The primary goal in treating glaucoma is to halt the progression of optic nerve damage. For this purpose, the first priority is to reduce eye pressure. Eye pressure can be reduced with eye drops, laser treatments, or glaucoma surgeries.
In most patients, one or two eye drops are sufficient to lower eye pressure, but it is important to monitor whether this reduction is sufficient to stop the nerve damage through regular OCT and visual field tests. Eye pressure measurements showing only numerical reduction are not sufficient.
In patients requiring more than two drops, certain laser treatments or glaucoma surgeries can lower eye pressure and protect the optic nerve if other treatments are not effective. The crucial point here is to make a surgical decision and implement it without delay if nerve damage is progressing.
Otherwise, when most nerve cells die, there is no point in performing surgery, and blindness becomes inevitable. Prof. Dr. Ahmet Akman is specialized in both medical and surgical treatments of glaucoma.
Videos: Prof. Dr. Ahmet AkmanIs Glaucoma Dangerous?All Videos/a>
The first method used to lower eye pressure is medication. Essentially, there are four groups of glaucoma eye pressure-lowering drops. These can sometimes be applied as a single medication in one bottle or as a combination of two medications in one bottle. If eye pressure cannot be reduced with a single medication, a second medication is added. The general rule is to avoid adding a third drop whenever possible, but in some patients, a third medication may be necessary.
If eye pressure does not decrease with medications, methods such as ALT and SLT with lasers can lower it for a few years. The most effective method for lowering eye pressure is glaucoma surgeries. Glaucoma surgeries can lower eye pressure to levels that cannot be achieved with medications alone. There are various types of glaucoma surgeries. Whether surgery is necessary and which surgery is suitable can only be determined after an examination.
There is a treatment for glaucoma. However, once damage has occurred due to glaucoma, it cannot be reversed. Known as the silent thief of vision, glaucoma is treated to maintain the condition at the time of diagnosis. Therefore, if diagnosis is delayed, glaucoma leads to blindness. Individuals over the age of 50 should have an eye examination every year to measure eye pressure and perform visual field tests.
Glaucoma treatment is not only about reducing eye pressure but also about monitoring whether optic nerve damage is stopping or not. OCT and visual field tests form the basis of this monitoring. Without these tests and by only measuring eye pressure with a fancy device, glaucoma monitoring and treatment cannot be conducted. If centers that only measure eye pressure with a fancy device exist, it means that glaucoma treatment is not adequately performed.
Eye pressure in glaucoma patients can only be accurately measured with applanation tonometry that approaches the eye with blue light. In patients who have been diagnosed early and are under regular follow-up by an experienced glaucoma specialist with the right equipment, the risk of blindness is almost negligible.
The treatment of eye pressure (glaucoma) is primarily carried out by reducing intraocular pressure, but additional measures may be required in some cases. Among these measures are correcting systemic hypotension and performing certain laser procedures on the eye.
The foundation of treatment is to prevent optic nerve damage and halt existing damage. For this purpose, intraocular pressure should be reduced with medications, laser, or surgery, and it should be monitored whether this reduction is sufficient or not through OCT and visual field tests. Treatment usually starts with eye drops, and if there is no deterioration in OCT during follow-ups, medications are continued. If deterioration is observed, new medications may be added or surgery may be required. When performed by glaucoma specialists, glaucoma surgeries are highly effective operations that significantly lower intraocular pressure.
Videos: Prof. Dr. Ahmet AkmanEye Pressure (Glaucoma) Surgery ProcessAll Videos
Lasers do not have a big place in the treatment of eye pressure. Although methods called SLT and ALT reduce eye pressure for a while, they are not effective in every eye or their effects disappear after a while. Cyclodestructive applications are also applied with laser, but are generally applied as a last resort in eyes with impaired vision where there is no other treatment option. For these reasons, lasers do not have a great effect on reducing eye pressure in the treatment of glaucoma. They are applied in special cases.
The most effective and permanent method for reducing eye pressure is glaucoma surgeries. Seton surgeries such as trabeculectomy and Ahmed glaucoma valve surgeries are the methods that provide the best reduction in intraocular pressure. These surgeries are difficult operations that are successful when performed by glaucoma specialists or ophthalmologists experienced in glaucoma. While an eye can undergo surgery more than once, the success rate generally decreases in repeated surgeries. Prof. Dr. Ahmet Akman is an experienced surgeon with 25 years of scientific studies and publications in glaucoma, whose book has been published in the USA, and who gives courses every year at the American Academy of Ophthalmology. Glaucoma surgeries are one of his areas of expertise.
