Primary open angle glaucoma – features, symptoms, stages, treatment

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Primary open angle glaucoma is the most common type of glaucoma. It is diagnosed in 1/200 people over 40 years of age. The incidence increases with age, is more common in men, and may also be family and hereditary. The disease is very insidious, at first it does not cause any pain symptoms.

Primary open angle glaucoma – definition

Primary open angle glaucoma is the most common type of glaucoma. The ailment is defined as a chronic, slowly progressing optic neuropathy with characteristic features of anatomical and functional damage. The risk of developing the disease increases with age, and the disease affects men more often. Glaucoma can be genetic and hereditary. The disease develops secretly, without pain attacks, and often its only symptom is scotoma in the visual field. The intraocular pressure is moderately elevated and the eye looks normal on the outside. Over time, visual field defects and significant visual impairment begin to appear. Glaucoma is usually diagnosed during a visit to an ophthalmologist for periodic examinations or during the selection of appropriate glasses.

Characteristic features of primary open angle glaucoma

The characteristic features of this ailment include:

1. the occurrence of glaucoma in adulthood,
2. gradual changes in the appearance of the optic disc,
3. deepening defects in the field of view,
4. high intraocular pressure,
5. open angle of percolation.

There are reasons that influence vision loss in this ailment. First of all, in developed countries, more than half of patients are unaware of their disease, it develops asymptomatically until the patient loses sight in one eye.

Factors influencing primary open angle glaucoma

The stimuli significantly influencing the formation of open angle glaucoma include:

1. low blood pressure or nocturnal hypotension,
2. high intraocular pressure (a factor that increases the risk of glaucomatous neuropathy),
3. circulatory system disorders leading to repeated hypoxia in the area of ​​the optic nerve,
4. older age – the disease develops mainly after the age of 40,
5. hypertension,
6. black race – in this group of people, glaucoma develops more often and has a much more rapid course,
7. Inheritance,
8. retinal diseases, e.g. central retinal vein occlusion, is much more common in patients with open-angle glaucoma,
9. diabetes
10. high degenerative myopia.

Symptoms of primary open angle glaucoma

Most patients do not develop any characteristic symptoms, glaucoma gradually begins to develop, attacking larger and larger areas of the field of view. Open angle glaucoma develops in both eyes, but it is an uneven process. For this reason, visual defects widening to the area of ​​its nasal quadrants are blurred by the overlapping area of ​​the other eye’s visual field. Such a situation causes that the patient, even for many long years, is unaware of the presence of the disease, which, unfortunately, is often diagnosed only at an advanced stage.

However, the first symptoms of glaucoma can include:

1. headaches,
2. the feeling of seeing through a fog,
3. the appearance of rainbow circles in the field of view, especially around light sources,
4. pain in the eyes and the surrounding area,
5. tearing
6. problems with the proper selection of glasses due to the constantly changing breaking power of the optical system in relation to the length of the eyeball.

Different stages of primary open-angle glaucoma

Open-angle glaucoma is a progressive disease that manifests itself mainly by changes in the visual field. We can distinguish four stages in the development of this disease.

Stadium I – is characterized by the enlargement of the Mariotte blind spot and the presence of scotomas in the lower or upper visual field. The dark spots begin to gradually enlarge, blending in turn with each other and with the blind spot, then a large Bjerrum scotoma is formed.

Stadium II – begins to come to a closer field of vision from the nasal area.

Stadium III – the scotomas begin to gradually attack both halves of the nose, approaching the central field of vision. The island of central vision and the island in the temporal field of view appear.

Stadium IV – the vision of the central field is lost, leaving some residual elements of the field of vision in the area of ​​the temples.

How is primary open angle glaucoma diagnosed?

Thanks to the early diagnosis and implementation of appropriate glaucoma treatment, irreversible functional and anatomical changes can be prevented. In every patient over 40 years of age who visits an ophthalmologist for the selection of glasses, an examination of the optic nerve disc and the assessment of intraocular pressure, which is the main factor in the formation of glaucoma, should be performed.

In Poland, a free preventive examination financed by the National Health Fund is performed in people over 35 years of age (when determining the age, the year of birth should be taken into account), who have not been tested for glaucoma in the last 24 months. People who have already been diagnosed with glaucoma cannot be examined. No referral is required.

Ophthalmological examination in the diagnosis of glaucoma also includes general elements of an ophthalmological examination. The ophthalmologist assesses:

1. with the help of gonoscopy – filtration angle,
2. near and far visual acuity,
3. the front part of the eye (in a slit lamp),
4. pressure with a Goldman applanation tonometer,
5. field of view,
6. position of the vascular bundle and the target in both eyes,
7. the fundus of the eye, the shape and width of the retinal nerve ring.

The doctor diagnoses the disease based on the diagnosed defects in the field of view; damage to the optic disc, which is a typical symptom of glaucomatous neuropathy; open angle of filtration and increased intraocular pressure.

Primary open angle glaucoma – treatment

Treatment of primary open-angle glaucoma requires a lot of systematic work on the part of the patient. It is also important to follow medical recommendations and report for checkups in a timely manner. Glaucoma treatment aims to stop the progression of optic nerve damage so that the patient can maintain decent visual acuity for the rest of his life.

The most important form of treatment (to achieve inhibition of damage) is the reduction of the intraocular pressure to the target pressure, which causes the inhibition of the disease development or its maximum slowing down. The pressure level depends on the size of the optic nerve damage (the higher the damage, the lower the level).

Treatment of primary open-angle glaucoma includes:

1. laser treatment using trabeculoplasty – this procedure is aimed at repairing the outflow of aqueous humor through the angle of filtration. It is used when pharmacological treatment does not bring any effects or is poorly tolerated by the patient;
2. pharmacological therapy – in the case of primary open-angle glaucoma, it must be carried out for life. The doctor recommends taking the following preparations: carbonic anhydrase inhibitors, prostamides, α2-agonists, β-blockers. The implementation of treatment is based on an individual approach to the patient, his needs as well as the level of advancement and development of the disease. Other risk factors and possible side effects from medications should also be considered.
3. surgical treatment that uses trabeculectomy. It is a procedure consisting in lowering the intraocular pressure, it is performed in the case of progressive glaucomatous neuropathy and changes in the visual field with the use of pharmacological therapy and sometimes trabeculopasty.

If you notice disturbing symptoms of the eye, sign up for a glaucoma diagnostic check-up offered by the Eyemed medical center.

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