March 8th to 14th is World Glaucoma Week. But what is Glaucoma?

We asked leading Consultant Ophthalmologist Professor William Ayliffe for some information on this common eye problem.

What is Glaucoma?
It’s a major global health condition and takes a large proportion of the patient referrals that we get to eye clinics. Glaucoma is a disease where the delicate nerve layer at the back of the eye becomes damaged. In many people this is associated with pressure but not always, and particularly in the early cases pressures can be normal. Eventually it leads to damage of the nerves and loss of sight, gradually encroaching in from the outside causing tunnel vision and eventually blindness. Luckily blindness is rare with modern treatments, we have a number of drops and laser surgeries and formal surgical procedures which can prevent blindness occurring in the vast majority of patients, particularly if they are caught early in the condition.

What tests do you do?
We do a full eye examination. If we find features that suggest Glaucoma but the field test is normal, we perform Electrodiagnostic tests which helps us pick up Glaucoma at a very early stage, before it leads to structural changes in the optic nerve, or other parts of the eye. We can pick up subtle changes using a machine called an OCT, which enables us to pick up some cases before they develop, enabling us to prevent blindness many years before the diagnosis would have been made traditionally, based on a loss of vision in a traditional field test.

What advice do you have for patients that are worried about developing Glaucoma?
Certainly if you have family history of Glaucoma it’s important to see your Optometrist, mention that you have this family history and they will screen. If they find anything worrying, they can refer on to a Glaucoma specialist, for assessment and see if treatment is needed, or a particular specialist follow up.

How can people ensure they don’t leave it too late?
Regular eye checks. We tend not to value our eyes until something is wrong with them and then we realise how important they are. Don’t leave this too late, regular eye checks will pick up all of the common, treatable causes of eye disease.

How do you reassure patients who have developed Glaucoma?
First, we assess the status of the Glaucoma, whether there’s been any damage to the nerve layer, or function loss, which means loss of vision or visual field. We start treatment to get control of the condition rapidly and in most cases this leads to stability of the Glaucoma, and very rarely do we need to proceed to the next stage. The next stage in many cases would be some sort of laser procedure, and if that’s unable to control loss of nerve layers, finally the options are surgery.

In your career, what advances have you seen in the treatment of Glaucoma?
It’s a very exciting time in Glaucoma. When I first started working as a junior doctor, many of our treatments would have been recognised by our Victorian ancestors. Topical beta blockers arrived, giving fantastic improvements in quality of life. Older treatments caused stinging, reduced your field of vision and the tablets made people very tired and sick. Then a range of topical treatments became available and now the vast majority of glaucoma patients can be treated with eyedrops alone. More recently there have been advances in shunts, which are little tubes we can place into the drainage apparatus of the eye during cataract surgery or as a separate procedure, depending on the severity of the glaucoma.

AccuVision screen for Glaucoma as part of our full optical health assessment using the detailed Spectralis 4D OCT Eye Health Check Diopsys and Field tests form just part of the full screening service.
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Other sources Understanding_Glaucoma.pdf Pages/Diagnosis.aspx