Glaucoma, commonly known as eye hypertension or high eye pressure, is a very insidious disease that arises from damage to the optic nerve, leading to a narrowing of the visual field initially and irreversible blindness at advanced stages. Worldwide, glaucoma is the second leading cause of blindness after cataracts.
In individuals with high eye pressure, there is a high likelihood of glaucoma, which is why eye hypertension and glaucoma are often used interchangeably. However, not every high intraocular pressure leads to glaucoma; this condition is called ocular hypertension.
Sometimes glaucoma can occur even if eye pressure is low. This condition is referred to as normal tension glaucoma. Therefore, in the diagnosis of glaucoma, it is important not only to measure eye pressure but also to evaluate the integrity of the optic nerve.
The primary characteristic of glaucoma is that it often does not present any symptoms until there is serious and irreversible vision loss. This is because the visual loss in glaucoma starts from the periphery rather than the center, making it impossible for the patient to notice this loss with both eyes open.
In most glaucoma patients, eye pressure gradually increases without any symptoms appearing. However, the optic nerve deteriorates slowly every day, and by the time the patient notices central vision loss, it is often too late. Therefore, individuals over the age of 45 should undergo an annual eye examination, which should not be limited to just measuring eye pressure but should also include an examination using an OCT (Optical Coherence Tomography) device that counts nerve cells. This way, glaucoma can be diagnosed at very early stages and early treatment can be administered.
In individuals with suddenly elevated eye pressure, eye pain can be felt, which is one of the symptoms of glaucoma. Additionally, temporary central vision loss can occur due to sudden and significant increases in eye pressure.
In acute glaucoma crisis;
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Glaucoma is actually a group of diseases, primarily categorized as open-angle and angle-closure glaucoma.
Glaucoma is the death of the cells of the optic nerve. The reason for this death is often the high eye pressure that disrupts the blood circulation to the nerve and compresses the nerve cells. Additionally, if the eye pressure is not very high but the blood pressure is low, less blood reaches the eye, leading to normal tension glaucoma.
In conclusion, either elevated eye pressure or reduced blood supply to the eye can cause damage to the optic nerve and result in glaucoma.
Eye pressure is the pressure created by the aqueous humor, a fluid inside our eye resembling a balloon to maintain the integrity and vitality of our eye. This fluid is produced in one area and exits the eye through another area, mixing with the blood.
Eye pressure generally increases due to a disruption in this outflow system; that is, while the fluid produced remains constant, the fluid exiting the eye decreases, resulting in increased intraocular pressure.
The average eye pressure in the population is between 16-21mmHg. As mentioned above, sometimes eye pressure values of 26-28mmHg do not affect the eye, while in some patients, damage can occur even at 10mmHg.
These values are especially valid when measured with a reliable device called applanation tonometer, which measures eye pressure by approaching the eye with blue light. Measurements made by blowing air into the eye have a high margin of error.
Eye pressure measurements should never be made with air-puff devices in glaucoma patients. You should ask your doctor for the results of measurements made with an applanation tonometer, which is the real eye pressure measurement device.
It is not possible to measure eye pressure directly. This can only be done by inserting a needle into the eye, which is not practical. However, the intraocular pressure is indirectly measured from outside the eyeball through several different methods.
The most commonly used method is the air-puff device that blows air into the eye. Although this device provides easy measurements, it is essentially a screening device. The real device that should be used in the diagnosis and follow-up of glaucoma patients is the applanation tonometer, which measures eye pressure by dropping drops into the eye and measuring with blue light. This device is the most sensitive device in eye pressure measurement, and the likelihood of making a mistake is much lower compared to air-puff devices.
In our clinic, we frequently encounter patients who have been unnecessarily diagnosed with glaucoma and use glaucoma medications due to high measurements taken only with air-puff devices in other centers. The way to prevent such mistakes is to make eye pressure measurements with the real device.
Until recently, home pressure measurement was not possible, but new technology has made it possible. However, this device is quite expensive. The patient can take measurements themselves, and the results can be accessed by the doctor from the computer. There are patients in our country who have purchased this device.
It should be remembered that there is no need to measure pressure every minute of every day. The most important thing is the nerve evaluation tests performed by your doctor, OCT and visual field tests. If these are deteriorating, the doctor understands that eye pressure is going bad, and if the damage has stopped progressing, it is understood that eye pressure is good.
As mentioned above, glaucoma is not a single disease but a general name for many different diseases. Although glaucoma can be seen from birth, it usually appears after the age of 40-50.
Unlike other eye diseases, since central vision is preserved until the last stage in glaucoma, the patient does not notice the narrowing visual field. It is called the silent thief of vision because it does not show any symptoms until the last stage.
The assessment of the optic nerve is carried out in our clinic using the OCT device and visual field test, which are the latest technology models. Detailed information on these topics can also be found on our YouTube page. Prof. Dr. Ahmet Akman's YouTube Channel ▶
In the early stages of the disease, optic nerve tomography, "optical coherence tomography" or OCT, is used, while visual field testing is important in advanced stages. Prof. Dr. Ahmet Akman has been serving his patients in Ankara on glaucoma and eye hypertension for many years.
