Glaucoma in the elderly

Glaucoma in the elderly

Glaucoma definition
Glaucoma is a type of eye disease caused by degeneration of the optic nerve. Or the optic nerve is damaged, which is the nerve that connects the eye and the brain. The main factor is high intraocular pressure. Caused by obstruction and deterioration of eye drainage Causing inadequate drainage from the eyeball. Resulting in a slow increase in intraocular pressure that eventually destroys the optic nerve.

The symptoms of the disease vary in nature and severity depending on the type of glaucoma it is. Which glaucoma can happen to people of all sexes and ages and the incidence increases with age but will occur more often in the elderly. Especially in people aged 40 years and over, people with a family history of glaucoma. or people with diabetes, etc.

Additionally, the World Health Organization (WHO) states that glaucoma is the second leading cause of vision loss in the world after cataracts. It found patients around the world who may suffer from primary vision loss from glaucoma. Such as closed-angle glaucoma and open-angle glaucoma, about 4.5 million people, 12 percent more than the number of blindness worldwide.

Glaucoma symptoms
Glaucoma is generally asymptomatic. or the signal appears at first And will cause symptoms to varying depending on the type of glaucoma as follows:

Open-Angle Glaucoma
It is the most common type of glaucoma. Caused by reduced water flow in the eye. The exact mechanism is not known. It is assumed that it is the degeneration of the drainage channel from the eyeball. As a result, the water in the eye can not flow out normally. Causing high intraocular pressure resulting in damage to the optic nerve.

Most have no symptoms in the early stages. However, if not treated early, it will result in slow vision loss, slightly blurred vision, like a side fog. Which eventually leads to blindness Patients are often unaware Except for those who are quite well observed.

Angle-Closure Glaucoma
It is less common than open-angle glaucoma. Symptoms will come on quickly. Because the drainage structure from the eyeball is suddenly clogged. At the corner of the eye, there is a sieve-like tissue called Trabecular Meshwork, which is a passage of water in the eye. When a blockage occurs, Thus causing high intraocular pressure resulting in damage to the optic nerve.

Symptoms that can occur are headache, red eyes, blurred vision, rainbow lights, and nausea and vomiting. In the case of acute occurrence, there is a pain in the eyes or the same headache as the eye.

Congenital glaucoma or hereditary
Born in an infant or child, symptoms are often severe and difficult to control. If not treated in the early stages, it can lead to blindness. Detecting the disease can be difficult, but the child’s behavior can be observed and physical observations, for example:

  • Has bigger eyes than normal people.
  • Does not like bright lights.
  • Inability to control blinking.
  • Red, watery, or cloudy eyes.
  • Rubbing eyes often.

Secondary Glaucoma
May be due to complications from abnormalities of the eye or caused by other eye diseases such as injury or an accident that has a tumor or an eye for a long time using steroids. Causing it to develop into glaucoma.

Causes of Glaucoma
In our eyes, there is a fluid called aqueous humor, which is produced by the tissue called the Ciliary Body. The created fluid flowing into the anterior chamber Serves to nourish the corneal lens and then is absorbed through the eyeball towards the corner of the eye. The corner of the eye has a sieve-like structure called Trabecular Meshwork, which is located at the edge of the iris. When the water nourishes the eyes that are produced and the discharge of water in the eyes is balanced will cause eye pressure to be normal.

Glaucoma is caused by a damaged retina. With a gradual deterioration of the optic nerve and there was a blind spot in the field of vision. It is most often caused by high intraocular pressure due to an imbalance in the intraocular fluid flow and discharge. A blockage in the outlet of the drainage channel nourishes the eyeball.

This causes more eye care to be created, but the flow slows down. Raising the pressure in the eye. It may happen slowly or suddenly. Depending on the type of glaucoma. However, the cause of high eye pressure is not yet known. But it is assumed that this may be caused by many factors such as genetics, use of eye drops, taking medications such as corticosteroids, a decrease in the blood supply to the optic nerve and high blood pressure conditions, etc.

In addition, various problems with the eyes can also be the cause of glaucoma. Although it is a very common cause such as inflammation, severe infection, injury caused by shock or chemicals, Vascular thrombosis, and surgery, etc.

