What is glaucoma?
Glaucoma is a chronic, bilateral eye disorder characterized by progressive destruction of the fibers of the optic nerve, the nerve responsible for transmitting information from the eye to the brain.
Glaucoma is often associated with increased pressure in the eye. Intraocular fluid tension represents the balance between its production and drainage. Aqueous humor is a clear fluid produced continuously by the ciliary body, which provides the necessary supply of oxygen and nutrients to the lens, cornea and iris and is drained into the venous system. Normal intraocular pressure is essential for the optical functions of the eye, but elevated intraocular pressure can cause irreversible damage to the cells that constitute the optic nerve. Statistically, pressure values between 9-21 (normal eye pressure) are considered normal.
If glaucoma medication and laser treatment haven’t helped treat your glaucoma, your doctor may recommend surgery. Surgery can’t cure glaucoma or reverse vision loss, but it can help protect your vision and prevent it from getting worse.
Surgery involves either laser treatment or making a cut in the eye to reduce intraocular pressure. The type of surgery your doctor recommends will depend on the type and severity of your glaucoma and the overall condition of your eye.
How do you know if you need glaucoma surgery?
Glaucoma tests are painless and don’t take long. Your ophthalmologist will test your vision. Eye drops will be used to dilate your pupils and examine your eyes. Your optic nerve will be checked for signs of glaucoma. They may take photographs so they can see changes at your next visit. They will do a test called tonometry to check your eye pressure. They may also do a visual field test to see if you have lost peripheral vision. If your doctor suspects glaucoma, it may request special imaging tests of your optic nerve.
If you have the following symptoms:
- observing halos around bright spots
- loss of vision
- red eyes
- eye pain
- narrowing of the visual field (tunnel vision)
Because loss of vision caused by glaucoma is irreversible, regardless of the stage of the disease, it is very important to have a regular comprehensive ophthalmological check-up, including measurement of intraocular pressure, so that the diagnosis can be made in the early stages of the disease and the doctor can recommend an appropriate treatment plan.
It mostly affects adults over 40 years old, but young adults, children and even infants can have it. You’re more likely to get it if:
- You suffer from high intraocular pressure
- You are over 40 years old
- You have a family history of glaucoma
- You have myopia or hypermetropia
- You have poor vision
- You have diabetes
- You take certain steroid medications such as prednisone
- You take certain medicines for bladder control or seizures or some over-the-counter remedies
- You had an eye injury
- You have thinner cornea
- You have high blood pressure, heart disease, diabetes or sickle cell disease
What does glaucoma surgery involve?
Glaucoma can be treated in several ways, depending on its stage and progression.
- laser treatment
- surgical treatment
All types of treatment are available at Dr. Holhoș clinics.
There are a few different types of glaucoma surgery that can help relieve pressure in the eye:
Laser iridotomy is a procedure that consists of making a drain channel for aqueous humor through the iris to facilitate its removal. The aim is to equalize the pressure between the anterior and posterior ocular chamber and open the iridocorneal angle. It is the procedure of choice for closed-angle glaucoma due to pupillary blockage.
Laser trabeculoplasty consists of widening the trabecular spaces, thus allowing easier removal of aqueous humor from the eye, and is indicated for the treatment of open-angle glaucoma or closed-angle glaucoma after laser iridotomy.
Peripheral laser iridoplasty consists of peripheral contraction of the iris with the laser to open the iridocorneal angle. It is used when iridotomy cannot be used, or as a preparatory stage for trabeculoplasty.
Laser cyclophotocoagulation consists of destroying a portion of the ciliary body to decrease aqueous humor secretion. The aim is to decrease intraocular pressure and eye pain.
Surgical treatment for glaucoma
The most commonly used surgical techniques are drainage surgery – making a small hole in the cornea to create a new aqueous drainage pathway and reconstruction surgery to reconstruct the aqueous drainage pathway.
What to expect after glaucoma surgery?
Your doctor will prescribe eye drops to prevent swelling and infection and you will need to use them for a few weeks. These eye drops are different from other glaucoma eye drops you may already use.
While you recover, you may need to avoid some activities for 2 to 4 weeks, such as lifting heavy things. You will also need regular eye check-ups to make sure your eye is healing well. After surgery, your eye may feel uncomfortable and be red, and your vision may be slightly blurred for up to 6 weeks, but should return to normal.
What complications can occur after glaucoma surgery?
Laser treatment can cause side effects, just like any procedure.
You may experience swelling or pain. Sometimes the laser can scratch the cornea (the clear front layer of the eye) or make the cornea very dry. This can be painful, but the pain usually goes away quickly as the cornea heals. Your doctor may prescribe you eye drops to help.
When it comes to surgery for advanced cases of glaucoma, the benefits usually outweigh the risks. The following are (rare) glaucoma surgery risks or side effects:
- Loss of vision
- Bleeding in the eyes
- Low eye pressure (or hypotonia)
- Possibility of cataract development or set-in
What is the specialist's advice after glaucoma surgery?
Recovery time after glaucoma surgery varies depending on the patient and each surgery, but most patients heal within 3 to 6 weeks. During the remainder of the recovery period, it is generally recommended that patients with postoperative glaucoma avoid intense activity. This type of activity includes heavy lifting, exercise, stressful work, etc.
With any procedure there is a small risk of infection after surgery. Some common precautions that most doctors recommend patients to take in order to avoid infection and other problems after glaucoma surgery include:
Don’t rub or scratch your eyes. It is common for vision to be blurred for a few days after glaucoma surgery, and for the eyes to sometimes feel itchy.
Take all prescribed eye drops. These eye drops can help soothe the itching mentioned above and prevent infection.
Avoid heavy lifting and intense activity. While no one is asking you to spend the next few weeks on the couch, it’s wise to avoid the gym during recovery. If your job requires heavy lifting, you may need to request a medical leave from work or request other tasks while you recover.
Avoid swimming pools. No matter how refreshing a dip in the water might sound, pools, hot tubs and saunas are breeding grounds for bacteria that cause infections and it’s best to avoid them during recovery.
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