What is glaucoma?
Glaucoma is a progressive disease of the optic nerve leading to irreversible vision impairment. We distinguish two major types of glaucoma:
- open-angle,
- closed-angle glaucoma.
Very rarely, some specific types of glaucoma may occur, such as congenital, childhood, or juvenile glaucoma. Glaucoma may be sometimes associated with the occurrence of other ocular disorders, such as pseudoexfoliation glaucoma (PEX) or pigmentary dispersion syndrome (pigmentary glaucoma). Untreated or poorly treated glaucoma may, and unfortunately often does, lead to blindness.
The course of the disease is highly varied. It sometimes develops very slowly and insidiously over many years, in a way unnoticeable and painless for the subject, damaging the optic nerve. If the problem concerns one eye, the patient may in fact fail to notice the loss of vision in this eye, which is accidentally discovered by covering the healthy eye or during an ophthalmological examination. Sometimes the patient loses vision due to glaucoma within a few months, and sometimes he ends up at an ophthalmologist with strong symptoms of so called glaucoma attack, or severe pain in the eye, headache, eye redness, lacrimation, nausea or even vomiting, vision deterioration, or a phenomenon of rainbow-coloured circles. These symptoms are associated with the closure of the iridocorneal angle and sudden increase of pressure in the eye.
The only method to detect glaucoma is regular ophthalmological testing, especially in subjects with a positive family history. During a routine ophthalmological examination, the ophthalmologist checks intraocular pressure, which is the primary risk factor for the development of glaucoma, and the only one which may be treated. In the course of the examination, the ophthalmologist assesses the eye anatomy, iridocorneal angle, and the appearance of the optic disc. In order to detect and monitor glaucoma, the patient should also regularly undergo other tests, e.g. examination of the visual field and examinations imaging the optic nerve, like OCT, HRT or Gdx.
The treatment of glaucoma includes pharmacotherapy, laser treatment and surgical procedures whose purpose is to reduce the intraocular pressure. Therapy starts with pharmacological and laser treatment. In cases of advanced and progressive glaucoma, despite the above treatment, surgical treatment is introduced. These methods are also used with so called normal tension glaucoma, when a typical injury of the optic nerve develops despite normal intraocular pressure.
Laser treatment
Currently, laser treatment is more and more often proposed as first line therapy, also for ocular hypertension. After the procedure, the patient should use anti-inflammatory drugs for a few days, but may return to his/her regular activity already on the next day. Laser treatment is also used when it is not possible to control the intraocular pressure with the use of medications.
Selective laser trabeculoplasty (SLT) with the use of Nd:YAG laser
It is a safe, quick and little invasive method. It is effective in cases of open-angle glaucoma, pigmentary glaucoma, pseudoexfoliation glaucoma (PEX), as well as after other ophthalmological procedures. The procedure is performed within the iridocorneal angle, and a minimal tissue damage occurs during the procedure. It is usually carried out during a single session. The average effect is up to 30% reduction in IOP, and the effect lasts for up to 1-5 years. A very important advantage of SLT is that it may be repeated, so it has become widely used in recent years. An older alternative for SLT is classic laser trabeculoplasty with the use of argon laser (ALT), but due to tissue damage, it may be used only twice in the eye.
Nd:YAG laser iridotomy
It is used in the case of closed, or narrow but in danger of closure, angle and in acute glaucoma attack. It involves formation of an opening in the peripheral part of the iris. It is usually performed only once. Iridotomy, similarly to other laser procedures, involves a risk of transient increase in the intraocular pressure and transient inflammation, which is a response to the procedure. It may also involve bleeding into the anterior eye chamber.
Trabeculectomy
This procedure is a gold standard in surgical treatment of glaucoma. The surgery is offered to patients for whom other treatment methods are ineffective, when the disease is progressing, or when it is very advanced at the time of diagnosis. The procedure involves formation of a new aqueous drainage system from the anterior eye chamber down the conjunctiva, which is supposed to reduce the intraocular pressure. After the surgery, a so called filtering bleb is formed. Other anti-glaucoma procedures include sclerotomy, canaloplasty and procedures with the use of implants, e.g. Ahmed implant. The purpose of all these surgeries is reduction of the intraocular pressure and inhibition of the disease development, not vision improvement.
Innovative laser only at OCHO!
In July 2017, we introduced at our Centres the first in Poland Cyclo G6 laser from an American company IRIDEX, for permanent use in the novel treatment of glaucoma by micropulse cyclophotocoagulation. The procedure is very safe and effective ? about 70% efficacy after the first procedure and almost 90% after another one. It is recommended for all types of glaucoma, both those resistant to treatment with other methods, and those requiring the use of a lot of drops or a surgical procedure.
FAQ
During a basic ophthalmological visit, the patient’s ophthalmological history is taken, and the following examinations are conducted: autorefraction, keratometry, intraocular pressure measurement, visual acuity examination, slit lamp examination and fundoscopic examination.
In most cases, yes. If the doctor decides that some additional examinations are necessary, they may be performed during the visit, or if the doctor does not perform that kind of examinations, the patient is referred to another specialist.
An ophthalmological visit with performance of basic examinations lasts about 20 minutes. In some Centres, the examinations being part of the visit are performed by auxiliary personnel in the examination room. These activities are also included in the time of the basic visit.
Yes, it is recommended that contact lenses be removed before the visit. The patient should bring the lenses to the visit, since the doctor may ask the patient to insert them.
The cost of a visit is as per the price list on our website.
The waiting time for a private visit is up to a week. This time may be longer if the patient wants to see a particular specialist. The waiting time for a National Health Fund visit is according to the waiting list. Please call or e-mail us to appoint a specific date.
Yes, but you should inform the doctor that you would like to select glasses or lenses at the beginning of the visit.
Yes, you should normally apply your eye drops.
An ophthalmological visit does not require special preparation. If this is your first visit at the centre, you should have the identity card, which is necessary to create a patient record. Also remember that in most cases it is not allowed to drive a car after an ophthalmological visit.
During the first visit, the doctor takes the patient’s ophthalmological history. If the patient has any ophthalmological documentation from other institutions, it is worth taking it to the visit.
You can return to work/school after the ophthalmological visit, but please remember that if you received eye drops at the visit, your vision may be disturbed and blurred for about 2-3 hours.
Ophthalmological check-ups is an individual matter. The doctor usually informs the patient during the visit when he/she should return. Patients over 50 should have a check-up at least once a year.
If you received pupil-dilating drops at the visit, you must NOT drive a car directly after the visit. You should wait for about 2-3 hours.