remember put one in. However in
order for glaucoma to remain well controlled it is important to use your drops
regularly as instructed. If you are going away from home remember to take the
bottles with you. Always keep a spare bottle so that you have a constant supply
and cannot run out.
Am I able to still drive?
The vast majority
of people with glaucoma can continue to drive. However you must, by law, inform
DVLA. They will then arrange a special driving visual field, and obtain a
report. If you then meet the minimum standards of vision required for driving
you will be allowed to continue to do so. It is also advisable to inform your
insurance company. If you have any concerns regarding driving please ask the
doctor or optometrist at your next appointment.
Other sources of information
The following is
a small list of helpful organisations and websites:
For information
regarding driving contact DVLA:
Website:
www.dvla.gov.uk
Address: Drivers
Medical Branch
DVLA
Swansea
SA99 1TU
For information
regarding glaucoma, support from others with glaucoma and up-to date news on
treatments there is the International Glaucoma Association or IGA
Their symbol is a
green frog.
Website:
www.iga.org.uk
Address: IGA
Woodcote House,
15, Highpoint
Business Village,
Henwood,
Ashford,
Kent.
TN24 8DH
For general
information there is the Glaucoma Foundation. It is mainly geared towards the
American patient but has very useful information around eye drops.
Website:
www.glaucoma.org
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