Glaucoma drug treatments are performed aiming to combine the effectiveness of the drug with the least side effects, planned by a glaucoma specialist. Prof. Dr. Ahmet Akman applies all drug, laser, and surgical methods for glaucoma treatment in Ankara.
The selection of medication should be planned according to certain principles, based on the problems in each patient's eyes, the extent of damage, and systemic diseases. The important point here is that not every treatment will be suitable for every patient. Experienced glaucoma specialists create a personalized treatment plan tailored to the characteristics of each patient.
Eye drops are used in the treatment of glaucoma. These drops contain various drugs with different properties. Some drops contain two combined medications at the same time. Essentially, there are four groups of glaucoma drugs in our country.
The glaucoma specialist decides on the treatment based on both the effectiveness of the drug and the potential side effects that may occur in the patient. Every drug has side effects; substances without side effects cannot be considered as drugs. Patients should discuss these side effects with their doctors without being attached to the drug leaflets. In addition to glaucoma drops, there are some temporary pills or serum treatments used for a few days to lower rapidly rising eye pressure, but these are not long-term treatments.
Glaucoma is a disease that often lasts a lifetime, and its treatment also lasts a lifetime. Drugs only provide a decrease in eye pressure for the day they are used, so the treatment should continue almost throughout the patient's life. In cases where temporary eye pressure reduction is achieved due to cataract surgery, medication treatment can be paused for a period.
Since the damage caused by glaucoma is irreversible, it is necessary to continue the treatment continuously in accordance with the recommendations of the doctor. Another important point is that treatment should be monitored not only with intraocular pressure measurements but also with OCT and visual field tests to ensure that the damage is not progressing and the treatment is sufficient.
Glaucoma is a chronic disease that lasts a lifetime, similar to systemic hypertension. When the necessary treatment is applied under the control of a specialist and regular follow-ups and necessary tests are performed, vision loss does not occur in patients. However, it should not be forgotten that the damage caused by glaucoma will not be reversed. Therefore, early diagnosis is crucial.
With early diagnosis, adequate treatment, and good follow-up, patients can live without suffering from vision loss throughout their lives. This is the point where modern glaucoma treatment has come today. Patients should not think that they will not recover. Treatment will prevent blindness, but it is not a disease that can be said to be healed after a temporary treatment is applied.
There is no herbal treatment that reduces eye pressure. Occasionally, medications claimed to be herbal are brought to the agenda by fraudsters, but it is not possible to prepare eye drops from plants and sterilize them. However, healthy eating, not smoking, paying attention to general health, and walking are beneficial for glaucoma.
In recent years, a vitamin called citicoline, which may be beneficial for the optic nerve, has been mentioned, but there is insufficient scientific evidence yet. This substance should not be applied as drops but should be taken orally.
The average eye pressure in the community is below 21mmHg. However, these values can vary depending on factors such as the measurement method, the thickness of the patient's cornea, and previous eye surgeries.
The gold standard, which is the most reliable method in eye pressure testing, is the applanation method where a drop is applied to the eye and yellow dye is painted, and the measurement is made by the doctor with a blue light device. Air puff tonometers can make many errors; therefore, they are only used for screening purposes and are not suitable for glaucoma diagnosis and follow-up. Clinics that do not use the applanation method for glaucoma monitoring do not perform adequate follow-up.
Another important point is the relationship between eye pressure and glaucoma. In some types of glaucoma, blindness occurs even with an eye pressure of 10mmHg, while in some patients, damage does not occur with a pressure of 25-30mmHg.
Therefore, it is important not how much eye pressure is but how much pressure the eye can withstand. In this regard, fundus examination, OCT, and visual field tests become important. If deterioration is observed in these tests, regardless of the value, that pressure is excessive for that eye and should be reduced. If no damage occurs, the patient can be followed without reducing eye pressure, and eye pressure-lowering medications protect their side effects.
As can be seen, what is important is not the numerical pressure values but the correct evaluation of the tests by a glaucoma specialist and the implementation of personalized treatment plans. Our approach in our clinic is in line with this principle.
Patients whose eye pressure is slightly high, who do not have damage in OCT and visual field, and whose risk factors are not high can be followed with 4-6 month intervals using OCT progression analysis method. In such patients, reducing eye pressure may not always be necessary, but follow-up is very important. If deterioration is observed in the patient's optic nerve, and this is confirmed with OCT and visual field tests, lowering eye pressure is the basis of treatment. For this purpose, initially drugs, in some cases laser treatments, and if these are not effective, glaucoma surgeries come into question.
You can call us immediately for detailed information, consultation or appointment.
Contact informationAhmet Akman, MD, FACSProfessor of Ophthalmology
COMMENTS
About Me
Contact Us