Treatment of glaucoma

The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: “Why not self-medicate?”. Treatment of glaucoma is a complex process that includes medical and / or surgical treatment, depending on the stage and degree of visual impairment.

Damage caused by glaucoma cannot be repaired. But treatment and regular check-ups can help slow and stop vision loss, especially if the disease is detected early, since the first stage is still treatable.

The goal of glaucoma treatment is to reduce pressure in the eye (intraocular pressure). Depending on the situation, options may include: eye drops, advanced laser techniques, or surgery. There are standards for the treatment of the disease, and depending on them, the necessary method or their combination is selected.

Glaucoma of the 1st degree, when there is no loss or impairment of visual function, is curable. At the same time, the disorders caused by glaucoma cannot be cured. Only treatment is possible through maintenance therapy, which is aimed at preventing the progression of the disease. At the fourth stage (it is also terminal), when glaucoma is already running, healing and return of vision is impossible, so you should think about the importance of timely detection of this disease.

Treatment of open-angle glaucoma, which is most common in the elderly, requires lowering IOP (intraocular pressure) by increasing drainage of moisture, or reducing its production. Medications can serve both of these purposes, and surgery and laser therapy aim to improve the drainage of fluid in the eye.

If diagnosed late, open-angle glaucoma can lead to severe visual impairment and even cause blindness. Most often, patients complain that their head and eyes hurt, they notice redness and severe eye discomfort. Once diagnosed, glaucoma is usually controlled with eye drops that lower IOP. Glaucoma is a lifelong condition and requires constant monitoring and treatment.

Close-angle glaucoma differs from open-angle glaucoma in that the symptoms occur quite suddenly, the eye is very painful and red. If the high pressure in the eye is not relieved quickly, blindness may soon follow. Usually, an acute attack of angle-closure glaucoma is treated with a laser method.

Appropriate treatment depends on the nature and stage of glaucoma. Pigmentary, congenital, chronic and other types of glaucoma are treated in accordance with the standards and treatment protocols. The appearance of the optic nerve and peripheral vision should be monitored. If there is no effect on drug treatment or if there are intolerable side effects, the doctor may change medications or help choose one of several surgical techniques. ^[1][2]

Prevention of glaucoma

There is no way to completely prevent glaucoma, but these steps can help detect it early, limit vision loss, slow progress, and enable you to live a better life:

1. You need to regularly take care of your eyes, to be examined by a doctor, before irreversible damage occurs. As a general rule, there should be comprehensive eye exams every four years starting at age 40 and every two years from age 65. More frequent screening may be needed if there is a high risk of glaucoma.
2. You need to know your family’s medical history. Glaucoma tends to occur in relatives. If a person is at increased risk, then more frequent screening may be required.
3. Exercises. Regular, moderate exercise can help prevent glaucoma by reducing pressure on the eyes. It is advisable to talk to your doctor about an appropriate exercise program.
4. Regular use of prescribed eye drops. Taking eye drops can greatly reduce the risk of high blood pressure. To be effective, eye drops must be used regularly, even if there are no symptoms – this rule must be remembered forever.
5. Wearing eye protection. Serious eye injuries can lead to glaucoma. Wear safety goggles when using power tools or when playing dangerous sports. Prevention of eye damage plays an important role in preventing glaucoma, and it is very important to try to protect yourself from this rather than get rid of the consequences.

Foods needed in the diet to prevent eye disease: dark green, yellow and orange fruits and vegetables. Lutein and zeaxanthin are especially important for good eyesight, fruits and vegetables rich in vitamin C, foods rich in vitamin E (eggs, fortified cereals, fruits, wheat germ, nuts, nut butters, vegetable oils, green vegetables and whole grains) and vitamins A and D, rich in zinc and omega-3 fatty acids.

It is very important to monitor the hygiene of the lighting in the room, it is advisable to use table lamps, avoid too bright lighting, insufficient lighting is also undesirable, get rid of the habit of watching TV with the lights off, working on the computer, as well as sleeping in a completely dark room, normalize your mode.

