Primary glaucoma is a progressive disease of both eyes, characterized by increased intraocular pressure (IOP) and the development of glaucoma atrophy of the optic nerve, ultimately leading to irreversible blindness. Glaucoma is the leading cause of blindness and low vision among other eye diseases worldwide. The danger of the problem lies in the absence of vivid symptoms, glaucoma is often called the “silent killer” of the optic nerve, even with maintaining good vision, a person may have the penultimate stage of glaucoma development.  

Diagnostics and treatment of glaucoma is one of the priorities in the work of our clinic. We carry out a comprehensive diagnostic examination, which includes 12 diagnostic tests and takes about 1.5 hours. The value of such a detailed examination lies in determining the type and stage of glaucoma, the degree of compensation of intraocular pressure, and determining the “target pressure”. Target pressure is the level of intraocular pressure at which further death of the nerve fibers of the optic nerve is suspended; this is the pressure to strive for when treating a patient with glaucoma. It is also possible to conduct an examination – electrotonography, with the help of which it is possible to determine the ratio of the inflow and outflow of intraocular fluid. Electrotonography indices influence the choice of further treatment. Antihypertensive eye drops, laser or surgical treatment are prescribed for each patient individually.    

Glaucoma is open-angle and closed-angle.

Open-angle glaucoma “does not hurt” and the patient will come to the doctor only when his vision is impaired. In this case, the treatment may no longer be effective.

Angle-closure glaucoma is accompanied by periodic pain in the eye, in the corresponding half of the head, manifested by an acute pain attack, in which the intraocular pressure will be significantly increased, and the visual acuity will be markedly reduced. If such an attack is not removed in time, the eye will go blind.

The goal of glaucoma treatment: to reduce intraocular pressure to a safe level for each individual patient, to prevent the development of optic nerve atrophy.

Optical tomograph Cyrrus HD OCT

The indisputable advantage of the complex diagnostics of glaucoma in the conditions of our Clinic is the study of the state of the optic nerve using the method of optical coherence tomography of the eye, which makes it possible to determine the size, area, depth of glaucoma changes in the optic nerve, the thickness of nerve fibers, which is very valuable information for detecting glaucoma at an early stage. This is a highly informative intravital layer-by-layer diagnosis of the optic nerve. 

The photo shows the optic disc of a patient with glaucoma. A deep “pit” is visible – the excavation of the optic nerve head, which occurs as a result of pressing and death of nerve fibers from too high intraocular pressure

It is important to remember about the risk factors for glaucoma:

• age over 40;
• the presence of glaucoma in the next of kin;
• high or low blood pressure;
• myopia II-III degree; 
• hyperopia;
• long-term use of steroid drugs.

The norm of intraocular pressure (IOP): it is considered to be a normal level of IOP with contact tonometry from 17 to 24 mm Hg. If we take into account the risk factors, then each person has his own “safe” IOP rate. With an increase in IOP beyond the safe level in the eye, irreversible changes in the optic nerve fibers occur, which lead to a narrowing of the visual field, and then to complete blindness.

Glaucoma is open-angle and closed-angle. Before understanding how glaucoma develops, it is necessary to understand how fluid circulates within the eye.

Fluid is produced within the eyeball by a structure called the ciliary body. The fluid passes through the pupil and leaves the eye through the eye’s drainage system – the trabecular meshwork. In healthy eyes, there is a balance between the fluid that is produced in the eyes and the fluid that flows out of the eye. As a result, normal pressure is established inside the eye. This pressure is called intraocular pressure, it is it that the doctor measures at the reception.

Open-angle glaucoma is the most common type of glaucoma. It runs latently, without any symptoms. Even a significant increase in the level of IOP can go unnoticed for a person, the eye does not hurt, but gradually fades. The reason for the increase in IOP is the clogging of the drainage system of the eye – the trabecular network through which the outflow of fluid from the eye is carried out. As a result, fluid cannot leave the eye at the same rate as it is produced. There is an accumulation of excess fluid, which leads to an increase in IOP. If no treatment is carried out, then in the future there is a loss of the peripheral, then the central field of vision, followed by atrophy of the optic nerve and blindness.

Angle-closure glaucoma is manifested by attacks, during which there is a sharp pain in the eye area, pain in the superciliary area and the temple area, accompanied by a sharp decrease in vision, the appearance of “fog”. With such complaints, it is necessary to urgently consult a doctor for medication. Lack of timely assistance can lead to irreversible blindness! In angle-closure glaucoma, fluid accumulates inside the eye due to the fact that the iris overlaps the angle of the anterior chamber of the eye, that is, there is no access to the natural drainage system of the eye. Anything that can dilate the pupil, such as dim light, certain medications, and even pupil-dilating eye drops that are given before an eye exam can cause the iris to block the circulation of intraocular fluid in some people. When this form of the disease occurs, the eyeball quickly hardens, and the sudden rise in pressure causes pain and blurred vision. It is with this form of the disease that an acute attack is possible – a sharp increase in pressure in the eye. Due to the fact that it is accompanied by nausea and a general worsening of the condition, it is often confused with other diseases and time is wasted. And help in this case should be provided in the next day, otherwise blindness may occur. 

The goal of glaucoma treatment:

• Decrease intraocular pressure to a safe level.
• Preservation of visual functions, stabilization of the glaucomatous process.

It must be remembered that the earlier glaucoma is detected, the higher the likelihood of maintaining good vision! Reducing IOP is achieved in three ways: medication, laser or surgical treatment. All three methods are carried out in our Clinic by highly qualified specialists using the latest equipment that meets modern standards for glaucoma treatment.  

It is also important to maintain visual functions when the normal IOP level is reached. For this, there are courses of anti-dystrophic vascular therapy, which are also carried out in our treatment room. Treatment takes an average of 10 days, consists of parabulbar (in the periorbital tissue), intravenous, intramuscular injections, electrical stimulation of the optic nerve.