Medical supervision and following the appropriate guidelines can keep glaucoma inactive and minimise its effects on the optic nerve.

1. Anticipation is vital  

People at risk of glaucoma can end up developing it if they are not treated. Periodic check-ups and, if necessary, advanced treatment are our best course of action.

2. Correct diagnosis

Beyond the measurement of eye pressure, patients with signs of glaucoma are subjected to a pachymetry. This is a test that measures corneal thickness, which determines the right pressure for each patient.

3. Follow the instructions of your ophthalmologist

When glaucoma is diagnosed, it is necessary to monitor it continuously and to keep taking the medicines you have been prescribed. If you suffer from glaucoma and you have been prescribed medication, follow the instructions.

4. Inform your medical team about it

Your doctors should be told that you suffer from glaucoma and about the medication you are taking. And if you are experiencing side effects, let your ophthalmologist know.

5. Watch your diet

The right diet, containing omega-3, vitamins C, E and B1, DHA and antioxidants, can help to improve your visual health. You should also avoid consuming trans fat and too many carbohydrates.

6. Lead a healthy life

Look after yourself. Do moderate aerobic activities.

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To mark World Glaucoma Week, the Institut de la Màcula conducted an awareness campaign in conjunction with Farmaoptics and the Teknon Medical Centre. We describe its most important features below.

What is glaucoma?

Glaucoma is a disease of the optic nerve that, if untreated, leads to irreversible deterioration in vision that can cause blindness. It has a prevalence of 2% in the over 40s. At present, it is the second cause of blindness in the world.

There are two types of glaucoma, depending on whether the eye’s filtering system (camerular angle) is open or not: Open-angle glaucoma and narrow-angle glaucoma.

Principal risk factors

The most common risk factor tends to be intraocular pressure that is higher than the structure of the optic nerve can withstand. This leads the nerve to lose fibres and the patient’s peripheral vision to be affected. 70% of cases are usually associated with a high intraocular pressure while 30% correspond to normal pressures in sensitive eyes.

Other risk factors include: myopia, thin corneas, race and the taking of corticoids.

Symptoms

In most cases, glaucoma shows no symptoms. The loss of lateral vision that occurs in the disease usually goes unnoticed, particularly at first. Sometimes, patients experience a certain clumsiness on going down stairs or difficulties in recognising obstacles on either side of them. Often they do not relate these with visual problems and therefore many patients do not see a doctor until the disease is very advanced and affects a great part of vision. It is calculated that approximately half of patients with glaucoma are unaware of it.

Glaucoma in initial stages GIVES NO WARNING: THERE ARE NO SYMPTOMS

If UNTREATED, it causes VISION LOSS and BLINDNESS

VISION lost due to glaucoma CANNOT BE RECOVERED

Diagnosis and treatment

At present, it is vital to view the structure and function of the optic nerve in diagnosis and not only to take the patient’s intraocular pressure.

Today, it is impossible to recover the nervous tissue that has been adversely affected prior to diagnosis, but it is possible to prevent the damage to the nerve from progressing. Once the disease is established, the reduction of intraocular pressure is the only treatment capable of halting its progression. To attain this reduction hypotensive eye drops are used at first. If this is not enough, other surgical procedures or lasers can be used.

Glaucoma is a chronic disease that requires lifelong monitoring to ensure that it does not progress.

How to manage glaucoma?

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وتبدو كل هذه الأرقام واضحة لكن الأسوأ هو مايتعلق بوعي الذين يعانون من هذا المرض. حيث يعتبر  الزرق مرضا صامتا، إلى درجة أنه يعتقد أن أقل من نصف المصابين فقط، يعرفون حالتهم، في البلدان المتقدمة. ويكتسي هذا الجانب أهمية بالغة، إذ يمكن السيطرة على مرض الزرق ولاسيما في مراحله الأولى، لكون الضرر الذي قد يحدثه لا رجعة فيه، بسبب استحالة إعادة توليد أنسجة العصب البصري المتضررة بالمرض بواسطة التقنيات المتاحة في الوقت الراهن.

الحل في الوقاية

وبالتالي فإن الحل يكمن في الوقاية، أي في الفحوصات الروتينية التي تسمح باكتشاف وكبح مرض الزرق قبل إضراره بالعصب البصري.

هناك صنفان من مرض الزرق وذلك حسب نظام الترشيح في العين (زاوية كاميرول) وإذا ما كانت مفتوحة أم لا. ويتم ربط 70 %  من الحالات بالضغط المرتفع  داخل العين، في حين أن 30 % من الحالات تعود إلى ضغط عادي في عيون حساسة. وتصل نسبة الإصابة بالمرض حوالي 2 %  بين المرضى الذين تتجاوز أعمارهم 50 سنة.