An important point in the prevention of glaucoma is medical examination and examination by an ophthalmologist. ^[3][4].

Treatment methods for glaucoma

There are several different treatments available, including eye drops, lasers, and surgery. The best treatment is selected individually and depends on the circumstances.

Treatment cannot reverse any loss of vision that has already occurred, but can help improve the overall condition and prevent progression of the disease.

Treatment depends on what type of glaucoma the person has, for example:

• primary open-angle glaucoma is usually treated with eye drops, laser or surgery;
• angle-closure glaucoma often requires immediate treatment in the hospital with drugs to reduce pressure in the eye;
• secondary glaucoma may be treated with eye drops, laser, or surgery, depending on the underlying cause;
• Pediatric or congenital glaucoma often requires surgery to correct a developmental problem in the eye, resulting in fluid buildup and increased pressure.

Because glaucoma cannot be cured and treatment does not always prevent further vision loss, people may turn to non-traditional therapies such as acupuncture or marijuana. But most of them have either not been studied or proven effective in glaucoma. Such treatment can be costly and even dangerous to health.

Also, some patients who, in addition to glaucoma, also have cataracts, may require combined treatment: surgical treatment of glaucoma and lens replacement ^[4][5][6].

Medication method of treatment

Medical products (drugs, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor’s prescription. Recommended reading: “Why can’t you take medications without a doctor’s prescription?”. Conservative treatment begins with eye drops. They can help reduce intraocular pressure by improving the flow of fluid from the eye, or reduce the amount of fluid the eye produces. The doctor may also prescribe an oral medication if the drops don’t work, usually a carbonic anhydrase inhibitor. The following side effects may occur: tingling of the toes and hands, frequent urination, indigestion, depression and dysuria.

The medical treatment of glaucoma has such directions ^[5][6][7][8]:

• to reduce intraocular pressure;
• to improve blood supply to the eye;
• also to improve eye metabolism.

Types of drug treatment

Tablets are usually a short term treatment. The tablets may cause tingling in the hands, feet and lips, nausea and fatigue in some patients. They may contribute to the formation of kidney stones in some patients after prolonged use. Tablets are an alternative treatment for people whose disease is not controlled by eye drops. Their disadvantage is a large number of side effects, which is due to the fact that they have an effect on the entire body, so there are restrictions for their use. Also, for the complex treatment of glaucoma, various tablets can be used that improve metabolic processes, painkillers, or statins. For the treatment of glaucoma, the following names of drugs can be taken: Prozerin, Clonidine, Cavinton, Anaprilin, Acetazolamide (Diamox®), Metazolamide (Neptazane®), Mexidol, Picamilon, Ceraxon, Actovegin, Aspirin, or other drugs in the form of tablets.

Drops are the most common treatment for glaucoma. Doctors use several different categories of eye drops to treat glaucoma. They either reduce the amount of fluid (aqueous moisture) in the eye, or improve its external outflow, and some have both effects, even drops are used for treatment that affect the metabolic processes in the eye (Taufon, Oftan Katahrom). Sometimes doctors prescribe a combination of eye drops.

People using these medicines should be aware of the purpose and potential side effects, which should be discussed with their doctor. Many patients use Japanese drops because they are believed to be the most effective. However, only a doctor can decide which medications are best for treatment.

There are different classifications of drops, here are some of the most important medicines:

