Services / Diagnostic tests / Extended glaucoma diagnostics

Extended glaucoma diagnostics



Glaucoma is defined as a progressive disorder of the optic nerve. The exact cause of glaucoma has not been identified; it is thought to be caused by a disruption of the aqueous humor outflow. Aqueous humor is a substance that fills the anterior chamber of the eye. Its function is to nourish the cornea and lens, and to carry away toxic metabolic waste products. If the aqueous humor is not drained from the eye, intraocular pressure increases, which in turn can damage the optic nerve and retinal cells. It also narrows the visual field and lowers visual acuity. Therefore, untreated glaucoma can lead to blindness.

Two main types of glaucoma:

They differ in the way they inhibit the outflow of aqueous humor from the eye. Aqueous humor flows from the ciliary body into the anterior chamber through a tissue called trabecular meshwork, which is located at the angle where the cornea and the iris meet.

It is important to know whether the angle is closed or open, as this indicates the type of glaucoma.  And a correct diagnosis of the type of glaucoma is important, for example, when prescribing neurological and psychiatric drugs. And also ophthalmologically the two types require different treatment.

closed-angle glaucoma results from mechanical/anatomical abnormalities of the cornea, iris and lens

open-angle glaucoma differs from the closed-angle in that the structures responsible for the outflow are healthy (iris, cornea and lens), but the trabecular meshwork (i.e. the sieve through which aqueous humor seeps) gets blocked.

Treatment of glaucoma

In most cases glaucoma treatment begins with glaucoma eyedrops. The exception is the acute angle-closure glaucoma, which requires an immediate surgery.

The goal of treatment is to achieve the target intraocular pressure. The target pressure is the pressure in the eye that does not cause further changes in the optic nerve and, consequently, does not worsen visual acuity.

If we cannot lower the pressure to the desired level with eyedrops, we recommend a surgery.

Glaucoma treatment (diagnostic package)

The key goal in glaucoma treatment is to halt the disease progression and decide upon the most appropriate strategy for the disease management. Therefore, regular diagnostic tests are very important.

Very often glaucoma can be asymptomatic at the beginning, which is why diagnostic tests in risk groups are so important.  Everyone in a risk group for glaucoma should undergo a comprehensive eye exam every 2 years until the age of 50, and then – every year.

Diagnosing glaucoma requires several different eye tests. The progression of the disease is determined by comparing results of tests taken over the years. That is why at the Retina Ophthalmological Outpatient Clinic and Hospital we offer a ‘glaucoma package’, which is a set of tests recommended for patients at risk of developing glaucoma, as well as for those who have already been diagnosed with the disease.

The ‘glaucoma package’ contains tests that provide a comprehensive evaluation of the anterior and posterior segment of the eye:

  • visual acuity test, autorefractometry, slit lamp examination,
  • measurement of intraocular pressure (IOP)
  • measurement of corneal thickness (pachymetry), measurement of corneal curvature (keratometry),
  • gonioscopy – measurement of the iridocorneal angle to assess the size of the structure responsible for the outflow of aqueous humor,
  • perimetry – visual field test,
  • OCT of the optic nerve (compatible with GDX and HRT tests),
  • OCT of the iridocorneal angle.

Some of the tests may require pupil dilation.

Attention! Patients who had their pupils dilated should not drive for about 3 hours after instillation of the drops.

Symptoms of glaucoma

Jaskra przez długi czas może przebiegać bezobjawowo. Pierwszym niepokojącym znakiem są powracające poranne bóle głowy przechodzące w migreny. Inne symptomy to pojawiające się tęczowe obwódki wokół przedmiotów oraz tęczowe plamki, a także pogorszenie widzenia i zmniejszenie pola widzenia. Takie objawy mogą rozwijać się powoli, dlatego trudno je zauważyć. Nieleczona jaskra może dawać objawy takie, jak zawroty głowy i nudności, intensywne i odporne na leczenie zapalenie spojówek oraz problemy z utrzymaniem równowagi. Musimy jednak pamiętać, że kiedy wystąpią objawy, nieodwracalne zmiany w oku już się dokonały. Im później zaczniemy leczenie jaskry, tym gorsze są efekty leczenia.

Glaucoma eyedrop treatment

Wszystkie krople podawane przy jaskrze należy brać do końca życia, bo jaskra jest chorobą nieuleczalną. Dzięki kroplom zmniejsza się ciśnienie wewnątrzgałkowe, co jest jednym z czynników ryzyka rozwoju choroby. W zależności od nasilenia schorzenia, konieczne bywa przyjmowanie jednego lub dwóch rodzajów kropli. Obecnie istnieją preparaty wieloskładnikowe, które upraszczają przestrzeganie zasad leczenia.

Acute angle-closure glaucoma

It refers to the sudden onset of severe eye pain caused by a rapid increase of the intraocular pressure due to complete obstruction of the aqueous humor outflow. The pain is very severe, comparable to an acute renal colic or a heart attack. The pain lasts until medical intervention – it does not go away on its own.

Acute angle-closure glaucoma requires a surgical treatment. Restoration of aqueous humor outflow can be achieved either by a laser surgery or a conventional surgery. In both cases, a small hole is cut in the eye to connect the posterior chamber, where the humor is produced, and the anterior chamber, where the humor drains out.

Risk factors for developing glaucoma

  • elevated intraocular pressure,
  • myopia,
  • history of glaucoma in the immediate family,
  • age over 40,
  • very low or high blood pressure,
  • constantly cold hands and feet,
  • migraines, recurrent headaches,
  • autoimmune diseases (e.g., thyroiditis),
  • diabetes, atherosclerosis, hypertension,
  • in ophthalmic examination: enlarged optic disc cup, lens exfoliation syndrome, visual field loss, usually peripheral, up to narrowing of the visual field (so-called tunnel vision).