Glaucoma is a chronic, progressive, degenerative disorder of the optic nerve that produces characteristic visual field damage. Glaucoma is the second cause of blindness, and importantly it is irreversible. It is estimated that around 80 million people have glaucoma worldwide. Approximately 50% of the individuals with glaucoma are unaware that they have the disease, and this number may be even higher in underdeveloped countries. This is because in its early stages, glaucoma is asymptomatic. If untreated, glaucoma may progress to blindness.
Periodic testing allows early diagnosis to prevent visual disability.
Although it may present at any age, those over 50 years old are at higher risk of glaucoma. First-relatives of affected individuals and myopic patients are also at higher risk. Individuals with African heritage have a higher risk of having Primary Open-Angle Glaucoma (POAG). Primary Angle-Closure Glaucoma (PACG) is more frequent in Asia and in hyperopic persons. If no risk factor is present, testing may be done every 3 years under the age of 45, and every one to two years after 45 y/o. Testing should be more frequent in individuals with risk factors.
Glaucoma is considered a multifactorial disease and elevated intraocular pressure (IOP) is the main risk factor for its development and progression. Frequently, glaucoma occurs with IOP in the normal ranges. Once the diagnosis and the stage of the disease have been established, treatment is indicated to prevent or delay the progression. Treatment involves reducing the IOP with a number of tools that include eye-drops, lasers and surgeries. Several types of eye-drops are available, but these should be used on a daily basis to reduce IOP. Thus, compliance is important and the opposite, non-compliance is a frequent cause of damage progression. Preservative-free formulations, slow-release devices and other modalities that reduce side effects have been and/or are being developed to reduce non-compliance and also improve quality of life.
Different lasers are also available to treat the disease. In the last few years several new surgical procedures with minimum trauma have been added to our classical surgical armamentarium. Thus, the ophthalmologist has numerous tools to be used in the different stages of the disease to reduce IOP. Regular physical activity and a healthy diet are also recommended to patients.
Several advances have been made to understand how the damage is produced in the disease and thus, develop new treatment strategies that may not only include preventing the progression of the disease, but also restoring the vision loss through modern technologies and approaches.