The Silent Threat: What is Glaucoma and How is it Treated?

Glaucoma, commonly known as high eye pressure, is a silent and progressive eye disease. It occurs when increased pressure within the eye causes permanent damage to the optic nerve, which is responsible for transmitting images to the brain. Because the condition typically progresses in its early stages without causing any noticeable symptoms, it can be incredibly difficult for patients to detect on their own. For this reason, having regular eye examinations is the most effective and reliable way to prevent potential vision loss.

• If left untreated, glaucoma can lead to permanent vision loss and blindness.
• In its early stages, it rarely presents symptoms like pain, redness, or visual disturbances.
• Regular eye exams are the most critical step for early diagnosis.
• The condition can be successfully managed with eye drops, laser therapy, and surgical methods.
• A healthy diet and the right lifestyle habits support the medical treatment process.

What is Glaucoma?

To maintain its healthy structure and nourish its tissues, our eye continuously produces a clear fluid called aqueous humor. Once this fluid has fulfilled its purpose inside the eye, it drains out through a specialized meshwork of channels. However, if a blockage or slowdown occurs in these drainage channels, the fluid begins to build up, leading to an increase in intraocular pressure (pressure inside the eye). This elevated pressure presses against the optic nerve at the back of the eye, damaging its delicate nerve fibers. This gradual deterioration of the optic nerve is what we call glaucoma.

According to expert projections, glaucoma is one of the leading causes of irreversible blindness worldwide, with the potential to affect over 111 million people globally by 2040. There are two primary types of the disease. Open-angle glaucoma is the most common form, progressing slowly over many years without presenting any symptoms. Closed-angle (or narrow-angle) glaucoma, on the other hand, occurs when the eye's fluid is suddenly blocked, revealing itself through rapidly developing, severe pain. Additionally, there are cases of normal-tension glaucoma, where the optic nerve sustains damage even though the eye pressure is measured at completely normal levels.

What Causes Glaucoma and Who is at Risk?

While the exact cause of glaucoma is not always fully understood, the primary factor is an imbalance in the production and drainage of fluid within the eye. The reasons behind this elevated eye pressure are often closely linked to genetic predispositions, anatomical differences, and the natural aging process. As the drainage channels inside the eye narrow over time, it sets the stage for pressure to rise. Because the disease is multifactorial, some individuals are at a much higher risk of developing this condition than others.

The high-risk groups for glaucoma who should undergo regular screenings include:

• Advanced age (The risk increases significantly for individuals over 40).
• Genetic predisposition (Those with a family history of glaucoma, particularly in parents or siblings).
• Anatomical features of the eye (Especially having thin corneas).
• Systemic conditions (Diabetes, high or low blood pressure, and circulation disorders).
• Severe refractive errors (High degrees of myopia or hyperopia).
• Long-term cortisone use (Prolonged or unmonitored use of corticosteroids in the form of eye drops, pills, or ointments).
• Eye trauma (A history of severe physical blows to the eye or serious eye infections).
• Sleep apnea syndrome (Drops in oxygen levels during the night can damage the optic nerve).

What Are the Symptoms of Glaucoma?

The main reason glaucoma is called a "silent thief of sight" is that it causes almost no symptoms during its early and intermediate stages. In open-angle glaucoma, the eye pressure rises so gradually that the eye adapts to the change, meaning no pain is felt. Symptoms usually only become noticeable when the damage to the optic nerve reaches a certain threshold and the visual field begins to narrow. A patient may start to lose their peripheral (side) vision, as if they are looking through a narrow tube. In advanced stages, central vision is also affected, leading to permanent vision loss.

In stark contrast, closed-angle glaucoma attacks are sudden and dramatic. As eye pressure spikes to dangerous levels within a matter of hours, severe symptoms emerge. This can cause unbearable pain in the eye and on the corresponding side of the head, prominent redness in the eye, blurred vision, seeing rainbow-colored halos around lights, nausea, and vomiting. If you experience these symptoms, seeking immediate medical attention is vital to save your vision.

How is Glaucoma Diagnosed?

A diagnosis of glaucoma cannot be made with a simple eye pressure check alone. A comprehensive and detailed eye examination is essential to catch the disease in its early stages. During the exam, an ophthalmologist carefully inspects the front and back structures of the eye using a specialized device called a biomicroscope (slit lamp). Intraocular pressure is measured in millimeters of mercury (mmHg) using a method called tonometry. However, having a normal pressure reading does not entirely rule out the risk of glaucoma.

To confirm the diagnosis and determine the stage of the disease, a series of advanced tests are performed. Pachymetry is used to measure corneal thickness, as a thin cornea can cause eye pressure to read lower than it actually is. Using an Optical Coherence Tomography (OCT) device, the thickness of the optic nerve fibers is analyzed at the micron level to detect any thinning. A visual field test maps out whether the patient is experiencing any loss in their peripheral vision. Additionally, a specialized lens is used in a procedure called gonioscopy to examine the fluid drainage angle inside the eye, which helps determine the specific type of glaucoma.

Glaucoma Treatment and Lifestyle Recommendations

The primary goal of glaucoma treatment is to lower intraocular pressure to a safe level, thereby halting the progression of optic nerve damage and preserving existing vision. Treatment is tailored to the individual, depending on the type and stage of the disease, as well as the patient's overall health. The first line of defense usually involves prescription eye drops that either decrease the production of fluid in the eye or improve its drainage. Using these drops consistently and correctly at the same time every day is absolutely critical for the treatment's success.

