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Glaucoma Awareness Week and Treatments

Glaucoma Awareness Week 8th to 14th March

Glaucoma: what is it?

Glaucoma is a term we give to a group of conditions characterised by changes in the optic nerve. The commonest form of Glaucoma in the UK is Open Angle Glaucoma and almost always occurs without symptoms.

Angle closure glaucoma is much rarer and can have symptoms such as, redness, pain, blurred vision or haloes around lights but is also often asymptomatic.

The silent thief of sight

The lack of symptoms is one of the problems with glaucoma and where the term “the silent thief of sight” comes from.

Worldwide, glaucoma is the 2nd most common cause of blindness and the commonest cause of irreversible sight loss. 4.5 million people are blind globally from glaucoma. Even in the UK, there are 11,000 new cases of glaucoma every year and Bristol Eye Hospital manages over 25,000 glaucoma appointments per year.

It’s estimated that while 700,000 people in the UK have glaucoma, another 50% (that’s an extra 350,000, are unaware that they have glaucoma).

Risk factors
The commonest cause of glaucoma is raised pressure in the eye. But remember this is an association and raised eye pressure does not equal glaucoma. Some people have raised eye pressure but do not get glaucoma: this is called ocular hypertension. Conversely other people have normal eye pressure but still get glaucoma.

Other risk factors are:
• age. We’re more at risk as we get older
• ethnicity
• family history

Intra-ocular pressure (IOP) or Eye pressure
Eye pressure is a balance between fluid entering the eye, and fluid leaving the eye. Fluid is produced by a gland called the ciliary body behind the coloured part of your eye (iris). It drains in front of the lens, through the pupil into the front chamber of the eye where it circulates and exits through a sponge like drain (trabecular meshwork) between the cornea and iris.

Raised pressure is due to a reduction in drainage of this fluid: gradual due to trabecular meshwork clogging in open angle glaucoma, but sudden due to a physical narrowing of the gap between cornea and iris, often due to iris position in angle closure glaucoma.

How do you know you have glaucoma?
Glaucoma is asymptomatic in it’s early to mid-stages. Therefore, it is most often picked up by a routine sight test with an optometrist where eye pressure, peripheral vision and the optic nerve are assessed. In some patient’s, eye pressure is raised. In patients where eye pressure is normal, glaucoma is detected by looking for characteristic changes to the optic nerve and/or characteristic visual field damage.

Treatment for glaucoma is based around lowering eye pressure. The first line treatment is currently eye drops. Other options are using laser and in severe cases surgery may be the best option.

The best place in Bristol to be referred for glaucoma treatment is Bristol Eye Hospital.

Here there are 3 full time specialist glaucoma consultants running new patient clinics. They are Rani Sebastian, Michael Greaney and Demetri Manasses. These are eye doctors (ophthalmologists) who specialise in glaucoma. They are supported by glaucoma specialist optometrists, junior doctors and optometrists training in glaucoma.

Early detection
If you are going to get glaucoma it is better to be picked up as early in the disease progression as possible. That is why Lynne Fernandes Optometrists offer a service beyond routine sight testing for those at risk. The simple way to think about this is that if eye pressure, optic nerve health and visual fields are measured more accurately, more frequently under a protocol designed by a specialist we’re likely to find change earlier. This can mean that glaucoma could be treated before it effects your quality of life.

Personalised glaucoma monitoring
These assessments, also compliment, those offered for those patients being monitored by Bristol Eye Hospital for glaucoma. This is because they are different to the standard NHS protocols for glaucoma patients and their frequency is not constrained by economics or capacity.

When looking at glaucoma qualifications in your optometrist look for the letters DipGlauc DipTp (IP) after their name. This indicates they are a glaucoma specialist optometrist with therapeutic experience.

If you would like to know more do contact your practice or, ask your optometrist at your next appointment.

Gerard Fernandes BSc (Hons) MCOptom DipGlauc DipTp (IP)
Optometrist Director I Lynne Fernandes Optometrists I Bristol
Glaucoma Specialist Optometrist I Bristol Eye Hospital

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