Glaucoma in 33 questions


2. week of March is World Glaucoma Week just like every year. A couple of organizations are being held in order to raise the awareness of the people about glaucoma by expert ophthalmologists and glaucoma associations.

They explain the ways to struggle with this insidious disease through the conferences, panels, screening programs and try to find a way to detect this disease in an early stage as much as possible. We also have something to mention about glaucoma as TOBB ETÜ Hospital Health Magazine. Here it comes!!


1-What is glaucoma?

Glaucoma is a degenerative disease of optic nerve; the one make us see. It is colloquially known as ‘karasu (black water), also.’

2-What is high eye pressure?

High eye pressure or more precisely intraocular pressure is a pressure that is made to eye walls by the liquids in the eye. It provides continuance of vision by keeping the eye tumid. Like the air holding a football ball tumid…

3-Is high eye pressure is the same thing as glaucoma?

Even if glaucoma has been colloquially called as high eye pressure, these two matters are not exactly the same things. There is an intraocular pressure (tension) for every eye. However, glaucoma is a optic nerve disease.

4-Is there a connection between glaucoma and high eye pressure?

High intraocular pressure is a risk factor for glaucoma. In other words, the possibility of having glaucoma disease of a person whose intraocular pressure is high is more than the ones whose intraocular pressure is normal or low.

5- Can glaucoma be seen when intraocular pressure is normal?

Of course, high pressure is just a risk factor. The main point is the destruction in visual nerve.

6- Can a person understand if s/he has glaucoma?

The patient cannot understand that s/he has Glaucoma from the start of the illness to 10-15-year period. Only after this term, some visual problems occur; it can be recognized as in this way.

7- Does not the patient have a complaint apart from vision defect?

If the intraocular pressure is high, slight headache, a dumb feeling in/around the eye and quick changes in the prescription-glasses number may be observed. However, in first 10 years of glaucoma the intraocular pressure is less than 25 mm Hg and in these pressures, the numbers stated are not seen.

8- Are all glaucoma caused by high intraocular pressure?

No. Nearly 1/6 of glaucoma patients have normal intraocular pressures. This glaucoma type is named as ‘normotensive glaucoma’ and ‘low-pressure glaucoma.’

9- Does every patient, whose intraocular pressure is high, have glaucoma disease?

No. High pressure without nerve disease, known as ‘Ocular Hypertension’ is seen at the rate of 1/6. Optic nerve or vision are not affected anytime in this entity. However, in order to make a decision on this subject, it is necessary to monitor the structural characteristics of visual nerve and vision function for 10 years and determine that there is no change/destruction.

10- Do all glaucoma have a similar course?

‘Primary open-angle glaucoma’, comprising %90 of glaucoma has a silent and insidious course. It is similar to Alzheimer and Parkinson diseases with this aspect. However, apart from these, the glaucoma, having high pressure, called as close-angle, childhood glaucoma and glaucoma secondary to other eye diseases have more serious course. The problem of being late in making diagnosis is the point in question for primary open-angle glaucoma, comprising the majority of glaucoma.

11- In which ages is glaucoma seen at most?

Glaucoma is mostly seen in middle-aged or old aged people; more than %90 of the people who are suffering from glaucoma is above 40 age. Nonetheless, it can be seen in young people, even in neonates. The frequency of prevalence of this disease increase in line with the age, it approximate to %10 in old ages.

12- Is glaucoma seen in just one eye, or is it seen in both eyes?

In general, primary glaucoma is a disease, involving both of the eyes together; however, involvement may not be symmetrical in two eyes. A patient suffering from glaucoma can lose the half of her/his vision capability while her/his other eye can see fully.

13- Does glaucoma lead to blindness?

Yes. When there is no a complaint about vision in the start years of this disease, the patients starts to recognize that their visual space is getting narrower 8-10 years later; sometimes this situation can be recognized appear dramatically like car crush due to narrowing of the visual space. In the later years, central vision also starts to decrease; in a non-treated glaucoma, the half of the patients lose their vision capacity in one eye in 15th years and in both eyes in 20th years.