1. Alpha-adrenergic agonists. These drugs reduce the formation of aqueous humor and increase its outflow. Side effects include blurred vision, fatigue, and increased heart rate (heart rate) and BP (blood pressure). Examples: Apraclonidine, Brimonidine, Epinephrine.
2. Beta blockers. This type of medication acts on ocular (intraocular) pressure by decreasing the amount of fluid produced and the rate at which fluid flows into the eye. Beta-blockers modify the response of the nervous system by “occupying” receptors that might otherwise elicit a response. In glaucoma, they cause the body to produce and release less aqueous humor, resulting in an average reduction in IOP of 20-27%. However, in addition to the effects on the eyes, there may be side effects that affect the heart, lungs, and other organs. Examples include: Timolol, Levobunolol, Metoprolol, Betaxolol.
3. Carbonic anhydrase inhibitors are eye drops that reduce the production of fluid in the eye. This can lower IOP by about 15-20%. They can also improve blood flow to the retina and optic nerve. When used as eye drops, side effects can include burning, loss of appetite, and changes in taste. Examples: Dorzolamide, Brinzolamide.
4. Miotics. This type of drug is a cholinergic, which causes the pupil to become much smaller in diameter and improves drainage of fluid from the eye. Side effects include eye irritation and allergy symptoms, as well as an increased risk of myopia and cataracts. Side effects may include: dermatitis, nasal congestion, urinary incontinence, pulmonary congestion and heart damage, including changes in heart rate. Examples: Pilocarpine, Echothiophate, Carbachol.
5. Combination preparations include two or more of the above drugs that have been combined into one composition for better results. These include eye drops with the following generic and brand names (in brackets): Dorzolamide and Timolol (Cosopt®); Latanoprost and Timolol (Xalacom®); Brimonidine and Timolol (Combigan™), Brimonidine and Brinzolamide (Simbrinza™).
6. Injections. An acute attack of glaucoma is a very formidable condition; intensive therapy methods and various injections of fast-acting drugs are used to stop it. During intensive care, intravenous injections are used.

For this, they can be assigned:

• 15% solution of Mannitol, intravenously drip for at least 30 minutes, 10-13 ml/kg;
• Urea IV drip 1-1,5 g/kg, slowly;
• Furosemide IV or IM 20-40 mg per day.

A lytic mixture may also be used. Emergency care for people with an acute attack involves the administration of various drugs, and if this drug therapy is not used, this can lead to undesirable consequences. The advantage of this type of treatment is that the effect comes very quickly. In complex treatment, Cortexin and Dexamethasone are also used in the form of intramuscular injections. ^[5][6][7][8].

Surgical treatment method

When medical and laser therapy fails, such patients are operated on. The surgical method of treatment includes: trabeculectomy, implantation of artificial bypass devices, non-penetrating deep sclerectomy and viscocanalostomy.

Complications of such operations can be quite significant, for example, blood entering the anterior chamber of the eye, or the vitreous body. Also, the cause of the complication can be a sharp decrease in intraocular pressure, which leads to accumulation of blood and detachment of the choroid.

A frequent complication is an excessively strong decrease in IOP, and this further leads to serious consequences, in particular, a degenerative process in the cornea. Symptoms of this complication are various sensations of discomfort in the eye and decreased vision. The reasons for a large decrease in IOP can be: detachment of the uvea and too rapid outflow of fluid. These complications are detected quickly, but there are long-term consequences. These include cataracts if the lens was affected during surgery, or a cyst formed. Immediately after the operation, complications such as inflammation, pupillary block, and some others may develop.

Indications for surgical treatment of glaucoma are:

• insufficiently effective drug treatment;
• growth of ophthalmotonus;
• rapid progression of deterioration of visual function;
• inability to comply with the doctor’s prescriptions by the patient;
• increased disturbances of the optic nerve when its atrophy appears, even with optimal IOP values;
• the patient’s own desire to resort to this type of intervention.

Trabeculectomy is used for both open-angle and angle-closure glaucoma. A passage is created in the sclera to remove excess fluid. Sometimes the surgically created hole can close and the IOP rises again. This is because the body is trying to “tighten” the new hole as if it were an injury. Many surgeons perform trabeculectomy with an antifibrotic agent, which reduces such scarring during the healing period. About 50% of patients no longer need medication after surgery for a significant period of time. Between 35% and 40% of those who still need medication have better control of their IOP.