حملة Farmaoptics و المركز الطبي Teknon-Grupo QuirónSalud

وقد بدأ مركز البقعة الصفراء (Institut de la Màcula)  بلتزامن مع اليوم العالمي والأسبوع العالمي لمرض الزرق، حملة مشتركة مع Farmaoptics والمركز الطبي Teknon-Grupo QuirónSalud من أجل توعية السكان بخصوص ضرورة إجراء مراقبة دورية بهدف الكشف عن مرض الزرق. وبنفس مستوى أهمية التشخيص، هناك متابعة وعلاج المصابين بالمرض.

العلاج

تعتمد علاجات مرض الزرق على مراقبة الضغط داخل العين. ويتفاوت الضغط الأمثل من مريض لآخر، لكن المهم هو الحفاظ عليه في مستويات تسمح باستمرارية بنية العصب البصري بشكل مستقر في الزمن. ويقوم الفريق المتخصص في مرض الزرق في مركز البقعة الصفراء (Institut de la Màcula )، تحت قيادة الدكتورة مارتا باثوس بمتابعة دقيقة لمرضانا، من خلال أحدث وأوثق الأدوات والتقنيات والمعارف العلمية.

The post لا تغفل عن مرض الزرق appeared first on Institut de la Màcula.

Dr. Marta Pazos presented the paper Mathematical modelling in glaucoma at the 2016 Congress of the European Association for Vision and Eye Research (EVER), held in Nice. This is the forum organised by Europe’s leading ophthalmological research association and it covers all areas of the visual sciences. Dr. Pazos’s lecture took place at a Special Interest Symposium (SIS) that presented recent studies focused on mathematical and automatic methods to quantify both the structural and cellular changes appearing in the retinal layers and the optic nerve in animal models of glaucoma.

Developments in image analysis technologies have enabled more precise and objective study of the morphological changes associated with glaucomatous optic neuropathy

The Institut de la Màcula’s glaucoma specialist explained how developments in image analysis technologies have enabled more precise and objective study of the morphological changes associated with glaucomatous optic neuropathy (GON). All GONs share, as a distinctive feature, a progressive loss of ganglion cells (RGC) and their axons with the presence of defects in the field of vision, structural and molecular changes in the optical disc and other cellular responses in the whole of the retina. A good understanding of the changes that occur in the optic nerve in experimental glaucoma (the one that occurs in animal models) is key to understanding the development of the disease in humans.

Apart from her presentation, Dr. Pazos moderated a poster session.

At present, EVER has over 850 members from 48 countries worldwide. It represents 11 scientific sections, ranging from epidemiology to optics, the cornea to the retina, and from immunology to genetics. One of EVER’s main activities is the organising of high-level scientific meetings.

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World Glaucoma Week is held on 6-12 March to make people aware of how important it is to detect the disease early. The second cause of the blindness throughout the world, glaucoma is estimated to produce visual impairment in some four million people and this number is expected to 11,200,000 by 2020. Glaucoma progressively damages the optic nerve and is caused mainly by an increase in intraocular pressure. This translates into a loss of peripheral vision, although the patient is unaware of this in the disease’s initial stages. This is why since 2004 World Glaucoma Week has promoted the slogan Beat the Invisible Glaucoma, which has become a recurrent argument around the world.

Information campaigns have been conducted across the globe to mark World Glaucoma Week. They include this one by the association Thai Glaucoma, which advocates the accompanying of the elderly, the need for periodic check-ups and the right treatment to minimise the damage this condition causes:

https://youtu.be/cFrz07HLBdk

World Glaucoma Week is a joint initiative of the World Glaucoma Association (WGA) and the World Glaucoma Patients’ Association (WGPA). It aims to eliminate glaucoma blindness through regular check-ups, including those of the optic nerve. Recommended frequency varies with age:

• Under 40 years old, every 2, 3 or 4 years.
• From 40-54, every 1, 2 or 3 years.
• From 55-64, every year.
• Over 65, once or twice a year.

These frequencies vary according to the patient’s characteristics. The specialised glaucoma unit at the Institut de la Màcula gives advice on the tests needed at any time and the possible treatments that should be applied.

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For many people, the arrival of summer is synonymous with holidays, hot weather and open-air activities. For patients with glaucoma, the season may bring a variety of challenges and lead to doubts that we hope to resolve in this post.

Glaucoma and sunlight

Ultraviolet light can cause damage to the eyes without the right protection. Light is reflected off surfaces like water or sand and can cause burns in the surface structures of the eye (the conjunctiva and the cornea). When there is exposure over a long period, damage to more internal structures, such as the crystalline lens or the retina, has been described.

The specific case of glaucoma also involves the sensitivity to light and the tendency to be dazzled that these patients usually experience. These symptoms may be considerably improved by wearing good-quality sunglasses and a double-brimmed or peaked hat.

