Pandemic Prevents Early Diagnosis of Glaucoma

Yeditepe University Hospitals Ophthalmology specialists pointed out that the isolation in the community and the decrease in routine examinations during the Covid-19 pandemic caused serious problems in the diagnosis of glaucoma and the evaluation of the adequacy of treatment.

Experts stated that early diagnosis of glaucoma, which progresses without symptoms, is vital and stated, "Pandemic restrictions are the biggest obstacle to early diagnosis of the disease in this period when we are closed to home. Anyone over 40 years of age with a family history of glaucoma should have their eyes checked,".

Glaucoma, popularly known as 'eye tension', ranks 2nd among the causes of blindness in the world. Today, glaucoma affects approximately 70 million people worldwide, 6 million of whom are completely blind. Turkish Ophthalmology Association aims to increase social awareness against glaucoma by carrying out various activities throughout Turkey within the scope of World Glaucoma Week held between 7-13 March 2021.

Quarantine is the Biggest Obstacle to Early Diagnosis

Yeditepe University Hospitals Ophthalmology specialists pointed out that the isolation in society and the decrease in routine examinations during the Covid-19 pandemic caused serious problems in the diagnosis of glaucoma and the evaluation of the adequacy of treatment. "For this reason, everyone over the age of 40 with a family history of glaucoma should have their eye checks as soon as possible without delay, or glaucoma patients who have received treatment should have their controls," stated the experts, and they also underlined that there is no case of Covid-19 and glaucoma coexistence so far, except for a single case, and that glasses should be used to protect the eyes as well as using masks while protecting against coronavirus. While it is estimated that there are nearly 2 and a half million glaucoma patients in Turkey, only one out of every 4 patients can be diagnosed and treated. The most important feature of glaucoma, which is a serious social health problem leading to irreversible vision loss, is its insidious course and late diagnosis without showing symptoms in a large proportion of patients.

Pain Mistaken for Migraine May Be Eye Tension

Speaking at the World Glaucoma Week, Yeditepe University Hospitals Ophthalmology Specialists stated: "In the most common type of glaucoma, known as open-angle glaucoma, the disease is usually detected incidentally in patients who come to the eye examination for a different complaint. Many patients usually learn that they have eye tension when they consult an ophthalmologist due to near vision impairment after the age of 40. In another type of glaucoma known as narrow-angle glaucoma, patients confuse the symptoms of glaucoma with migraine attacks. Headaches that are mistaken for migraine may actually be an eye tension disease that progresses insidiously and can lead to blindness over time. Regardless of the type of glaucoma, with early diagnosis and treatment, the disease can be controlled, and vision can be preserved."

Genetic Predisposition Increases Glaucoma 7 Times

The most common type of glaucoma is open-angle or in other words insidious glaucoma. Having first-degree relatives such as a mother, father, and siblings with glaucoma increases the risk of the disease in family members 7 times. Narrow-angle glaucoma, which is rarer, is more common in women and people with high hyperopia. Other risk factors for glaucoma include diabetes, eye-related causes, or long-term cortisone treatment for other reasons. Although glaucoma usually occurs as a result of high intraocular pressure, in some special conditions glaucoma can occur at normal or even low pressures. This type, called normal-tension glaucoma, can be seen in patients with vascular problems, low blood pressure, and sleep apnea.

Beware of Glaucoma in Babies

Yeditepe University Ophthalmology specialists reminded us that glaucoma can also occur in babies and continued their words as follows: "If the intraocular canals that carry the eye fluid out of the eye are not fully developed in the womb, eye pressure may increase in the fetus during pregnancy and the baby is born with some symptoms. This type, which we call congenital glaucoma, is very different from adult glaucoma. Until the age of 3, since the outer tissue of the eye is very elastic in babies, the increased pressure enlarges the eye and the baby may be born with large eyes. This can be more easily recognized if it is unilateral, but it can be overlooked when it is bilateral. The family should be especially careful with babies with unilateral large eyes. These babies have excessive watering, discomfort from light and eye color cannot be recognized well. If these symptoms are present, they should immediately consult an ophthalmologist". Experts also emphasized that eye tension measurement, which is an integral part of the ophthalmological examination, has a very important place as the first step in the diagnosis of glaucoma, but diagnosis and treatment planning is not made only with pressure measurement, and patients are followed up with other advanced methods that measure the visual field or can even catch early losses in the visual nerve. He emphasized that the corneal tissue becomes thinner, especially in patients who have undergone myopic surgery, and that this may cause the eye pressure to be measured falsely as normal and the disease may be missed and underlined that these patients should be more careful.

The most important cause of glaucoma is high intraocular pressure. Under normal conditions, there is an intraocular fluid called "aqueous", which is continuously produced in the eye and nourishes some of our eye tissues, and protects the form of our eye. This fluid must leave the eye through special channels in the eye and mix with the blood circulation. The balance between the production of aqueous fluid and its outflow from the eye creates "normal eye pressure". This is a measurable value and is accepted as 10-21 mmHg. If this balance is disturbed, i.e., the outflow of the produced fluid out of the eye decreases, the eye tension rises. As a result of the long-term continuation of high pressure in the eye, it damages the visual nerve. The patient may not have any complaints during the increase in intraocular pressure, but over time, first, the peripheral field vision narrows, and then complete blindness occurs. Since the optic nerve is not able to regenerate itself, the loss cannot be reversed with treatment, but the disease can be stopped, or worsening can be prevented. Therefore, early diagnosis of this asymptomatic disease is very important.