Glaucoma is not a single diagnosis, but a collective concept that combines many different eye diseases that have a common symptom – increased intraocular pressure. Therefore, it is not necessary to talk about a single method of treating such a diverse pathology; nevertheless, a big shift has indeed taken place in the treatment of glaucoma.
aif.ru told about this ophthalmologist, professor of the Department of Ophthalmology named after acad. A. P. Nesterova N. I. Pirogov “of the Ministry of Health of the Russian Federation, head of the ophthalmological center of the FKU” TsVKG im. P. V. Mandryka” of the Ministry of Defense of the Russian Federation, member of the Presidium of the Russian Glaucoma Society, Doctor of Medical Sciences Alexander Kuroyedov.
The cause of the disease is unknown
Elena Nechaenko, aif.ru: – Alexander Vladimirovich, how many diseases can be hidden under the diagnosis of glaucoma?
Alexander Kuroyedov: – About 60. All of them are united by a single symptomatology: an increase in the level of intraocular pressure (IOP) and the death of the membranes of the eye, primarily the optic nerve and its processes (axons) and, accordingly, a change in visual fields, and, in fact, central vision. However, the distribution of forms of the disease among these 60 diseases is heterogeneous: up to 96% is occupied by primary open-angle glaucoma. The remaining forms are secondary, angle-closure, congenital or juvenile glaucoma. And these are very difficult patients.
Why does glaucoma occur?
For more than 200 years, doctors have been trying to solve the problem, but so far in vain. Academician A. P. Nesterov, for example, he formulated the concept according to which glaucoma, as a multifactorial disease, develops by coincidence of circumstances and individual risk factors that “met” at the moment in a particular patient. There is no single cause of glaucoma – whoever finds it will be given a golden monument, because the scale of this problem is huge: at least 100 million people worldwide suffer from glaucoma, one and a half million cases have been detected in Russia, and approximately the same number of people suffer from this disease, themselves without knowing it. This is also a “silent” problem, because until the patient begins to see very badly, he simply does not know about his diagnosis and does not go to the doctor.
Don’t wait for symptoms
How can a person suspect that they have a disease?
– It is impossible to independently determine it before the onset of the advanced stage of the disease – there are simply no symptoms. That is why it is necessary to regularly conduct dispensary examinations, be observed by an ophthalmologist. When in 1976 the legendary “Order to strengthen measures for the early detection and active monitoring of patients with glaucoma” was adopted, in just a couple of years 20 million people were examined and a huge number of cases of glaucoma were detected, both in the initial and advanced stages. It became clear that the group of patients with this disease is very heterogeneous – they are people of different ages, gender, with different levels of intraocular pressure at the time of diagnosis. Approximately half of them are people with the initial stage of glaucoma. These “lucky ones” are lucky – if the disease is found at an early stage, the patient has at least two decades of normal vision ahead (of course, during treatment). If the disease is diagnosed with a sufficiently high level of intraocular pressure and at advanced stages, then there is not much time left before blindness. With an advanced stage of the disease, urgent surgical treatment cannot be dispensed with, otherwise the person will go blind very quickly.
At what age is glaucoma more commonly diagnosed today? And what risk factors play a decisive role?
– Absolutely everyone suffers from glaucoma, and it all depends only on how many risk factors “met” in a particular person at a certain moment. On average, in our country, glaucoma is diagnosed at the age of about 62 years. And the most critical age for the occurrence of glaucoma is about 53-55 years (gender does not matter), it is at this time that it is extremely important to conduct ophthalmological examinations in order to detect glaucoma in time. In addition to age, concomitant diseases matter: high myopia (more than 6 diopters), arterial hypotension, diabetes mellitus, sleep apnea (stopping breathing during sleep). Heredity also plays a role: if relatives had glaucoma, the risk increases 10 times, and glaucoma develops earlier (on average, by about 4-5 years).
– How is the disease progressing?
— In 2004, the famous scientist Weinreb, one of the presidents of the World Glaucoma Association, formulated the so-called glaucoma continuum. He drew it in the form of an arc, where at the very beginning there was an absolutely healthy person, and at the end – a blind person. Exactly half of the arc is exactly the asymptomatic course of the disease: for many years the patient has been sick, but does not know about it. It has been retrospectively calculated that, if untreated, a person goes from health to complete blindness in an average of 5-7 years. The main complaint with which people with glaucoma come to the doctor is blurred vision. Another classic symptom is a narrowing of the visual fields (for example, before a person, when looking directly, saw what he had on the right, left, top, bottom, and then he had only a couple of angles left). But at this stage, unfortunately, almost nothing can be done.
— Is it true that glaucoma occurs even at normal levels of intraocular pressure (IOP)? How, then, to identify it, if screening consists only in measuring IOP after 40 years?
– Officially singled out such a form of the disease as “low pressure glaucoma.” The norms of IOP are individual. Among the entire healthy population there are people with low eye pressure (17-18 mm Hg), they are about 22%. There are people with an average level of pressure (20 mm Hg) – this is the most common group (72% of the entire population). And there is a group with a high level of ophthalmotonus (6.5%). Most of all, oddly enough, the lucky person with high intraocular pressure – the doctor immediately suspects he has glaucoma and takes it under control, although it is not at all necessary that such a patient has glaucoma. But the category of patients with low IOP is the most difficult. They may have seemingly “good” intraocular pressure and may develop glaucoma.
Fortunately, “low pressure glaucoma” is well understood and is in fact no different from the most common primary open-angle glaucoma. But problems with its identification do exist. In some countries, a general medical examination includes not just measurement of the level of intraocular pressure, but also an examination of the fundus with a wide pupil. Unfortunately, it is not yet included in our screening program. Therefore, it is important that patients themselves inform the doctor about the signs characteristic of low pressure glaucoma – low blood pressure, a high degree of myopia, the presence of relatives with glaucoma. Upon learning of this, the doctor will most likely prescribe additional studies.