Glaucoma diagnosis
A doctor will perform a diagnosis of glaucoma based on a medical history and a thorough eye examination In which the doctor will perform the following tests:

  • Check intraocular pressure The doctor will first drop an anesthetic to the eye and then use a tool called a tonometer to measure the intraocular pressure. Eye pressure has a normal value of 12-20 mm Hg. If the eye pressure is higher than 21 mm Hg Showing that there is an abnormality.
  • Check the optic nerve and the screen, Examination with ophthalmoscopy, a tool that examines the inside of the eye Let the doctor see the damage or deterioration of the retina. Help the doctor see into the eye. The shape and color of the retina can be diagnosed.
  • Measurement of visual field performance, Examined by using a visual field detector able to analyze the visual field by radiating light to a point to a different position, the machine can monitor eye movements and analyze data with a built-in program. It shows the test results accurately and helps diagnose glaucoma.
  • Measurement of corneal thickness, The corneal thickness gauge, known as Corneal Pachymetry, is examined using a corneal thickness measurement device. Measuring the thickness of the cornea can be used to more accurately assess the measured eye pressure. This is because the thickness and thinness of the cornea affect the measurement of corneal pressure.
  • Examination of the flow of the vitreous in the eye, Intraocular gonioscopy is examined for open or closed-angle glaucoma. Which can be examined in different directions to see the angle of the drainage and the area that serves to drain fluid from the eye.

Glaucoma treatment
The optic nerves of people with glaucoma are permanently damaged. Treatment is therefore support to prevent further damage to the optic nerve and to maintain the existing vision for as long as possible. Treatment will depend on the type of glaucoma and the stage of the underlying disease. The goal of treating glaucoma is to reduce the pressure in the eye. There are several treatments for glaucoma, including the use of eye drops. Taking medicine Laser surgery and other types of surgery.

Using eye drops
Glaucoma treatment is usually started with eye drops prescribed by your doctor. Which drops in the eyes will help reduce intraocular pressure by reducing the creation of water to nourish the eyeball or helps increase the outflow of water to nourish the eyeball.

Examples of eye drops used to treat glaucoma are as follows:

  • Cholinergic Agents
  • Carbonic anhydrase inhibito are available as eye drops and oral pills It works by reducing fluid production in the eye.
  • Prostaglandins, Helps reduce intraocular pressure by increasing the outflow of intraocular fluid.
  • Beta-blockers reduce the intraocular fluid formation and reduce the flow of fluid entering the eyeball.
  • Alpha-adrenergic Agonis, reduces the production of intraocular fluid and increases the outflow of liquid.

Taking medicine
If the eye drop does not bring the pressure in the eye to the desired level. Your doctor may recommend oral medication. In general, Carbonic anhydrase inhibito is used. Which are available as eye drops and oral tablets It will help reduce fluid build-up in the eye. But there are side effects that can occur, including frequent urination, numbness of the fingers and toes. Have depression Have stomach pain or may cause kidney stones.

Other treatments
As a method other than using eye drops and oral medications, Which consisted of many types of surgical procedures or laser therapy. These methods aim to improve the drainage of fluid in the eye and reduce the pressure in the eye, such as laser treatment where the doctor will shoot a laser to treat open-angle glaucoma. It uses laser light to create a small opening in the corner of the eye to help drain the eye better and help reduce eye pressure or may use surgery to open drainage to let the water come out under the conjunctiva to reduce intraocular pressure when initial treatment is ineffective, etc.

Glaucoma complications
Untreated or poorly curable glaucoma can worsen symptoms and eventually loss of vision. However, even patients with glaucoma have already received treatment. But it can also be at risk of blindness, with 15 percent of those treated with at least a 20-year chance of losing sight in at least one eye.

In addition, surgical treatment of glaucoma can lead to bleeding in the eye or an infection in the eye, or using self-bought eye drops without consulting a doctor can also cause eye problems, so patients should not buy the medication themselves. But should consult a doctor and use drugs as prescribed by your doctor only.

Glaucoma prevention
Glaucoma is an eye disease that cannot be prevented; however, if it is examined and treated early, it may help prevent macular degeneration or reduce the damage of the optic nerve so as not to make the patient lose sight.

By taking care of your eye health and reducing the risk of severe symptoms from glaucoma are as follows:

  • Exercise to improve blood circulation and reduce the pressure in the eyes. However, you should consult your doctor about exercise methods that are suitable for your physical condition and should not play sports that require hanging their head, This can increase the pressure in the eye and cause harm.
  • Have regular eye exams By those under 40 years of age, eyes should be examined every 5-10 years, 40-54 years old, should be examined every 2-4 years, 55-64 years old, should be examined every 1- 3 years. And people aged 65 years and over should be examined every 1-2 years, for those who have a high risk of glaucoma or have a family history of eye disease. May need to be checked more often.
  • Eat nutritious foods especially foods that contain vitamins to nourish the eyes and avoid drinking drinks with too much caffeine, This can increase the pressure in the eye.
  • Wear glasses or protective equipment when playing sports or engaging in dangerous activities. Because eye injuries can lead to glaucoma.
  • Always use eye drops as prescribed by the doctor to help reduce the risk of developing hypertension that can lead to glaucoma and the medication should be continued as prescribed by a doctor, even without symptoms of glaucoma. For the most effective treatment.
  • When sleeping, make the pillow at the right level. Not too high or too low by raising the pillow approximately 20 degrees from the horizontal, This may help reduce intraocular pressure while sleeping.

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