Glaucoma and flying

Patients sometimes ask whether the changes in atmospheric pressure during a regular flight can affect glaucoma. In fact, changes in pressure inside the cabin are rigorously controlled these days and are made very gradually as the plane climbs and descends. As a result, the effect on eye pressure (intraocular pressure) is almost non-existent. However, these changes act on the volume of gas in the air, which could affect patients who have recently undergone retina surgery. Surgeons sometimes leave a gas bubble to keep the retina in its place. This may last for 6-8 weeks and can expand with altitude changes, increasing intraocular pressure suddenly.

In general, patients who have undergone retina surgery and who have received gas are advised that flying during these months is contraindicated. These gases are not used in glaucoma surgery and therefore such patients do not usually face restrictions when flying. In any event, it is best to ask the ophthalmologist before travelling, above all when surgery has taken place recently, in order to make sure.

In any case, the air inside the cabin is normally very dry. This means that it is recommendable to use artificial tears, especially in patients with glaucoma who take drops chronically and who show a greater tendency to suffer from dry eye. Likewise, we recommend that –just like any other medication- they always carry glaucoma drops in their hand luggage to avoid missing doses in the case of delays, longer flights or loss of luggage. The bottle should be closed to avoid spillages and kept in a cool place to avoid overheating.

Summer and glaucoma drops

Changes of locality can make adherence to the treatment more difficult and can lead to doubts about storing glaucoma drops. Most pharmaceutical companies recommend keeping the drops at 15-25ºC, so if we are travelling to warmer zones we should try to prevent the drops being exposed to direct sunlight and keep them in a cool place when we arrive at our destination. The instruction leaflet normally explains how a medicine should be kept. If you are still unsure, you can ask your chemist or find out on the website of the pharmaceutical company involved.

Picture: Lovely beach by Luke Ma.

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Drops are the most common treatment for reducing intraocular pressure (eye pressure) and are often the first therapeutic option when glaucoma is diagnosed. It is the ophthalmologist who will inform us which type of drop we need to apply and how often a day we should do so.

Despite being applied topically –directly into the eye– we should not forget that these drops are medicines and should therefore be used in a specific way (one or more times a day depending on the active ingredient). Nor should we forget that they may have side effects (especially eye irritation, dryness, red eye etc.).

As glaucoma is a chronic illness, drops must be applied for a long time, possibly years. It is most important to apply the treatment correctly as proper control of intraocular pressure is the only method that has been shown capable of halting glaucoma.

Here is a short set of recommendations that may help us with the treatment:

1. Follow the instructions of the ophthalmological specialist
It is the ophthalmologist who will inform us which type of drop we need to apply and how often we should do so. Some drops are more effective in the morning (e.g. timolol) and others at night (e.g. latanoprost). In addition, the more advanced the glaucoma the lower the eye pressure needs to be. This may mean that more than one medication needs to be taken.

2. Tricks to help us remember to take the treatment
Often the most difficult part of the treatment is remembering to apply the drops when required as this may be at a set time of day (morning, night etc.) If we get used to inserting the drops at the same time as we perform a daily activity (e.g. putting on cream in the morning, cleaning our teeth or leaving the drops on the bedside table by a book we read before going to sleep etc.), it is much easier to remember to carry out the treatment properly.

For technology fans, a good idea is to make use of our mobile phone alarms or smart apps that inform us when it is time for our drops (e.g. EyeDROPS)

*What to do if we forget?
If we forget to take drops and a short time has elapsed (e.g. one or two hours), we should administer the dose and continue normally with the treatment. If a longer time has passed (four or five hours), it is better to wait until the next dose. 

3. Adopt the right technique
Doing this right will ensure the drops enter properly and the intraocular pressure is better controlled.
• Wash your hands properly 
• Move your head backwards slightly whether you are seated, standing or lying down. Gently press your lower lid downwards with your index finger to form a small “pocket”.
• Look upwards. Press the bottle until a drop comes out and falls into pocket of the lower eyelid. Do not blink, do not rub your eye and do not allow the tip of the bottle to touch your eye.
• Close your eye as if you were asleep. Keep your eye closed for two or three minutes without blinking. Gently press the inner corner of your eye (the area of the lacrimal point) with your index finger and thumb for these two or three minutes (this will reduce the amount of drops that enter the throat and go on to the rest of your body).
• Remove any remaining product around your eyes with a gauze cloth.
• If you need to insert another drop, you must always wait at least five or ten minutes between the two. This will prevent the second drop from washing the first away and will ensure that the treatment is effective.

