Glaucoma is a degenerative chronic ocular illness which damages the optic nerve. It can lead to an irreversible loss of vision, and even to blindness in some cases if it is not treated properly. At present, more than 67 million people in the world suffer from glaucoma, and that figure is expected to increase to 80 million in the next few years.
There are two types of this illness: primary open angle and closed angle glaucoma. The first is responsible for 74 per cent of all cases, and "is closely related with age, because it generally appears as the years progress. It starts to show itself from the age of 40, but peaks from 60 onwards," explains Dr Maribel Canut, a surgeon at the Barraquer Ophthalmology Centre and specialist in glaucoma.
The principal risk factor for glaucoma is high intraocular pressure (IOP), which becomes worse with age - especially after 60 - and is the only treatable risk factor. "It is a chronic condition which can become serious if it is not controlled. In fact, untreated glaucoma can lead to an irreversible loss of the optic nerve and that means that the patient can never recover their visual acuity," says Dr Canut.
The specialists insist that early detection is very important. Because there are no symptoms, 50 per cent of patients who are affected start to lose vision without realising that they suffer from glaucoma. "Early diagnosis is essential to ensure that the illness can be monitored and treated, so that the patient retains their sight and a good quality of life," explains Dr Canut.
There are three courses of treatment and some may be used rather than others, depending on the type of glaucoma and how it evolves:
-Medical (drops put into the eyes). This is the main form of treatment. It usually reduces the IOP by between 15 and 35 per cent, depending on the basal value.
-Laser. There are different types of laser: YAG Iridotomy (or argon), which is very efficient in treating closed angle glaucoma; Trabeculoplasty laser, with a hypotensive effect which can be equal to or better than eye drops, and cyclophotocoagulation diode laser, in cases of refractory glaucomas and in advanced stages.
-Surgery. Filtering procedures are normally the operations of choice in the majority of cases (trabeculectomy/non penetrating deep sclerectomy) and they have a success rate of 60 to 80 per cent over five years. There are also valvular implants, which are highly effective in the first year (70 to 90 per cent), but can drop over the years to less than 50 per cent, and associated medical treatments.
With regard to treatment of glaucoma, "effectiveness, tolerance and complying with the treatment are the basic pillars" says Dr Canut.
Recently a new option for treating glaucoma has been presented in Spain: a drug which has been approved by the European Union to reduce high intraocular pressure in adult patients with open angle glaucoma, for whom monotherapy produces an insufficient reduction of the same.
One drop is applied to the affected eye twice a day; it combines two recognised treatments to reduce IOP in a single multi-dose package, thereby simplifying the number of containers and drops necessary each day when compared with using brinzolamide and brimonidine tartrate separately. In clinical trials, this drug has shown to be much more effective than using each of its components separately.
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