If eye drops are insufficient, cause side effects, or if the disease continues to progress, laser therapies may be introduced. Laser procedures help open the drainage channels within the eye, allowing fluid to flow out more easily. In more advanced cases, glaucoma surgery options are considered. Trabeculectomy is a procedure that creates a new drainage channel in the eye. Additionally, tube implant surgeries and innovative methods like minimally invasive glaucoma surgery (MIGS), which has become increasingly popular in recent years, offer highly successful outcomes.

Alongside medical and surgical treatments, the changes patients make in their daily habits directly impact their eye health. Lifestyle recommendations for glaucoma patients include:

• Eating a diet rich in leafy green vegetables, omega-3 fatty acids, antioxidant-packed fruits, and foods containing vitamin B3.
• Using supplements like turmeric and ginkgo biloba, which are thought to support ocular blood flow, only with a doctor's approval.
• Avoiding sleeping face down or applying pressure to the eyes during sleep; instead, using pillows that keep the head slightly elevated.
• Steering clear of heavy yoga poses that involve head-down positions and avoiding tight swimming goggles, as these can temporarily spike eye pressure.
• Quitting smoking entirely, as it severely damages blood vessels in the eyes and increases free radical production.
• Limiting the consumption of alcohol and excessive caffeine, which can elevate intraocular pressure.
• Engaging in regular, light-to-moderate walking and breathing exercises to improve blood circulation.

Complications and How to Lower Eye Pressure

By its very nature, glaucoma is a progressive disease that can lead to severe complications if not kept under control. The most significant and irreversible complication is total vision loss, or blindness. Once optic nerve cells die, it is impossible to revive them or restore lost visual fields with current medical capabilities. Therefore, taking a proactive approach to glaucoma management and focusing on preserving your current vision is essential.

Many patients looking for ways to lower their eye pressure may turn to herbal remedies or alternative methods. However, the only safe and permanent way to reduce eye pressure is by using the drops prescribed by a specialist and strictly adhering to recommended medical treatments. Factors like a healthy diet, stress reduction, meditation, and regular exercise serve only as supportive measures to medical therapy. Never missing a dose of medication and gently pressing on the inner corners of your eyes after applying drops (to prevent the medication from entering the bloodstream) are crucial parts of daily management.

When Should You See a Doctor?

Because glaucoma often presents no symptoms, it is vital for everyone over the age of 40 to have a comprehensive eye exam at least once a year. Those with a family history of glaucoma, diabetic patients, and individuals with high myopia should begin these screenings at an earlier age. Beyond routine check-ups, if you notice any sudden changes in your eyes, you must seek medical help without delay.

If you experience any of the following emergency warning signs, you should immediately go to the nearest hospital emergency room or call 112:

• Sudden, severe, and throbbing pain in or around the eye.
• A sudden drop in vision quality, blurriness, or the appearance of dark spots.
• Seeing rainbow-like colored halos around lights.
• Noticeable and sudden redness in the white of the eye.
• Severe headache, nausea, and vomiting accompanying eye pain.

Glaucoma Treatment and the Process at BHT CLINIC

At the BHT CLINIC İstanbul Tema Hastanesi Ophthalmology department, the diagnosis and treatment of glaucoma are carried out at international standards using the most up-to-date technological equipment. When you visit our hospital, you will undergo a detailed eye examination by our specialist physicians. Your intraocular pressure will be measured, your corneal thickness evaluated, and your optic nerve analyzed in detail using advanced imaging techniques like OCT.

Op. Dr. Belma Karini and our experienced medical team will create a treatment plan best suited to the stage of your disease based on these findings. When necessary, modern surgical interventions such as laser therapies or minimally invasive glaucoma surgery (MIGS) are successfully performed in our operating rooms, which adhere to the highest safety standards. Our 24/7 emergency department is always ready to assist you in urgent situations, such as sudden eye pressure attacks. To protect your vision and halt the progression of the disease, you can easily book an appointment through our hospital's website.

Frequently Asked Questions

Can glaucoma cause blindness?

Yes, if left untreated or diagnosed too late, glaucoma can lead to permanent vision loss and blindness. However, with early detection and regular treatment, the progression of the disease can be stopped, allowing patients to maintain healthy vision throughout their lives.

What is the normal range for eye pressure?

In general, a healthy individual's intraocular pressure is expected to be between 10 and 21 mmHg. However, these values can vary from person to person. Some individuals may experience nerve damage even at levels below 21 mmHg, while others may not sustain damage despite higher readings.

Is glaucoma surgery risky?

As with any surgical intervention, glaucoma surgeries carry certain risks, such as infection, bleeding, or the pressure dropping lower than intended. However, thanks to advancing technology and modern surgical techniques, these risks have been significantly reduced, and surgeries are performed with high success rates.

Does high eye pressure cause headaches?

Slow-progressing open-angle glaucoma generally does not cause headaches. However, during closed-angle glaucoma attacks, where eye pressure suddenly spikes to very high levels, severe pain is felt around the eyes and head. The relationship between headaches and eye health should always be carefully evaluated.

Can glaucoma patients drink coffee?

Excessive caffeine consumption can cause temporary spikes in intraocular pressure. Therefore, it is recommended that glaucoma patients consume caffeinated beverages like coffee, tea, and energy drinks in moderation, ideally not exceeding one or two cups a day.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.