Condition

Glaucoma is the collective name for a group of eye diseases that are generally characterized by a combination of relatively increased eye pressure, damage to the optic nerve and a limitation of the visual field.

The eye keeps itself under constant tension. In this way the eye retains its clear convex shape and physiological processes can run optimally. The pressure that this aqueous humor exerts in the eye can vary individually. It is difficult to determine exactly where the line between normal and pathology lies. Normal eye pressure varies between 11 and 21mmHg.

Glaucoma causes progressive vision loss that begins in peripheral vision and slowly spreads toward the center. The loss of vision is permanent and irreversible. Without treatment, this disease can lead to blindness. In advanced glaucoma, driving becomes difficult and dangerous. Reading is also made more difficult because the field of vision is narrowed.

https://www.braille.be/nl/documentatie/oogkleding/glaucoma

Investigation

Only the ophthalmologist can determine the eye pressure. It is therefore advisable to make an appointment to determine your eye pressure as soon as you turn 60, and even earlier if one of your parents has glaucoma. The sooner high eye pressure can be diagnosed, the sooner preventive treatment can be carried out. After this examination, the doctor will determine the frequency of the consultations himself.

As with every visit to the ophthalmologist, the anamnesis(link), the refraction(link), the eye pressure or tonometry(link) will be taken.

If increased eye pressure is found, a visual field examination (link) will be planned. This examination takes about 20 minutes. Plan enough time for the consultation in your agenda!

At a later stage of the condition, an OCT(link) of the optic nerve may also be indicated.

Therapy

The aim of the treatment is to lower the eye pressure, which reduces or eliminates the risk of eye damage.

• Eye drops: the eye drops reduce the production of aqueous humor or stimulate its drainage. This requires consistent dripping, in principle for life.
  Eye drops come in many different strengths and combinations. In general, Dr De Brauwer will use the smallest amount and concentration of medication with the best results and the fewest side effects.
  To instill correctly, I refer you to the website
  www.oogdooien.nl
• Laser treatment: if the eye drops do not reduce the eye pressure sufficiently.
  The treatment consists of promoting drainage by making microscopic holes in the drainage pipes.
  A laser is a narrow but very powerful beam of light that can be used to create extremely small wounds or holes, depending on the type and strength of the laser beam. Laser treatments are performed during the consultation. There are different types of laser treatment for glaucoma. Dr De Brauwer will discuss this with you.
  Before the laser treatment continues, drops are administered to reduce the size of your pupil. This takes 10 to 20 minutes, depending on person to person. So plan enough time and be guided.
• Surgical intervention: if the 2 previous treatments are not satisfactory.
  The drainage of the aqueous humor is improved by creating a valve in the eye or by making an opening in the iris.
  Surgical treatment for glaucoma in adults can usually be performed under local anesthesia.

Trabeculectomy

In the most common, the so-called filtering operation, openings are made in the angle of the chamber and in the iris (peripheral iridectomy) so that the aqueous humor can more easily reach the anterior chamber of the eye and from there spread under the outer layers of the eye, finally ending up in the blood to be absorbed. To access the iris and the chamber angle, the ophthalmologist must make a small incision in the white of the eye. Because the aqueous humor flows under the outer layers of the eye after the operation, a so-called filtration bladder will be created. This is a slightly raised area that is usually paler than the surrounding area, but sometimes very little of such a filtration bubble is seen. Besides, there is not much visible to the outside eye, neither of the hole in the iris and the corner of the chamber, nor of the incision in the white of the eye. The operation requires careful and frequent follow-up. After the operation there will be a recovery period of several weeks, during which your vision may be somewhat reduced.