Glaucoma

Glaucoma affects the optic nerve connecting the eye to the brain (back portion of the interior of the eyeball). Damage very often occurs when the intraocular pressure (IOP) – the main risk factor for glaucoma – is too high. This happens, when the drainage of the aqueous humour, a watery fluid that fills the space between cornea and lens and amongst others maintains the normal pressure in the eye, is blocked.

While most kinds of glaucoma involve elevated eye pressure, there is a form of glaucoma called normal-tension glaucoma (NTG). It is defined as glaucoma without a clearly abnormal IOP, and depends on recognizing symptoms and signs associated with optic nerve vulnerability, in addition to absence of other explanations for disc abnormality and visual field loss.

• High pressure in the eye (IOP): the pressure in your eye increases, because the outflow of the aqueous humor (which maintains the normal pressure in the eye) is impaired for some reason.

Eye pressure can vary hourly, daily and weekly and is dependent on many factors. A statistically normal pressure varies between 10 and 21 mm Hg (millimeters of mercury, a scale for recording the eye pressure). In general: the higher the pressure, the more risk to the optic nerve. However, the eye pressure of some glaucoma patients is below 21 mmHg. In other words, the pressure tolerance of the nerve tissue depends also on the individual.

• Age: glaucoma is most common in elderly people, but may start in younger age also.
• Family history: if glaucoma occurs in your family, you are more likely to get glaucoma.
• Near or short-sightedness (myopia): if you have myopia of over -3 diopters the risk of glaucoma is higher.
• Race: If you are of African or Afro-Caribbean origin you are about 5 to 6 times more likely to get glaucoma than Caucasians.
• Certain other diseases: diabetes, artherosclerosis (hardening of the arteries), and hypertension (high blood pressure) may impair your blood flow in the eye and expose to glaucomatous defects.

To detect glaucoma, your doctor will examine your eyes with a special microscope, the so called slit lamp, providing a magnified, three-dimensional view of the structures within the eye. When used in combination with special lenses, in particular the back of your eye, where the optic nerve head is located, can be viewed (in someone with glaucoma, there are specific changes that can be seen in this area).

Your ophthalmologist will also measure the eye pressure as well as the thickness of your cornea, as this can affect your intraocular pressure reading. He will also test the angle where your iris meets the cornea via gonioscopy. In addition your field of vision may also be examined using a test called perimetry.

If the diagnosis is glaucoma, a pressure-lowering treatment is usually started.

If the pressure is high, but there are no signs of glaucoma, it is either possible to observe the situation without starting treatment or start prophylactic treatment. In any case, the decision should always be taken individually by the ophthalmologist.

As an alternative, laser treatment (laser trabeculoplasty) of the chamber angle aims at improving the outflow of the aqueous humor, in order to decrease the pressure - at least for a few years. If despite medical or laser therapy glaucoma progresses, surgical treatment may be used.

The most common form of glaucoma surgery is trabeculectomy. This is a procedure to relieve intraocular pressure by removing part of the eye’s trabecular meshwork and adjacent structures. It allows drainage of aqueous humor from within the eye to underneath the conjunctiva, where it is absorbed.

Tapros®/ Taflotan® / Taflotan-S®/ Saflutan® (0.0015% Tafluprost)
Cosopt®/Cosopt-S® (1% Dorzolamide + 0.5% Timolol)
Tapcom®/ Tapticom® (0.0015% Tafluprost + 0.5% Timolol),
Timoptol®/ Timoptic®/ Timoptol XE®/ Timoptic XE® (0.5% Timolol) Trusopt® (1% Dorzolamide)

NOTE
The approved status and availability of the product differs from country to country.