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Glaucoma

 


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Condition
Glaucoma
Class
Eye Health
Description
Glaucoma is the name given to a group of eye conditions in which the optic nerve is damaged where it leaves the eye. This nerve carries information about what is being seen from the eye to the brain and as it becomes damaged vision is lost. Glaucoma affects about two per cent of people over the age of 40 in the UK.

Although any vision which has been lost to glaucoma cannot be recovered, with early diagnosis,careful monitoring and regular use of the prescribed treatments, the vast majority of patients retain useful sight for life.
Causes
Chronic Open Angle Glaucoma (COAG) is the most common form of glaucoma. It is a slowlydevelopingcondition in which the eye pressure rises because the flow of fluid in and out of the eye becomes restricted and the pressure in the eye increases, squeezing the optic nerve and killing some of the nerve fibres, which leads to sight loss. This is not because of an obstruction blocking the flow: as the name suggests, the drainage angle remains ‘open’. There is no pain to warn of a problem, even though the optic nerve is being damaged.

Note: In some forms of glaucoma, the eye pressure is not raised. Normal (or low) tension glaucoma can develop where eye pressure is within the statistically ‘normal’ range but the optic nerve still becomes damaged.

High eye pressure does not always cause glaucoma. A common condition is ocular hypertension, where the eye pressure is above the statistically ‘normal’ level, but there is no detectable damage to the field of vision. This condition may be monitored or may be treated in the same way as glaucoma, depending on the specialist’s view of the risk of developing glaucoma.
Symptoms
Most types of glaucoma don't have any symptoms, it doesn’t cause any pain. The first areas to be affected are the off-centre parts of the vision. When part of the field of vision in one eye is damaged, the other eye may ‘fill in’ the gap because the damage may not have occurred in the same part of the field of vision in both eyes. For this reason, much damage will often have been done before the person with glaucoma realises there is a problem with his/her sight. If left untreated, the damage can progress to tunnel vision and eventual loss of central vision, although blindness is rare. It is important to diagnose and start treating sight threatening glaucoma early on, before it has advanced to a stage where there has been extensive sight loss.

Risk Factors
There are several risk factors which make the onset of glaucoma more likely and they tend to be cumulative in their effect.

Glaucoma is uncommon below the age of 40, but the number of people with the condition rises from about 2 per cent of people over the age of 40 and doubles for those over the age of 80.

People of African-Caribbean origin have about a four times increased risk of COAG when compared with those of a European origin. The condition also tends to come on at an earlier age and be more severe. Regular testing and treatment are therefore vital if visual impairment is to be avoided.

There is at least a four times increased risk of developing glaucoma if you have a close blood relative with the condition (father, mother, brother, sister, or child). Eye examinations are funded by the NHS for such people from the age of 40 years, but an earlier test is recommended,especially if you also fall into one of the other risk categories. If you have glaucoma, don’t forget to tell your relatives about the condition and the need for them to be tested.

People with severe myopia (very short sight) are known to be at increased risk of developing Chronic Open Angle Glaucoma, and should ensure that they are regularly tested for glaucoma.

People with diabetes may also be at an increased risk of developing glaucoma, although it is not known whether there is a direct link between the two conditions. However, all people with diabetes should have regular routine eye examinations for diabetic eye diseases and glaucoma tests can be requested at the same time.
Detection
All those who are at risk of glaucoma should ensure they have an eye test once a year, and ask
for all three glaucoma tests. These can be carried out by most high street opticians.
The three tests for glaucoma are:

• Ophthalmoscopy – an examination of the optic disc with a special torch
• Tonometry – a check on the level of pressure within the eye
• Perimetry – a check of the visual field to see if there are any signs of sight loss in the offcentre
part of the vision
Treatment
The aim of treating COAG is to reduce the pressure within the eye to a level at which no further damage occurs to the optic nerve. Treatment is usually by means of eye drops. These can work to reduce the amount of fluid being produced by the eye, to increase the rate of drainage of fluid from the eye, or both. Regular appointments with your eye consultants will be necessary to monitor the level of the pressures in your eyes. The NICE glaucoma guidelines published in April 2009 give guidelines on the maximum waiting time between appointments, for more information please visit: http://guidance.nice.org.uk/CG85. There have been major advances in medical (eye drop) treatment in recent years, and the newer drops are far more effective and have fewer side effects than those which were previously available. Usually, once eye drops have been started, it is necessary to continue using them for the rest of your life. If the eye drops do not provide a sufficient pressure lowering effect, laser or surgical treatments are available.

If you have difficulty getting the drops into your eyes, various compliance aids are available that can help, further information is available from the IGA Sightline on 01233 64 81 70 or by e-mail at info@iga.org.uk
Useful Tips
Follow your doctor's instructions. Take your medication on time, every time.

Always wash your hands before touching near your eyes or your eye drop bottles.

To avoid contamination, never touch the nozzle of the dropper bottle and avoid contact with the eye.

After the 1st drop, close your eye and press gently on the inside corner with a finger for 1 or 2 minutes. Then wait 5 to 15 minutes before instilling any further drop medication, to prevent the first drop being washed away by the subsequent drops.

Never use drops after their permitted 'opened' expiry date.

If you use soft contact lenses, remove them before instilling eye drops and wait at least 15 minutes after your last eye drop before re-inserting them. Store eye drops and all medicines out of the reach of children.
Further information
International Glaucoma Association
The Charity for People with Glaucoma
Woodcote House, 15 Highpoint Business Village
Henwood, Ashford, Kent TN24 8DH
Tel. 01233 64 81 64
Fax. 01233 64 81 79
Sightline 01233 64 81 70 (Mon-Fri, 9.30am - 5.00pm)
Website: www.glaucoma-association.com
Charity Registered in England & Wales N°274681




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