14- What is public health aspect of glaucoma?

According to the data of International Glaucoma Society, today there is 70 million people suffering from Glaucoma all over the world and it has been estimated that 6, 5 million of them are blind in both eyes due to glaucoma.

15-Can glaucoma be treated?

If diagnosis of glaucoma disease is made before the completion of coursing and treatment is started, the development of disease can be stopped or slowed down. However, the lost visual function cannot be brought back.

16- What is treated in glaucoma?

The main procedure we have applied in the patient suffering from glaucoma is trying to eliminate the risk factors. We can eliminate some negative factors about life style and intraocular pressure. It is the main part of the treatment that the patient complies with the treatment and follow-up.

17- Does glaucoma have a similarity with diabetes and hypertension?

It has major similarity with both of them due to its requiring a lifelong treatment and chronic. In fact, we target at the risk factors not the disease in these both diseases. Mostly, we cannot eliminate the results; however, we try to prevent it from being worse.

18- Does glaucoma have a relationship with these diseases?

The relationship with glaucoma and coursing table, called as metabolic syndrome, with hypertension, diabetes and obesity, has been shown.

19- Is there a disease, triggering the susceptibility to glaucoma apart from these diseases?

Susceptibility to glaucoma is seen in a couple of eye diseases, mainly myopia and eye traumas. Those suffering from hypermetropia have a susceptibility to angle-closing glaucoma.

Some systematic diseases and medications lead to glaucoma, as well.

20- Can genetic transition be mentioned in Glaucoma?

It can be said that there is no direct transition; however, susceptibility is in question. The people who have a close relative in 1th degree, who have glaucoma, can catch glaucoma disease quite likely, more than 10 times, rather than the ones having no such a genetic history.

21- Is there a connection between glaucoma and smoking?

It cannot be noted that smoking lead to glaucoma. However, it is known that glaucoma is developing faster in the ones who are smoking. Therefore, the ones’, who have get glaucoma diagnosis, quitting smoking, is accepted as adjuvant to treatment.

22- Do nutrition supplements affect the treatment of glaucoma?

The effectiveness of many popular nutrition supplements and antioxidant substance in glaucoma following has been examined. Positive results are taken with coenzyme Q-10.

There are also some studies, claiming that some other antioxidants such as Ginkgo extract, bilberry and omega 3 may be helpful in the treatment of this disease. Nonetheless, it should not be forgotten that none of all these things substitute for lowering the intraocular pressure.

23- Does the measurement of eye pressure is enough for making a Glaucoma diagnosis?

The measurement of intraocular pressure or with its much known name; eye pressure is a part of the standard ophthalmological examination but it is not enough to make a glaucoma diagnosis. In case of its being high, it forms a glaucoma suspicion with eye ground examination. Every patient, who is above 40 ages, should be sure that her/his eye ground examination and intraocular pressure measurement has been conducted during ophthalmological examination.

24- Which tests are being applied for Glaucoma diagnosis?

Glaucoma diagnosis is made after some tests, evaluating the function and view of visual nerve objectively. Eye ground examination, visual space tests, visual nerve and structural analysis of retina can be classified in these tests. These last tests provide a possibility to compare to the prior situation and objective documentation and have a vital importance in the follow-up.

25- How Glaucoma is treated?

Eye drops, laser applications and surgery in some specific conditions comprises the main treatment methods. However, the patient should be kept under control all the time no matter which treatment method is being preferred among them.

26- Is Glaucoma be treated with medication?

Various eye drops are being used 1-3 doses per day for glaucoma treatment. In the patients, whose control of treatment is difficult, 2, 3 and even 4 medications can be necessary to use for glaucoma treatment. The patient suffering from glaucoma should use the drops every day for life. Contrary to the other chronic diseases, there is no such a complaint that disturbs the patient in an early period in irregular medication usage. When a patient suffering from hypertension does not take her/his tension medication, s/he has a headache, snivels; or when the patient suffering from diabetes does not her/his medications and the patient feels it. There is no such a thing for glaucoma; just visual function is lost insidiously and slowly. Therefore, compliance to treatment in the patient suffering from glaucoma is vitally important.