Implantation of shunt devices. Various devices have been developed to help drain aqueous humor from the anterior chamber. All of these devices have a similar design: they consist of a small silicone tube that passes into the anterior chamber of the eye. The tube is connected to several plates (possibly one) that are sewn to the surface of the eye. The fluid is first collected on the plate and then absorbed by the eye tissues. This type of surgery is thought to lower IOP less than trabeculectomy, but is done in patients whose IOP cannot be controlled by conventional surgery or who have previous scarring. ^[5][6][7][8].

Laser treatments

Laser surgeries have become very popular for the treatment of various eye problems and diseases. There are several types of laser surgery used to treat glaucoma. The type of laser surgery will depend on the type of glaucoma and how severe it is. Lasers create a focused beam of light that can cause a very small burn or hole in the tissue of the eye, depending on the strength of the light beam. There is no pain during laser surgery, which is an advantage of this type of treatment.

The following are the most common laser surgeries to treat glaucoma:

1. Trabeculoplasty lasts 10 to 15 minutes and is painless. Eventually, after treatment, patients may stop using some of their medications. Complications from the laser are minimal, which is why trabeculoplasty is becoming increasingly popular. However, a second procedure may be required.
2. Argon laser trabeculoplasty (ALT) is a method of treating open-angle glaucoma. During this intervention, the trabecular network of the eye is processed with a laser, increasing the outflow of drainage, thereby reducing IOP. Usually only one half of the trabecular mesh is processed.
3. Selective laser trabeculoplasty (SLT) is a technique used for open-angle glaucoma. SLT is a new laser that uses very low energy levels. It is selective because it leaves some parts of the trabecular meshwork unchanged. For this reason, SLT is believed to be safe to repeat, unlike other procedures.
4. Laser peripheral iridotomy (LPI) is used to treat angle-closure glaucoma. This procedure is used to create an opening through the iris, allowing aqueous humor to flow from behind the iris directly into the anterior chamber of the eye, allowing the fluid to bypass its normal route. This technique is commonly used to treat narrow-angle glaucoma and prevent angle-closure glaucoma attacks.
5. Transscleral cyclophotocoagulation is used to reduce the amount of aqueous humor in the eye by destroying the part of the ciliary body that produces fluid. This procedure is usually indicated in cases where an increase in IOP persists after other unsuccessful attempts at traditional procedures, or in which filtration surgery is not possible or feasible due to the shape or other features of the eye.

Risks of laser surgery. As with any type of surgery, laser surgery can carry some risks. Some people experience a short-term increase in IOP shortly after surgery. But using glaucoma medication before and after surgery can help reduce this risk. There is also a small risk of developing cataracts after some types of laser surgery. However, the potential benefits of surgery usually outweigh any risks, as the number of people cured of the disease has increased since the advent of these methods. ^[5][6][7][8].

Sanatorium treatment

Glaucoma is often associated with other chronic diseases, and also occurs in diabetes mellitus, atherosclerosis, vascular, metabolic, immunological disorders, etc. Their correct treatment is very important and is directly related to the success of treatment and glaucoma. At the same time, sanatorium treatment has an undeniable value in the treatment of glaucoma. The natural healing factors of the resort are combined with the therapy of all types of baths (carbon dioxide, hydrogen sulfide, bromine), which have a positive effect on the body as a whole and affect the state of the organs of vision and visual function. Patients with primary glaucoma in the early stages of development and with normal intraocular pressure are sent to climatic resorts, and patients are also rehabilitated here.

Contraindications to sanatorium treatment:

• significant changes in intraocular pressure with symptoms of vasoconstriction, complicated by myopia, which, in turn, is complicated by changes in the fundus (repeated hemorrhage, changes in the vitreous body);
• acute attack of glaucoma of any form and stage of development, with increased IOP, with pain, loss of visual function, as well as secondary uncompensated glaucoma ^[9].

