FREQUENTLY ASKED QUESTIONS
IS GLAUCOMA PAINFUL?
In most cases, no, and that is why it is so important to visit your ophthalmologist regularly so that glaucoma can be detected before the optic nerve becomes damaged. Many people are often unaware that they have glaucoma until it has progressed so far that the damage has already been done and the eyesight has already been irreversibly affected.
IS THE GLAUCOMA TEST PAINFUL?
No. This test is painless. Your ophthalmologist will test for the following:
• Vision
• Optic Nerve assessment
• Intraocular pressure
• Visual field test
This test will take between 30 – 60 minutes.
WILL GLAUCOMA EVER GO AWAY?
The most common types of glaucoma are chronic, which means that treatment is life-long. Remember as soon as you stop your treatment the pressure will rise, and cause more damage to the eye, which will affect your eyesight!
WILL I BECOME BLIND?
Today, modern treatments for glaucoma will usually prevent your eyesight from deteriorating and will help to slow down any further loss of vision.
The message is clear: “Regular eye tests and taking your treatment as recommended by your doctor can stop you going blind”
HOW DO I PREVENT GLAUCOMA?
Currently there is no preventative method for glaucoma. Some people are more at risk of developing glaucoma than others. It is therefore important to visit your ophthalmologist regularly to test your eyes for glaucoma before it is too late.
WHAT IF I DEVELOP SIDE-EFFECTS TO THE MEDICATIONS?
Side effects are generally infrequent. Problems are mostly temporary and will go away as soon as you stop using the drops. Some problems include redness, burning and blurred vision. Ask your ophthalmologist for the best option for you. Best results will be achieved with:
• convenient dosing, e.g. once a day dosing
• easy application, e.g. devices to administer
• better tolerability, e.g. less side-effects
HOW DO I CORRECTLY INSTILL EYE DROPS?
You should follow carefully the instructions given to you by your doctor or pharmacist. Some eye drops given for glaucoma may sting when you first begin to use them. This is quite normal. You should never miss an appointment at your hospital clinic or at your eye specialist.
HOW DOES GLAUCOMA DEVELOP?
Circulation of aqueous:
The eye is like a balloon. It maintains its shape by inside pressure. Aqueous humour, a clear, watery fluid is continuously produced inside the eye and escapes from the eye gradually to maintain the pressure inside. It circulates through the anterior segment of the eye and leaves through the drainage channels in the eye .
This fluid is essential to maintain the structural integrity of the eye and also nourishes structures in the eye.
Problem in glaucoma:
These drainage channels become either non-functional (open-angle type) or get closed (closed angle type) resulting in elevated eye pressure.
As the pressure rises, parts of the optic nerve gradually become damaged.
Loss of nerve fiber function is reflected in loss of the visual field .
Part of the field of vision is lost. First, the edges of the visual field blur and disappear. As the pressure of one or both eyes rises, it reduces the blood supply to the nerves which send messages to the brain. These nerves then begin to fail and part of the field of vision is lost. If left untreated, the damage continues to spread and your view of the world becomes narrower, producing tunnel vision.
Glaucoma usually develops slowly and without any symptoms. Eyesight can be surprisingly bad by the time anything is noticed. Warning signs which might indicate a problem include:
TYPES OF GLAUCOMA
Glaucoma is classified into the following types:
[1]Primary: two sub-types, namely, open angle and closed angle.
In SA, Primary Open Angle Glaucoma (POAG) is the common type.
[2]Secondary: associated with other ocular problems
And can be open angle or closed angle type.
[3]Congenital or developmental:
Due to malformation of the drainage channels in the eye.
Usually evident either at birth or during the first year of life
Depending on the severity of malformation.
SYMPTOMS
Primary Open Angle Glaucoma (POAG) is a silent disease and is not associated with any symptoms. It is detected usually on routine eye examination.
Adults with advanced disease may present with:
• Poor sight in dim light
• Blurring of vision
A child (congential glaucoma) usually presents with:
• a large eye
• excessive tearing
• abnormal sensitivity in bright light
Angle closure glaucoma:
• can progress silently.
• However in an acute attack the patient presents with sudden onset of
• redness , severe eye pain , decreased or cloudy vision , with or without nausea and vomiting .
* Acute angle closure glaucoma is a medical emergency and requires immediate treatment!
RISK FACTORS
High eye pressure: eye pressure increases with age
Advanced age: risk increases with increasing age.
Family history: higher in relatives of patients affected with glaucoma.
Ethnicity: more common and more severe in persons of African origin .
Short sightedness (myopia)
Medical diseases: diabetes, high blood pressure, migraine
Long-term use of steroids
Eye injuries
DIAGNOSIS OF GLAUCOMA
Visual acuity: assesses the degree of clarity of vision
Tonometry: measures the eye pressure
Visual fields: tests ability to see objects ahead and on the periphery
First, the edges of the visual field blur and disappear. If left untreated, the damage continues to spread and your view of the world becomes narrower, producing tunnel vision.
