World Glaucoma Week

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World-Glaucoma-Week-March-2013This week March 10 – March 16 is World Glaucoma Week. Worldwide, glaucoma is the second-leading cause of blindness after cataracts. Glaucoma has been called the “silent thief of sight” because the loss of vision often occurs gradually over a period of time, and symptoms only occur when the disease is quite advanced. Treatment is aimed at preventing further loss, since once vision loss starts, normally it cannot be recovered.


A little Glaucoma History
The ancient Greeks were the first to mention glaucoma in their writings. ippokrates described “glaykoseis” as blindness, which occurs in the elderly. The word glaucoma came from ancient Greek, meaning clouded or blue-green hue, most likely describing a person with a swollen cornea or who was rapidly developing a cataract, both of which may be caused by chronic (long-term) elevated pressure inside the eye. The Hippocratic writings make no clear distinction between cataract and glaucoma. Both Classical and Alexandrian Greeks did not recognize the specific disease, which we now call Glaucoma.

Richard Banister, who died in 1626, was an English oculist of Stamford, Lincolnshire. He was educated under his relative, John Banister, the surgeon. He devoted himself especially to certain branches of surgery, such as ‘the help of hearing by the instrument, the cure of the hare-lip and the wry-neck, and diseases of the eyes. In 1622, Richard Banister provided the first, clear description and cause of glaucoma. He discussed different diagnosis of the disease as well.

Hermann Ludwig Ferdinand von Helmholtz was born August 31, 1821, he was a German physician and physicist who made significant contributions to several widely varied areas of modern science. In 1851, Hermann Ludwig Ferdinand von Helmholtz revolutionized the field of ophthalmology with the invention of the ophthalmoscope; an instrument used to examine the inside of the human eye. This made him world famous overnight and made it possible to diagnose glaucomatous changes in the fundus.

Friedrich Wilhelm Ernst Albrecht von Graefe (or Gräfe) born May 22, 1828 was a pioneering German ophthalmologist. One of his most important discoveries was his method of treating glaucoma. In 1857, Dr. Albrecht von Graefe operated successfully on an acute glaucoma. He was the first person ever to achieve this operation.
Further progress in the diagnosis of glaucoma was made later by the invention of the tonometer and the perimeter, and the use of cocaine. Drug treatment started in 1875 with the discovery of pilocarpine. Pilocarpine has been used in the treatment of chronic open-angle glaucoma and acute angle-closure glaucoma for over 100 years.

Today several different classes of medications are used to treat glaucoma, with several different medications in each class. Each of these medicines may have local and systemic side effects. Adherence to medication protocol can be confusing and expensive; if side effects occur, the patient must be willing either to tolerate them, or to communicate with the treating physician to improve the drug regimen. Initially, glaucoma drops may reasonably be started in either one or in both eyes.

Poor compliance with medications and follow-up visits is a major reason for vision loss in glaucoma patients. A 2003 study of patients in an HMO found half failed to fill their prescriptions the first time, and one-fourth failed to refill their prescriptions a second time. Patient education and communication must be ongoing to sustain successful treatment plans for this lifelong disease with no early symptoms.

The four major types of glaucoma
1. Open-angle (chronic) glaucoma is the most common type of glaucoma. The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve. Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease.
2. Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye. Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision. If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment. Dilating eye drops and certain medications may trigger an acute glaucoma attack.
3. Congenital glaucomais seen in babies. It often runs in families (is inherited). It is present at birth. It is caused by abnormal eye development.
4. Secondary glaucomais caused by Drugs such as corticosteroids, Eye diseases such as uveitis, Systemic diseases, and Trauma.
All adults should have a complete eye exam before age 40, or sooner if you have risk factors for glaucoma or other eye problems.

Risk Factors for glaucoma
1. Age over 45 years
2. Family history of glaucoma
3. Ethnic background
4. Medical conditions may increase your risk of developing glaucoma, including diabetes, heart disease, high blood pressure and hypothyroidism.
5. History of elevated intraocular pressure
6. Nearsightedness (high degree of myopia), which is the inability to see distant objects clearly
7. History of injury to the eye
8. Use of cortisone (steroids), either in the eye or systemically (orally or injected)
9. Farsightedness (hyperopia), which is seeing distant objects better than close ones (Farsighted people may have narrow drainage angles, which predispose them to acute [sudden] attacks of angle-closure glaucoma.)

If you have one or more of these risk factors, it is important to have a regular exam done. Make an appointment today with your eyecare professional.

Picture credit: Philippine Academy of Ophthalmology

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