27- Do Glaucoma medications have side effects?

Some of them have side effects in eyes and the other ones have side effects in respiratory and circulatory systems. For example, some medications in a patient having a problem are her/his respiratory system (such as asthma, bronchitis, and etc.)

Again, a group of medication cannot be used in the patients, having coloured eyes and a couple of glaucoma medications cannot be used in pregnant women and nursing mother.

28- What is laser treatment and what does it do?

Treatment with laser in glaucoma is the result of a method seeking, which does not affect the daily activity of the patient, have no side effects, form no chronic illness psychology, and lower the intraocular pressure safely. It has no side effects and harm to eyes. It is a process that is conducted in polyclinic area in minutes.

29- Which laser is being used in Glaucoma treatment?

There are so many laser types used in the treatment of eye diseases. The laser used in the treatment of myopia and the laser used in the treatment of diabetes are not the same. Similarly, the lasers used in cataract surgery, eliminating the posterior capsule opacification after cataract surgery, retina treatment of premature babies, acute angle closings are not the same. The used laser in primary open-angle glaucoma in recent years is Q-switched FD Nd:YAG, whose wave length is 532 nm, which starts to be communized all over the world after 2005, later than receiving FDA approval in 2001. The operation conducted is referred as Selective Laser Trabeculoplasty (SLT). The main superiority of it to the laser treatment (ALT) used until 2000, is its not leading to damage in anterior chamber angle and making the repetitions possible. Argon laser has been used in ALT. This laser is a completely different laser from the aspects of wave length, used energy and effect mechanism.

30- Can the patient, having a treatment with laser, can get rid of using medications for life?

Treatment of glaucoma with laser provides a temporary recovery in a mechanism that leads glaucoma; like eliminating the blockage in a drainage system. However, since the structural disorders, leading to blockage, continue the effect of the laser is temporary, also. Laser application in %40-50 of the patients is necessary again after five years; in this period, follow-up should continue. Laser patients can avoid from using medications and side effects of the medications, but they cannot avoid from the follow-ups!

31- In which conditions is surgical treatment used?

When laser and medication application cannot lower the intraocular pressure to safe levels, surgical operation is unavoidable. However, thanks to the effective medications and lasers, glaucoma surgery application is getting less every passing year. According to USA statistics, the numbers of glaucoma surgery in 2014 is decreased 20 times compared to 1995, 11 times compared to 2005.

32- Does glaucoma cause blindness even if it has been treated?

We have said that glaucoma that has not been treated before cause blindness in both eyes in nearly 20 years. Glaucoma, getting early diagnosis and still being treated, generally provide a vision possibility for the patients to make her/his own work. In developed countries, the number of blindness related to glaucoma is decreasing; however, the rate of blindness caused by glaucoma have not changed in developing countries, where glaucoma diagnosis is made in later periods, for 20 years.

33- What can be done for early diagnosis of Glaucoma?

Due to it’s not making any indications, routine screenings are must for early diagnosis. The patients, using glasses, are in the routine follow, they are luck to some extent. However, glaucoma screenings are to be spread to the whole society, especially the ones having relatives in the first ring and the population above 40.


Do you know that?

*Glaucoma is a disease that cause blindness,

*Vision loss can be avoided by getting early diagnosis,

*You should apply for an ophthalmologist if you have a relative suffering from glaucoma,

*You should share the situation with your relatives; brothers, sisters and children if you have glaucoma,

*The measurement of intraocular pressure and fundus examination is necessary in order not to skip glaucoma in every eye examination,

*It is not necessary to have high eye pressure in every patient having glaucoma,

*Glaucoma following should be done by glaucoma specialists?



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