A wonderful lady came to our office with her daughter. On examination we found she, the mother, had glaucoma. Unfortunately she had lost a lot of vision due to the disease. The daughter asked if she was predisposed to developing glaucoma and was there anything she could do to prevent it. This led us to educate her on the various nuances of the sight damaging malady Glaucoma. Here is a synopsis of our discussion.
Can glaucoma be prevented? Before you can prevent anything you have to understand what the entity is exactly. Let’s turn our attention towards the definition of glaucoma. It is defined as an increase in eye pressure leading to loss of nerve fiber layers that result in visual field damage: as demonstrated by a visual field examination.
Lets try to understand with a simple analogy. If the eye was a basketball and we kept filling it with air the increasing pressure would thin the wall of the ball. The layers making the wall would deteriorate. A similar process is happening in glaucoma. Instead of air we are dealing with eye fluid. Now we need to explore why does the eye pressure rise in the first place?
There are two types of glaucoma. One is angle closure and the other is open angle glaucoma. The etiology of each is different but the resulting mechanism of visual field deficit is through increased pressure.
So in essence, we need to study three things when you’re talking about prevention of glaucoma. One, can we prevent high pressure in the eye. Number two can we protect the nerve fiber layers and number three can we prevent the resulting visual field damage.
In narrow angle glaucoma we know we can prevent or treat increased eye pressure. This is achieved by using a laser to open another channel through the colored part of the eye called the iris. Another alternative is to replace the natural lens with a thinner synthetic biocompatible lens.
So yes that glaucoma can be prevented in these situations if intervention with laser or lens replacement is done at an appropriate time.
People with open angle glaucoma can lower the increased intraocular pressure by various new anti glaucoma drops. Another strategy is to use cool lasers to open up the angle of the eye. These lasers are different than the ones used in narrow angle glaucoma. If this modality of interference is not successful we can resort to stents akin to the ones used angioplasty of the heart. The final option is conventional glaucoma surgery with implants.
We have not forgotten about strengthening the nerve layer itself. In fact the protection of nerve fibers is the antithesis to the effects of raised eye pressure. There is tremendous ongoing research in this field. Vitamins rich natural green vegetables like spinach kale are considered neuroprotective. Colored fruits like carrots mangoes and nuts like almonds are also good for eyes. Increasing blood flow by regular excise provides nutrients to nerve fiber layer. Specific synthetic molecules are being studied. Another are of research is to investigate if alternate fibers can be employed for vision.
Remember, glaucoma is dangerous and we need to arrest its destructive march by all means possible.
She thanked us for this valuable discourse. I hope it’s equally instructional for you.