Glaucoma

What is glaucoma?

Glaucoma is a general term describing a group of conditions in which characteristic damage to the optic nerve at the back of the eye occurs, often together with raised intraocular pressure.

The damage leads to gradual loss of areas of the visual field, with severity varying from patient to patient. Without treatment, vision loss usually progresses over time. The damage is irreversible; however, with early diagnosis and appropriate treatment, progression of the disease can be significantly slowed.

In the early stages, most patients notice no symptoms, since central vision is preserved. Peripheral vision is affected first instead, which is important for driving and safe movement. This is why regular examination as part of a comprehensive check-up and assessment with visual fields and OCT RNFL remain central to diagnosis and monitoring.

Intraocular pressure alone does not prove glaucoma, nor does every rise carry the same prognosis; interpretation combines pressure, nerve morphology, visual fields and risk factors. Family predisposition, age and coexisting conditions (e.g. diabetes) reinforce the need for systematic monitoring.

Can it lead to blindness?

Complete loss of vision from glaucoma is rare, but it can happen, mainly when the diagnosis is made at an advanced stage or when the disease is not adequately controlled.

Contributing factors include:

• Insufficient control of intraocular pressure
• Poor adherence to treatment
• Delayed diagnosis

For most patients, the main burden of the disease relates to its chronic nature and the need for long-term treatment. Consistent attendance at appointments and adherence to the plan (drops, laser or surgery where indicated) are directly linked to protecting your remaining vision.

Early recognition of changes in vision or new symptoms (e.g. pain, blurring, flashes) requires immediate contact with your ophthalmologist, to rule out acute conditions, rapid progression, or other causes that mimic glaucoma symptoms.

Types of glaucoma

Glaucoma in adults is divided into two main categories:

• Open-angle glaucoma
• Closed- (or narrow-) angle glaucoma

Each category can be primary (unknown cause) or secondary (caused by another eye condition or state). Gonioscopy and the structure of the angle determine which treatment direction is appropriate; for laser details, see SLT laser (open angle) and YAG laser iridotomy (narrow/closed angle).

The classification does not change the need for individual risk assessment and the monitoring schedule set by the ophthalmologist.

Treatment of glaucoma

Treatment aims to reduce intraocular pressure and is individualised according to the patient, the severity of nerve damage, and the response to previous steps.

1. Medication (eye drops) — usually the first option. Eye drops:

• Reduce the production of aqueous humour
• Or improve its drainage

Correct and consistent use is decisive for the success of treatment.

2. Laser treatment — in selected cases, laser is applied to improve aqueous humour drainage and prevent a sudden rise in pressure. For example: SLT (trabeculoplasty) for open-angle glaucoma, iridotomy for prevention or treatment of closed-angle glaucoma. The procedure is performed at the practice, without the need for hospitalisation.

3. Surgical treatment — when pressure is not adequately controlled by other methods, surgery may be needed. For example: trabeculectomy (creating a new drainage pathway), valves/drainage devices (implanted for controlled drainage), MIGS (minimally invasive techniques for selected cases).

The choice between medication, laser and surgery is reviewed at regular intervals; adherence to eye drops and prompt reporting of side effects make it easier to adjust the plan without delay.

What you need to know

Glaucoma is a chronic condition that requires regular monitoring. Structural imaging with OCT and functional assessment with visual fields and OCT RNFL complement the clinical examination and help detect progression early, before central vision is affected.

• Vision already lost cannot be restored
• Treatment aims to preserve existing vision
• Early diagnosis and consistent treatment are decisive

Self-monitoring at home (e.g. covering one eye to detect gaps in the field) does not replace testing — it supports awareness so that reassessment is sought promptly.

For an overview of all the practice's options see services; for appointments and questions, contact us.