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What is Glaucoma

Glaucoma is name given to a group of eye conditions where pressure within the eye causes damage to the optic nerve at the back of the eye. In turn, this can lead to loss of vision and, potentially, to blindness. Glaucoma is a multifaceted disease and its cause, manifestation, progression and treatment varies from patient to patient.

The following is a guide to common questions patients ask. This may not necessarily cover your individual situation and if you require more tailored information, please make an appointment with Mr Bhermi who will be happy to  review your glaucoma status and advise an optimised management plan.

How common is Glaucoma

Approximately 1 in 50 of 40yr old people have a glaucoma related problem. This rises to 1 in 20 of over 75yr olds and is more common in patients of African ethnicity. People with one or more close family members with glaucoma are more likely to have the condition themselves and should have regular glaucoma assessments.

Types of Glaucoma:

In the normal eye, nutrient fluid (aqueous) is produced continuously in the ciliary body behind the iris. The aqueous travels across the pupil and exits the eye through small channels in a structure called the trabecular meshwork at the front of the eye.

What is a cataract

In Glaucoma patients , aqueous fluid cannot leave the eye quickly enough and this leads to a build-up of pressure inside the eye. This pressure can damage the optic nerve, and as the optic nerve carries vision signals from the eye to the brain, damage to the nerve leads to a loss of vision.

There are several types of glaucoma including:

  • Primary Open Angle Glaucoma (POAG)
  • Normal Pressure / Normal Tension Glaucoma,
  • Acute angle closure glaucoma
  • Primary angle closure glaucoma (POAG)
  • Congenital Glaucoma
  • Secondary Glaucoma
  • etc
Primary Open Angle Glaucoma is the most common type of glaucoma accounting for 9 out of 10 cases in the UK. The prevalence of other types of glaucoma varies with age and race.

Who is at risk:

Common risk factors for glaucoma include:

  • High pressure in the eye
  • Age over 40yrs
  • African ethnicity
  • Short sight (myopia)
  • Very long sight (hyperopia)
  • Diabetes
  • A family history of glaucoma
  • Poorly controlled blood pressure (very high or very low blood pressure)
  • A long history of migraines
  • People who have been using steroid medications for a long time

How do I know if I have glaucoma:

In the early stages, glaucoma commonly affects the peripheral vision, and the central vision can be  unaffected. Therefore people often don’t have any symptoms and are completely unaware that they have glaucoma. One only becomes aware of a problem when a large portion of the vision has been lost.

Glaucoma is often first diagnosed on a routine visit to the optician – usually when patients go for their first reading spectacles in their 40s. Therefore having an eye examination by an optician or eye doctor is an important  part of looking after yourself as you get older, and even more important if you have one or more of the risk factors mentioned above.

Preparation for your Glaucoma Consult with Mr Bhermi:

It will be very helpful if you can bring the following with you – if you have them available:

  • A summary of previous eye / glaucoma treatment, clinic letters, visual field tests and / or optic nerve scans, if you have them.
  • A summary of past medical history – previous operations, major medical events, etc
  • A list of your current medication
  • Your normal spectacles– distance or varifocal.
  • For contact lens users
    • spare contact lenses if you use daily-disposable lenses
    • or a contact lens case if they are not daily-disposable
    • back-up spectacles in case you cannot use contact lenses immediately after the consultation

If you are currently using glaucoma drops, please continue to use them as normal and do not miss any doses, even though you are coming to clinic.

Please note that you may need to have multiple tests which can take time. We suggest allowing 2-3 hours for your initial consultation and approximately 2 hours for a follow-up.

What happens at the examination:

Mr Bhermi will ask you about any eye symptoms you may have, ask about your general medical health (as this can be connected to various eye diseases) and perform a detailed examination of your eyes.

Common investigations for glaucoma include:
  • Measuring the level of vision
  • Examining the eye on a slit-lamp microscope
  • Measuring the intraocular pressure with a Goldman tonometer / Ocular Response Analyser
  • Assessing the trabecular meshwork and drainage angle of the eye with a Gonioscope
  • Measuring the corneal thickness with an ultrasound scan.
  • Examining the health of the optic nerve
  • Taking an image or OCT scan of the optic nerve if necessary.
  • Assessing the health of the peripheral vision by performing a Visual Field test.

Mr Bhermi will discuss the results with you and formulate a management plan which is tailored to your individual needs

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