Gonioscopy: examination of the angle of the eye.
Optic disc imaging: digital pictures of the eye and statistical data .
Regular Eye Testing is the only way to detect glaucoma before it causes damage to sight
●If you are over 40, you should have your eyes tested every two years, over 60 every year.
●If someone in your family has got glaucoma, you should have your eyes tested regularly. This is especially important if the affected relative was under 40 years of age when the glaucoma was first discovered.
You should go to an optometrist to have your eyes tested. Arrangements may then be made for you to visit an eye specialist or an eye clinic
General examination: Referral to a Physician or GP:
to exclude systemic diseases such as diabetes and hypertension and evaluate for neurological disorders .
Diagnosis in children may require examination under anesthesia in theatre .
PROGRESSION OF GLAUCOMA:
This is monitored with serial tests e.g.: tonometry, visual fields, optic disc imaging at regular intervals.
Early detection is vital to preventing progression of the disease.
Early diagnosis and treatment of Glaucoma is important because:
● It is progressive and requires life-long follow-up
● It causes irreversible loss of vision, leading to blindness.
at most times it is a silent disease i.e. without any symptoms.
TREATMENT
The most important goal is to prevent any further damage to your optic nerve. It is therefore very important to make sure the IOP does not increase. This is also the main reason why you should never stop using your medication.
There is no permanent cure for glaucoma as yet. However, treatment can slow down the disease and prevent visual loss. The only treatable component is the eye pressure. The treatment aims to control intra-ocular pressure to a target level. Target intra-ocular pressure for a patient is set depending on the extent of the optic nerve damage.
TREATMENT MODALITIES:
There are a number of treatments available for glaucoma. These lower the pressure of the fluid inside the eyeball to normal levels.
Medical: eye drops or tablets
Laser surgery: to the angle of the eye.
Incisional surgery , with or without insertion of a valve or a tube: The surgeon will make one or more tiny holes within structures within the eye to help the fluid inside to escape more quickly.
SOME IMPORTANT ASPECTS:
• Above the age of 40 years, you should have an eye examination every two years, above 60 every year.
• Ask your Ophthalmologist or Optometrist to measure your intra-ocular pressure.
• If you have any of the risk factors make sure that you mention this to your Ophthalmologist.
• If you have any of the risk factors, you should go for an eye examination at least once a year.
• If you have been diagnosed with glaucoma, inform your relatives so that they can also go for an eye examination.
• Once you start with your treatment – do not stop!
• You should never stop using your medication without first consulting with your Ophthalmologist.
• Ask your Ophthalmologist how drop instilling devices can assist you in applying the drops.
• Your treatment will only be effective if you adhere to the prescribed schedule.
• Visit your Ophthalmologist as directed – do not miss a visit!
PRACTICAL ASPECTS
1. How to instill eye drops
If you use more than one medication, always separate the instillation of these by at least 3 minutes (to prevent a wash-out effect). A single drop is adequate. The tip of the bottle must not touch the lashes or eyelids. Close the bottle immediately after use. Keep the eyes closed for at least 20 seconds after instillation. Always instill drops before ointment.
2. Use of drop instilling device when necessary
3. How to remember when to instill your eye drops:
Relate it to an activity that you do regularly e.g. instill drops before or after meals,
or use a fixed time e.g. 7 o’clock in the morning and 7 o’clock at night.
4. How to remember your next appointment:
At the Eye Clinic or with the Ophthalmologist: Mark on the calendar; put a note on the fridge; set the reminder on the cellphone.
5. Follow-up visits to the Ophthalmologist :
You are requested to bring all your medications for the follow-up visits, so that they may be identified as correct, expiry date checked and remaining quantity estimated.
6. Contact lens wearers:
Contact lenses should not be worn when instilling eye-drops. Use drops about 20 to 30 minutes before inserting contact lens and / or after removal of the contact lenses .
7. When going away on holiday:
Ensure that you have an adequate supply of your medications or have a prescription from your Ophthalmologist, have your medications in your hand-bag and the extra supply in another separate bag .
8. If you do forget:
use your drops as soon as you remember, then continue as per your normal schedule. If it is already close to your time for your next drop do not try to catch-up by applying extra drops.
9. Get into a daily routine to ensure that you do not forget to use your drops: for example use the drops straight after you have brushed your teeth every morning and / or evening.
DEFINITIONS
Ophthalmologist: medical specialist who treats diseases of the eye
Optometrist: person trained in the management of refractive errors:
Visual acuity: quality of vision
Eye pressure: normal eye pressure is 15.5 mm Hg
Angle of the eye: the area where the colour (iris) meets the outer eyeball structures
Optic nerve: the optic nerve carries visual information from the eye to the brain.
Visual field: looking straight ahead vision with the center and periphery of your vision.