Hydrotherapy in glaucoma

Hirudotherapy is a treatment using medicinal leeches. Hirudo medicinali have been used effectively in the treatment of a number of conditions for centuries. Currently, medical leeches are also used for glaucoma. In particular, they are used in the complex treatment of glaucoma, including the elimination of an acute attack and after antiglaucoma operations. Hirudotherapy contributes to the normalization of intraocular pressure, reduces pain in the eyes, improves blood circulation and hydrodynamics of the eyes, which in turn has a positive effect on the process of restoring visual functions in patients with glaucoma (expanding visual fields, increasing visual acuity) ^[10].

Physiotherapy methods for glaucoma

Physiotherapy for glaucoma is used for a general strengthening effect to relieve spasms, to reduce IOP, as well as to eliminate pain, improve the outflow and absorption of intraocular fluid, and reduce its formation. In general, physiotherapy improves blood circulation in the optic nerve and retina, which improves their functioning. Many patients use Vitafon, the effect of which is the impact of vibroacoustic waves. But this method is prescribed without fail only with drug therapy, and their selection is strictly individually carried out by the doctor. In addition, there are such methods as electrosleep, electrophoresis, mud applications, phonophoresis and others. These methods of treatment are not new, but can be very effective in combination with other methods. ^[11][12].

Magnetotherapy in glaucoma

Magnetotherapy is used in ophthalmology to reduce edema and corneal infiltration, as well as to absorb exudate. The magnetic field promotes regeneration processes, and also reduces IOP. Therefore, indications for magnetic therapy are glaucoma, retinal dystrophy, optic neuritis, traumatic iridocyclitis, and corneal erosion.

Magnetic therapy is contraindicated in various malignant neoplasms, acute purulent processes and severe hypotension. ^[13].

Ultrasound therapy

Ultrasound therapy is based on the impact of environmental vibrations with a frequency above 800 kHz. Ultrasonic energy affects the tissues of the eye, thereby increasing the permeability of the blood-ophthalmic barrier. It also improves blood circulation, normalizes metabolic processes in tissues. In addition, ultrasound treatment has anti-inflammatory, desensitizing, analgesic activity. Accelerates regeneration processes, resorption of infiltrate, exudate, cataract masses, and scar tissue.

There are the following contraindications to the use of this method: hypotension of the eye, intraocular recurrent hemorrhages, neoplasms ^[14].

Acupuncture for the treatment of glaucoma

One alternative treatment for glaucoma is acupuncture. It can be used along with other treatments. This method is very old, used in ancient China. Its essence lies in the fact that a puncture is made with needles of various thicknesses to a certain depth in order to activate bioactive points. This therapy is non-traditional and it is necessary to consult a doctor before using it. ^[15].

Treatment of glaucoma folk remedies

Many people note the effectiveness of the treatment of glaucoma with folk methods and homeopathy (for example, mummy treatment). Traditional medicine includes treatment with various lotions and compresses with herbs. But these appointments must necessarily go in combination with other methods of treating glaucoma: medication, surgery (surgery) or the use of a laser. For the treatment of folk remedies, compresses with nettle, lily of the valley flowers are most often used, you can also wash your eyes with aloe and make lotions using dill seeds. There are also various recipes that use honey, calendula and other herbs. The use of these folk remedies is effective, especially in the postoperative period, to speed up healing and recovery, and most importantly, such treatment is possible at home.

Recommendations for patients with glaucoma

Today, people are more and more interested in how lifestyle affects health. Several studies show that lifestyle factors can affect intraocular pressure. However, little is known about whether these factors contribute to the development (or worsening) of glaucoma. Sustained reduction in eye pressure is the most important part of glaucoma treatment, and lifestyle changes are only complementary. You can make a fairly large list of what should be avoided by patients.

First of all, patients with glaucoma are advised to reduce coffee consumption, since it has been found that the use of large amounts of caffeine contained in it increases IOP. Coffee consumers increase their risk if they drink five or more cups a day, or have a family history of glaucoma. Therefore, it is best to drink coffee in moderation and not consume caffeine before tonometry to avoid affecting IOP measurements. It is not known exactly how nicotinic acid affects IOP, but it is better to limit smoking. It is also better to remove alcohol from your life.