In the clinic of Prof. Dr. Ahmet Akman in Ankara, the most advanced devices used in the diagnosis and follow-up of glaucoma and eye hypertension, Zeiss Cirrus 5000 OCT device and Humphrey HFA3 visual field device, along with other modern eye examination devices, are available.
G1: Normal Optical Nerve / G2: Damaged Optical Nerve
In every patient where necessary, OCT was personally performed by Prof. Dr. It is made by Ahmet Akman. Also Prof. Dr. Ahmet Akman is the author of the world's first book on OCT in glaucoma, published in the USA and Europe, and has been giving courses on how to use OCT in glaucoma to doctors from all over the world at the American Eye Academy congress held annually in America for 5 years. The American Eye Academy congress is the largest and most prestigious eye congress in the world. Glaucoma, which is the second leading cause of blindness in the world, can be treated with drops when diagnosed at an early stage.
Thanks to today's treatment methods, glaucoma patients diagnosed early do not need to fear vision loss. However, the point that should never be forgotten is that follow-up is very important after glaucoma is diagnosed.
Understanding whether the treatment is sufficient is only possible by comparing OCT tests and visual fields over time. With the change programs in these two devices, they compare the structural and functional changes with the tests on the first day and inform the doctor if there is a loss of the optic nerve. For this reason, these tests must always be performed by the same doctor and on the same devices.
Even if they are devices of the same brand, it is not possible to compare different tests performed at different times, since there is no information in the devices.
For this reason, the glaucoma patient must be followed up by a glaucoma specialist whom he can trust throughout his life, and the follow-up must be done by the same doctor in the same center without any interruption.
Prof. Dr. Ahmet Akman has in his archive all OCT (Eye Tomography) images of his patients since 1996.
Prof. Dr. Ahmet Akman provides services in the diagnosis, follow-up and treatment of glaucoma patients with his 25 years of experience and modern OCT and vision fields in his eye clinic in Ankara.
In the first group, the most common open-angle glaucoma, where the channels draining the eye fluid malfunction, is found. In the second group, less common in our country but leading to a glaucoma crisis resulting in rapid blindness, is angle-closure glaucoma, also known as closed-angle glaucoma. Lastly, congenital or infantile glaucomas that occur in the womb or in the first one or two years of life are included. Open-angle glaucoma can consist of different subgroups. However, they all share the common feature of progressing slowly and insidiously. Since patients do not notice the deterioration in their eyes, they may not feel any symptoms until the disease reaches very advanced stages.
Therefore, individuals over 40 years of age should undergo regular eye examinations at intervals and ask their doctors about both eye pressure values and any changes in their optic nerves that may suggest glaucoma.
Closed-angle glaucomas, which occur anatomically due to the narrowness of the anterior chamber of the eye, arise in these eyes. In such eyes, stress, sitting in the dark for a long time, or the use of magnifying drops during eye examinations can cause a glaucoma crisis.
Eye pressure rises suddenly to above 50mmHg, intense pain in the eye, visual blurring, nausea, vomiting, and rapid loss of vision occur. When detected early by an eye doctor, a simple laser procedure eliminates this risk, preserving the patient's vision for life.
Another factor causing a glaucoma crisis in narrow-angle eyes is the use of various medications. Therefore, especially drugs with warnings about glaucoma in their leaflets, such as allergy and flu medications, should not be used by such patients without consulting an eye doctor.
Congenital or infantile glaucomas, which occur from birth or within the first two years of life, are among the most serious causes of blindness. They need to be detected early and urgently treated by surgery.
Especially consanguineous marriages lead to more frequent occurrence of congenital glaucomas. The reason for this is the hereditary transmission of the disease. However, congenital glaucoma can also occur in babies without a family history. The most important symptoms of congenital glaucoma are light sensitivity in the baby, watering of the eyes, and enlargement of the eyeball.
Ocular hypertension is the high measurement of eye pressure before glaucoma disease occurs. Although these patients have a high risk of developing glaucoma, all of them experience damage to the optic nerve.
Patients with ocular hypertension should be regularly monitored by an eye doctor using the OCT test at certain intervals. This way, unnecessary medication use is prevented, but when damage to the optic nerve is detected, medication should be started without delay.
Glaucoma is essentially a disease that requires continuous monitoring. The foundation of treatment is the evaluation of the optic nerve values performed at certain intervals with the same doctor and the same devices. If damage occurs in the nerve, eye pressure should be reduced. At this point, if drops are not sufficient, laser treatments and surgeries come into play.
A glaucoma patient diagnosed early under the supervision of a specialist doctor remains under good treatment throughout life, and blindness does not occur. The point to be feared is late diagnosis and inadequate treatment. Treatment of Glaucoma in Turkey ▶
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Contact informationAhmet Akman, MD, FACSProfessor of Ophthalmology
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