Glaucoma · Understanding the condition

Glaucoma Understand, detect and treat Understanding the condition helps protect vision. Dr. Nuno Lopes | Ophthalmology Glaucoma is a chronic disease of the optic nerve, the structure that carries visual information from the eye to the brain. It can progress without symptoms and cause irreversible vision loss. Raised intraocular pressure is an important risk factor. Difficulty draining aqueous humour can raise pressure and contribute to nerve damage. Glaucoma also occurs with pressure within the range considered normal. Raised pressure Raised intraocular pressure The arrows represent pressure exerted on the eye's walls. Optic nerve Carries visual information to the brain. Raised pressure is a risk factor; glaucoma can also occur with normal pressure. Why can it go unnoticed? In chronic open-angle glaucoma, visual loss is usually painless and can affect peripheral vision before it is noticed. Good central vision or absence of pain does not exclude the condition. Factors requiring attention Age over 40 and a family history of glaucoma. High myopia and prolonged corticosteroid use. Diabetes, sleep apnoea and other factors assessed during consultation. African ancestry, associated with a greater risk of some forms of glaucoma.

Diagnosis and treatment options Pressure alone does not establish the diagnosis Assessment may include tonometry, optic nerve examination, visual fields and optical coherence tomography (OCT). These tests complement one another, helping detect changes and monitor progression. Preserved Increased cupping Advanced damage More vertical and asymmetric cupping, with thinning of the neuroretinal rim. Treating to preserve vision Existing optic nerve damage is irreversible. Treatment aims to reduce pressure to an individual target and lower the risk of progression. Treatment How it can help Eye drops Lower eye pressure. The medication and number of applications are individualised; oral medication is sometimes added. Laser SLT improves natural drainage and can be an initial or additional treatment. Iridotomy creates a passage in the iris in selected cases of pupillary block. Surgery Improves or creates drainage pathways when target pressure is not achieved or disease severity requires a different approach. A plan for each eye. The choice depends on glaucoma type, existing damage, target pressure and previous response. Follow-up continues even when pressure is controlled.

Applying eye drops and maintaining follow-up Correct application makes a difference 01 Wash your hands before handling the bottle. 02 Tilt your head back and gently lower the bottom eyelid to form a small pocket. 03 Apply one drop without touching the eye, eyelids or eyelashes with the bottle. 04 Close the eye without squeezing and gently press the inner corner next to the nose for around 3 minutes, as instructed. This reduces the amount of medication entering the rest of the body. 05 If you use more than one type of eye drop, observe the prescribed interval. This guide uses a reference interval of at least 10 minutes between administrations. Day to day Keep to the schedule. Do not stop or change the drops without advice. If you forget a dose, follow the medicine leaflet or check with the team. Do not double the dose to make up for it. Use your medication on appointment days unless instructed otherwise. Tell your ophthalmologist about all medication you take and keep regular tests and appointments. SYMPTOMS OF A POSSIBLE ACUTE ATTACK Sudden severe eye pain, a very red eye, blurred vision, nausea or vomiting require urgent assessment. Do not wait for the next appointment. Glaucoma control is an ongoing partnership between patient and ophthalmologist. This guide is for information and does not replace individual assessment.