Commonly known as "Ocular Hypertension" or "Black Water Disease," glaucoma is damage to the optic nerve, usually caused by an increase in intraocular pressure. As a result, the person’s visual field gradually narrows.
Glaucoma is an insidious disease that typically manifests only in its later stages. If diagnosed late, it can cause severe and irreversible damage to the optic nerve.
Glaucoma develops when the fluid inside the eye, which is produced to nourish the eye, cannot properly drain. This leads to increased intraocular pressure, which in turn damages the optic nerve cells. Normally, a fluid called aqueous humor is produced inside the eye to nourish its internal tissues.
Think of the eye as a closed balloon. This fluid, which is produced regularly, flows through tiny drainage channels (trabecular meshwork) that surround the eye in 360 degrees and eventually mixes into the systemic circulation. In this way, the fluid does not accumulate inside the eye. However, if the outflow through these channels weakens, the continuously produced fluid begins to accumulate, leading to a rise in intraocular pressure over time. Increased pressure damages the optic nerve, and as the optic nerve is progressively injured, vision decreases.
Glaucoma is known as a "silent threat" because the damage caused by ocular hypertension begins in the peripheral visual field and gradually advances toward the center. Since we can still see the object we are directly looking at, we may not initially notice the narrowing that develops in our peripheral vision.
If left untreated, glaucoma can lead to blindness. However, with regular check-ups, timely diagnosis, and lifelong monitoring, the disease can be kept under control. It generally develops after the age of forty and shows no obvious symptoms. Patients usually notice it only when they experience advanced vision loss, at which point the damage is irreversible.
Eye pressure can be measured using two different methods. The devices that measure intraocular pressure are called tonometers. Generally, two types of tonometers are used: the air-puff tonometer and the applanation tonometer.
The air-puff tonometer is frequently used. The patient places their chin on the chin rest of the device and looks at a small digital screen in front of them while a puff of air is directed at the eye. The device then measures the intraocular pressure.
The applanation tonometer, on the other hand, measures eye pressure by direct contact with the eye. An anesthetic drop is first instilled into the eye. The tonometer then touches the cornea to measure intraocular pressure.
Glaucoma can be associated with genetics. People with a family history of glaucoma have a higher risk of developing the disease. In other words, mutations in one or more genes may make these individuals more susceptible.
The risk of glaucoma increases in individuals over the age of 40.
People with these risk factors are at higher risk of developing glaucoma. Therefore, they should undergo regular eye examinations to ensure early detection of any potential damage to the optic nerve.
For individuals with these conditions, it is important to have regular eye examinations in order to detect optic nerve damage at an early stage.
Measurement of intraocular pressure can be performed easily and quickly as part of a general eye examination. During comprehensive eye exams, eye measurements and intraocular pressure checks should always be performed. These measurements allow for the detection of glaucoma suspicion even if the patient does not have any symptoms.
The basis of glaucoma is the loss of the nerve fiber layer that forms the optic nerve. Therefore, it is necessary for individuals with signs of the disease to undergo a Retinal Nerve Fiber Layer (RNFL) examination to detect damage. Special light and photographic techniques, along with computer-assisted imaging methods, are used for this purpose. Additional tests, such as corneal thickness measurement and visual field tests, can also help assess intraocular pressure and detect glaucoma.
Glaucoma is a disease that can be easily treated if detected early. It is especially important for individuals with a family history of the disease to attend regular check-ups, as this significantly improves the chances of successful treatment.
Currently, the first-line treatment after diagnosis is usually medication. However, in patients who do not respond sufficiently to medication, laser therapy or surgical procedures may be applied. In particular, for cases diagnosed in the late stages or where long-term medication use is not suitable, direct laser or surgical interventions can be considered.
One of the main issues with glaucoma medications is the potential for allergic reactions. For this reason, some patients may find it difficult to continue medical treatment. In such cases, laser or surgical options are the preferred choices.
Recent years have seen significant advances in glaucoma medications, with effective new drugs greatly increasing treatment success. It is crucial for patients to use their medications consistently and regularly to maintain effectiveness.
Surgical procedures for patients who cannot use medications or who do not respond to medical therapy have also become increasingly successful in recent years, eliminating the need for lifelong medication and providing effective treatment.
Managing intraocular pressure is a lifelong process, as glaucoma is a chronic disease. Patient adherence to treatment is critical for treatment success. Consistency and determination are essential to preserve vision.
Eye drops are commonly used during glaucoma treatment. These drops lower intraocular pressure and help keep the disease under control. Typically, treatment begins with a single type of drop. The most important aspect is that the patient uses the prescribed drops at the recommended intervals.
To assess the effect of the medication, the patient is usually called back for a follow-up eye pressure check after 2–3 weeks of use. At this stage, the effectiveness of the medication is evaluated, and treatment continues either with the same medication or with a different prescribed drop. Patients must also inform their doctor about any other medications they are taking or any other health conditions they have.
Glaucoma is a process that requires cooperation between the patient and the ophthalmologist. Please maintain open communication with your eye doctor.
Glaucoma treatment represents your greatest responsibility to yourself and is the only way to protect against vision loss. Do not interrupt your treatment, and especially, do not stop using your medications.
The cornerstones of successful glaucoma management and treatment assessment are regular check-ups and, when necessary, tests such as HRT, OCT, and visual field examinations. Please do not miss your scheduled appointments.
For patients diagnosed with glaucoma, it is important to be aware that certain medications used for other health conditions may affect intraocular pressure dynamics and reduce the effectiveness of glaucoma treatment. Always inform your eye doctor about any other medications you are taking.
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