What might be more surprising is that even drinking water can increase IOP, but this is only if you drink a few glasses just a few minutes before the test, so you need to spread your fluid intake throughout the day.

Physical activity may have the effect of lowering IOP. But at the same time, they can probably lower blood pressure and blood flow to the optic nerve, so there are both pros and cons in general, although of course, exercise and light gymnastics are good for overall health and well-being. Therefore, you should always consult with your doctor to know what exercises and sports are compatible with glaucoma. ^[16].

Vitamins for patients with glaucoma

It is desirable for all patients with glaucoma to supplement the diet with foods containing vitamins C, A, E. Several nutritional supplements are sold as vitamins for the eyes. There have been clinical trials of eye vitamins or supplements that are used to treat glaucoma. One study found that taking folic acid may reduce the risk of certain types of glaucoma. Another showed that vitamin C may reduce the likelihood of glaucoma ^[17].

Dietary advice

The text is for informational purposes only. We urge you not to use diets, do not resort to any medical menus and fasting without medical supervision. Recommended reading: “Why you can not go on a diet on your own.” At the moment, there is little information about nutrition and its relationship with glaucoma. It has been found that trans fatty acids associated with higher cholesterol levels can damage blood vessels throughout the body, and this may play a role in optic nerve damage in glaucoma. By normalizing your diet, you can improve your overall health, including eye health.

Another type of food to avoid when you have glaucoma is foods or meals that are high in saturated fat. Studies have shown that a higher body mass index (BMI) may be associated with an increased risk of glaucoma and increased intraocular pressure. Foods to be limited include fatty meats such as beef and other red meats, especially lard should be avoided as a meal. Starvation with glaucoma will not help, you just need to make the right menu, and then you will be able to enjoy life ^[18].

Eye exercises

Physical exercises, massages are presented for informational purposes only. We do not recommend using them without a doctor’s recommendation. Recommended reading: “When can exercise and massages be a health hazard?”. Another way to improve vascular health is through exercises that improve blood circulation, they reduce the workload on the heart and increase breathing. Exercise can help fight glaucoma by lowering IOP slightly, but it needs to be done consistently to reap the maximum benefit. Exercise doesn’t have to be intense. The following exercise is recommended: tracing an imaginary number “8” (horizontal version, as a sign of infinity), about 20 centimeters from the eyes. It increases the flexibility of the eyes by relaxing the muscles. You need to follow the figure with your eyes, without moving your head, first in one direction, and then in the other. And don’t forget to breathe, relax, and blink from time to time to help your eyes relax. There are many different exercises and it is very important to work on yourself, and the doctor will help you choose the right and necessary ones.

Also great for relaxing the eyes is their massage: massage the critical points around the eyes with your fingers to relax the muscles. You just need to place your thumb under the eyebrow and over the inner corners of the eyes and rest on the forehead with the other four fingers. Then you need to press your thumb at this point and hold for 4 breaths ^[19].

Glasses and lenses

Glaucoma is one of the conditions that can cause or exacerbate painful photosensitivity (also known as photophobia) and a reaction to glare. This is primarily due to increased pressure in the eye, which can lead to a number of visual problems. Therefore, for patients with glaucoma, it is mandatory to wear special sunglasses, but heavily tinted sunglasses are contraindicated, as they strain the eyes and can increase pressure.

The best solution is to wear special green glasses that change the angle of light refraction. You can buy these glasses at a pharmacy or optician. Many patients leave positive feedback after the experience of their use.

Most patients with glaucoma must use eye drops for treatment. Most of them are consumed once or twice a day. Before use, it is preferable to remove contact lenses, because. some drops can damage them or provoke an infection. Also, contact lenses can prevent the complete penetration of drops into the eyes. However, there are special lenses for patients with glaucoma, they not only do not interfere with the flow of drops, but even improve their distribution in the eye. In addition, a new generation of lenses for patients with glaucoma has recently appeared, which are able to measure pressure in the eye using microsensors. ^[20][21][22].

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