« Today we cannot cure glaucoma but we can halt it so that patients can continue without symptoms for the rest of their lives »
12 March: World Glaucoma Day
At the Institut de la Màcula, we have added our voice to World Days with the aim of disseminating high-quality medical knowledge that helps raise public awareness of vision diseases. By doing so, we hope to contribute to its prevention and early diagnosis
Glaucoma is the leading cause of irreversible blindness. This year, it is expected to affect more than 100 million people worldwide due to the progressive ageing of the population. A high state of alertness is important both because this is a disease with no symptoms and because family history can multiply the risk of contracting it by 10. This is explained to us by Dr Marta Pazos MD, PhD, ophthalmologist specialising in glaucoma at the Institut de la Màcula and a member of the American Glaucoma Society, the Association for Research in Vision and Ophthalmology, and the Spanish Glaucoma Society (Sociedad Española de Glaucoma).
When we talk about glaucoma, we usually emphasise the importance of periodic check-ups from the age of 40. Would you maintain this message as a key idea for this year?
Yes. Although it may seem untrue, there are still people who lose their sight because of glaucoma. In most cases, patients arriving at the clinic in a poor state is due to them arriving late, because they have not previously undergone any previous check-ups. The biggest problem with the disease is that it has no symptoms; as patients do not notice anything, they do not visit and are diagnosed late.
To avoid this, periodic check-ups are necessary. Particularly for those with a greater risk. From the age of 60, an annual check-up by the ophthalmologist is to be advised in order to detect any ocular pathology, not just glaucoma.
If the disease is detected in time, how do we keep the level of vision as high as possible?
Today we cannot cure glaucoma but we can halt it so that patients can continue without symptoms for the rest of their lives. With treatment, what we do is drastically change the rate at which the disease would progress. We do that by lowering the pressure in the eye, even in those cases where the pressure is not particularly high.
What is its relationship with intraocular pressure?
Glaucoma is a disease of the optic nerve that is normally the result of a pressure that is too high for the nerve to withstand. But there is no magic number at which one begins to suffer glaucoma.
Who has a higher risk of suffering from it?
There are three groups of people with higher risks: those with ocular hypertension, those with a family history and the elderly. Background is very important: having a first-degree relative with glaucoma can multiply the chances of suffering the disease by 10.
Is the disease very prevalent in our country?
It is estimated that 1 million people in the Spanish state are affected. But most importantly only half of them realise this.
What is new with regard to early diagnosis?
Early diagnosis has improved greatly in recent years, especially in detection by imaging techniques. Today, we can detect damage to the optic nerve before it affects vision.
There are also certain patients that we treat before the disease is confirmed because the risk of suffering it is very high. For example, an elderly person, whose father had severe glaucoma and also has hypertension, even if the optic nerve has not yet been damaged.
What are the new therapeutic horizons for glaucoma?
Now we are in a " glaucoma renaissance." A new horizon is opening up because many minimally invasive surgical techniques are beginning to be developed. There are also developments in the drug delivery system; we will administer medication and patients will not need to apply drops at home. Now we are more proactive; we are ahead of the disease.
Depending on the degree of glaucoma suffered, what impact does it have on the day-to-day lives of patients?
Glaucoma clearly affects the quality of life of patients for various reasons. In the case of moderate glaucoma, they lose vision, especially the peripheral type. With advanced glaucoma, the person has tunnel vision. In these cases, patients have difficulty walking down stairs and seeing people approaching them from the side. They have more traffic accidents and more fractures of the femur because they fall more often etc.
Cases of non-advanced glaucoma, but those that are beginning to acquire a certain importance, are more asymptomatic. Patients notice fewer things that can easily be attributed to vision. They have peripheral vision defects but do not see a black spot or anything similar. There are areas in the field of vision in which they do not see very well but the brain deceives them by filling this area with information that comes from the side or the other eye. These people have a blind spot in their field of vision, but they believe they are clumsy and do not attribute this to their eyesight.