Fig.1 Drawing of the correct technique for inserting the drops (Source: Glaucoma Research Foundation: www.glaucoma.org)

4. Store the drops properly
It is important to keep the bottle for as long as the medicine lasts and throw it away when it is out of date or it has been open for 28-30 days (depending on the drug). After this time, the efficacy of the drops cannot be ensured. We should keep the bottle clean and take care to avoid direct contact with the eye and the face as it could become contaminated. The medicine should be rejected if it changes colour as it could be spoilt. It should not be directly exposed to sunlight nor to a high temperature (preferably at 20-25º). Most drops should be stored at room temperature in a cool place.

*Points of interest: 
• Some drops must be kept in the fridge in exceptional circumstances.
• Monodose drops are appearing increasingly on the market (i.e. instead of a bottle that lasts a month, these are in a box with thirty individual miniature bottles). This system is more hygienic as we open a bottle each day and then throw away the remains, minimising the risk of contamination. In addition, they can help us to remember to take the treatment as there is a miniature bottle for each day and it is more evident when we have forgotten a dose.

5. Look out for side effects
Drops are medicines and we should treat them as such. It is important to make sure that our ophthalmologist is aware of any disease we suffer from and of any other medications we are taking. Each type of medication has its possible side effects that need to be taken into account and discussed with the patient without forgetting that control of pressure is vital to maintain visual function.

Most glaucoma drops produce minor side effects such as eye irritation, dryness, slightly red eye etc. If new symptoms appear on starting new drops for eye pressure it is important to tell the ophthalmologist.

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World No Tobacco Day takes place on 31 May to raise awareness among the population of the negative factors of smoking. Smoking is a global epidemic that kills almost six million people each year. Ten per cent of them (600,000) are non-smokers who die as a result of breathing the smoke of others[1].

Everyone knows that tobacco smoke causes a great number of highly-differing pathologies: respiratory problems, cardiovascular problems, cancers etc. However, few of us are aware that tobacco also affects eyesight and does so in a particularly destructive way.

With regard to glaucoma, a variety of studies have found a significant association between high exposure to tobacco and the appearance of the disease[2], together with the possible increase of intraocular pressure in patients who smoke[3] [4]. If we add to this its harmful effect on ocular blood supply[5], which also includes the circulation of the optic nerve and its fibres (where damage by glaucoma occurs), it almost goes without saying that any patient with glaucoma should be advised to give up smoking.

You will see, therefore, that tobacco, as well as causing millions of deaths annually, can also leave us in the dark.

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We at the Institut de la Màcula implemented an awareness campaign to draw everyone’s attention to the importance of early detection in glaucoma. Now that the campaign is over, all that remains is to congratulate ourselves and, it goes without saying, all of you. Thanks to everyone, the campaign has been a success and therefore we would like to express our gratitude for placing your trust in us.

On the days when we conducted early detection tests, both at the Institut and at the different Ecoceutics pharmacies, we attended to 120 patients. Of these, 20% have an increased risk of suffering from glaucoma. This is why we recommended that they make an appointment to see their eye doctor.

This type of campaign is virtually essential to make people aware of the importance of glaucoma. The fact that one of every two sufferers are unaware of it means that we cannot just stand by. That is why it is so important not to lose sight of the disease, not just on red-letter dates like World Glaucoma Week.

You can see a video he video from the Institut open house held on 10, 12 and 17 March: 

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The Institut de la Màcula is joining World Glaucoma Week, which will be held from 8-14 March to coincide with World Glaucoma Day on 12 March.

What is World Glaucoma Week?

World Glaucoma Week (8-15 March 2015) is an initiative of the World Glaucoma Association (WGA) and the World Glaucoma Patients Association (WGPA) to raise public awareness about the disease and promote initiatives for its early diagnosis, given that over half of sufferers are unaware of it.

Most of the population do not know the consequences that glaucoma may cause and are unaware that early detection could reduce the impact of the pathology.

Activities at the Institut to mark World Glaucoma Week

Consequently, the Institut de la Màcula plans to join the initiative of World Glaucoma Week by organising a series of activities to raise awareness about the disease and highlight the importance of undergoing diagnosis and early treatment.

• Open-door campaign at the Institut de la Màcula.
  • During World Glaucoma Week, free examinations will be provided by appointment at the Institut to determine the risk of glaucoma. From the age of 40, it is almost essential to undergo complete periodic eye check-ups that include the measurement of eye pressure and assessment of the optic nerve. A special call goes out to those patients who have suffered from high eye pressure at some time, those people who are over 60 years old and those with a family history of the disease.

• Campaign with Ecoceutics Pharmacies
  • Training pharmacists to publicise and raise awareness of glaucoma.
  • Screening campaign with Institut personnel at Ecoceutics pharmacies. Find out which pharmacies will provide free early detection tests.

You can learn more about glaucoma in the graphic.

Don’t Lose Sight of Glaucoma!

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