Glaucoma

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: Glaucoma is a group of diseases characterized by structural damage to the retinal nerve fiber layer and optic nerve head, resulting in progressive visual field loss. The main mechanisms are optic nerve damage caused by mechanical and hemodynamic injury due to elevated intraocular pressure, reduced blood flow, and other factors.
• Main types (summary)
  • Primary open-angle glaucoma: The most common type. It is divided into glaucoma in which intraocular pressure rises due to increased resistance to aqueous humor outflow (high-pressure type), and normal-tension glaucoma, in which optic nerve damage progresses even though intraocular pressure remains within the normal range.
  • Acute angle-closure glaucoma: The aqueous humor outflow pathway becomes suddenly blocked, causing a rapid increase in intraocular pressure → severe eye pain, redness, decreased vision, headache, and nausea/vomiting. Emergency treatment is required.
  • Chronic angle-closure glaucoma: Closure progresses gradually, so there may be few or no symptoms.
  • Steroid-induced glaucoma: Increased intraocular pressure caused by long-term use of topical or systemic steroids.
  • Secondary glaucoma: Caused by other eye diseases, such as uveitis, cataracts, or retinal lesions.
  • Congenital (infantile) glaucoma: Increased intraocular pressure immediately after birth or during infancy, with symptoms such as photophobia, tearing, and corneal enlargement (enlargement of the black part of the eye).
  • Ocular hypertension: A condition in which intraocular pressure is high but there is not yet optic nerve damage or visual field impairment (follow-up observation is necessary).
• Main symptoms
  • Early stage (open-angle): Mostly asymptomatic (gradual loss of peripheral vision). Central vision is often preserved until the late stage.
  • Acute angle-closure: May be accompanied by extreme eye pain, severe headache, decreased vision, redness, nausea/vomiting, and rainbow-colored rings around lights (halos).
  • Late stage: Narrowing of the visual field (tunnel vision), interfering with daily activities, driving, and walking.

Treatment Methods (Including Standard Treatments and Precautions)

• Drug treatment
  • Mainly eye drops: Prostaglandin analogs (e.g., latanoprost) are commonly used as first-line drugs. Beta-blockers (e.g., timolol), alpha agonists, carbonic anhydrase inhibitors (topical/oral), and Rho-kinase inhibitors may be used in combination.
  • During an acute attack: Intraocular pressure is lowered immediately with oral or intravenous carbonic anhydrase inhibitors (e.g., acetazolamide), topical beta-blockers and alpha agonists, miotics (pilocarpine), and other treatments.
• Laser treatment
  • Selective laser trabeculoplasty (SLT): Used to lower intraocular pressure in open-angle glaucoma.
  • Peripheral iridotomy (laser iridotomy, PI): A standard procedure for preventing or treating angle-closure glaucoma.
  • Other treatments: Laser trabeculoplasty and others.
• Surgical treatment
  • Traditional surgery: Trabeculectomy and insertion of an aqueous humor drainage device (tube shunt).
  • Minimally invasive glaucoma surgery (MIGS): Intended to reduce intraocular pressure and the amount of medication used in moderate glaucoma.
  • In refractory cases and high-risk groups, the advantages and disadvantages of each surgery should be considered.
• Lifestyle management and supportive recommendations
  • Use eye drops regularly (follow the prescribed order and intervals for medications and eye drops), and have regular ophthalmology follow-up examinations (visual field testing, OCT, etc.).
  • An ophthalmology consultation is necessary when using topical or systemic steroids for a long period.
  • Monitor nocturnal hypotension (particularly when taking antihypertensive drugs): If nocturnal hypotension is present, the risk of glaucoma progression may increase.
• Precautions and risk of complications
  • If left untreated, glaucoma can cause permanent optic nerve damage and blindness.
  • Because drug side effects (local irritation, dry eyes, systemic beta-blocking effects, etc.) and postoperative complications (infection, hypotony, progression of cataracts, etc.) may occur, consult a doctor.
  • In an emergency (when acute angle-closure is suspected), visit an emergency room or ophthalmology department immediately.

Checklist Before an Outpatient Visit (Including Preparations and Example Questions)

• Items and records to prepare
  • A list of all medications and supplements currently being taken (including topical eye drops and steroids).
  • Copies of previous ophthalmology test results (visual field test results, OCT images/reports, intraocular pressure records), if available (these can be very helpful during the consultation).
  • A record of symptom changes: changes in the visual field, the time and frequency of pain attacks, times when vision decreases (morning/night, etc.), and whether nausea/vomiting occurs.
  • Family history (whether a parent or sibling has glaucoma), and a history of eye surgery or trauma.
• Information to tell the healthcare professional first during an outpatient visit (examples)
  • “Have you recently had eye pain or a sudden decrease in vision?”
  • “Are you currently using, or have you recently used, steroids (eye drops, oral medication, or inhaled medication)?”
  • “Are you taking heart or blood pressure medication, and do you have symptoms that could suggest nocturnal hypotension?”
• Preparing for examinations
  • Because fatigue and lack of sleep can cause errors in visual field testing and OCT, it is recommended to undergo these tests after getting sufficient rest.

Examples of General Questions to Ask the Doctor

• What are the main side effects and precautions for this medication (eye drops)?
• How advanced is my condition, and what is the prognosis?
• If intraocular pressure cannot be controlled with medication, when would the next step (laser treatment or surgery) be recommended?
• What precautions should I take in daily life (driving, exercise, alcohol consumption, bathing, etc.)?
• If a family member, especially a first-degree relative, has glaucoma, are preventive screening or treatment necessary?

Examples of Condition-Specific Questions

• Regarding normal-tension glaucoma/ocular hypertension
  • “My intraocular pressure is within the normal range, but I have optic nerve damage. What additional risk factors besides intraocular pressure should be controlled?”
  • “I have high intraocular pressure only, without any damage yet. Is preventive drug treatment recommended?”
• Regarding angle-closure glaucoma (possible emergency)
  • “What initial measures should be taken as an emergency if sudden severe eye pain, headache, or nausea occurs?”
  • “I had acute angle-closure in one eye. Is preventive laser treatment (iridotomy) also necessary for the other eye?”

(If necessary, preparing notes before making a medical appointment based on the questions above can make the consultation more efficient.)