Treatment of Glaucoma at Okomedikas Clinic

Intraocular fluid is a source of nutrition for many structures inside the eye and a component that ensures the stability of its inner workings. It is involved in metabolism and plays a key role in maintaining intraocular pressure (IOP). An increased amount of fluid inside the eye and / or impairment of the normal aqueous humor drainage can lead to elevated intraocular pressure and cause glaucoma. Ophthalmologist, laser surgeon Vadym Gennadiyovych Pecherii will tell us how to prevent the risk of this dangerous disease, how to detect it early and treat it successfully.

Please explain in simple terms, what are the dangers of glaucoma and how glaucoma affects our eyes?

Glaucoma is a whole group of diseases associated with an imbalance between the amount of intraocular fluid produced and the amount that drains away. An increase in IOP causes damage to the optic nerve and leads to its gradual atrophy. This process is accompanied, in the first place, by narrowing of the visual field and decreasing light sensitivity, later people with glaucoma might suffer from poor visual acuity.

Today, glaucoma is the main cause of irreversible blindness in the world. It is very important to understand that our visual functions which we lose every day if we leave glaucoma untreated are lost forever. That is why the key to maintaining good eyesight, if you already have this disease, is its early detection and immediate treatment.

You said “a group of diseases.” What does it mean?

There are a huge number of forms of glaucoma, and symptoms of the disease are different for each individual. To put it simply, we distinguish three large groups: open-angle glaucoma (OAG), angle closure glaucoma (ACG) and glaucoma associated with developmental anomalies of the eye (developmental glaucoma).

The last, fortunately, is very rare and makes its debut at birth, in childhood or adolescence.

Angle closure glaucoma (also called narrow-angle glaucoma) is a much more common condition in Asian countries than in Ukraine. But It doesn`t mean that we can just ignore it. Among our patients, the risk group consists of farsighted people and those genetically predisposed. ACG often starts with a so called “acute attack”: severe eye pain accompanied by pain on the same side of the head, a red eye, blurred vision, a dilated pupil. The symptoms may also include high blood pressure, nausea and vomiting.

There is a risk that after calling an ambulance, the patients might end up at the department of neurology with a suspected hypertensive crisis or an acute cerebrovascular accident because of the similar symptoms. A patient experiencing the acute attack, can completely lose their eyesight in a matter of hours or days. It is a medical emergency and it must be addressed immediately.

Open-angle glaucoma, on the contrary, is called a silent killer of vision. Since it develops gradually and is not accompanied by any concrete complaints, it goes unnoticed for a long time and, as a rule, succeeds in causing significant damage to the optic nerve before it is detected. Often, OAG is found by accident when the patient visits a doctor in order to discuss their other disorders, during a preventive eye exam or a vision screening.

Regardless of the type of glaucoma, the principal method for saving the optic nerve is to reduce intraocular pressure to an acceptable level, i.e. the level well-tolerated by ocular structures.

Fortunately, Okomedikas Clinic has all the necessary equipment for detecting glaucoma and determining its type even at its earliest stages as well as for providing adequate medical care, including laser treatment of the disease.

What are the ways to lower eye pressure? What are the advantages of the laser treatment you mentioned?

Until recently, eye drops were the preferred method of lowering IOP. In Ukraine, there are at least 5 classes of medications which reduce IOP, but the absolute number of the drugs is huge. And among them we should not look for “good” or “bad”, “strong” or “weak”, “new” or “old”. For each individual patient, or should I say, for each individual eye, we must select the best medication or a combination of them, taking into account a type and a stage of glaucoma, the initial level of IOP, possible side effects, interaction with certain drugs and many other factors. Over time, new drug substances may appear, our patients may develop new diseases, so the prescriptions can change dynamically. In order to receive relevant and adequate treatment at any time, it is important that our patients get their eyes checked regularly by their eye doctor and that the course of their disease is monitored.

The problem is that not all patients adhere to the medical regimen recommended by their doctor. There can be many obstacles: from systemic financial and economic, organizational difficulties (having no money to buy the drugs, not all the drugs can be found at local pharmacies, etc.) to simple individual ones (forgetfulness, having trouble instilling glaucoma eye drops because of shaking hands, joint problems, many different eye drops should be used at different times, a patient makes their own decision to stop taking the prescribed drugs if side effects were manifested and many more). Treatment breaks, cancellation or replacement of prescribed drugs by a patient, poorly monitored glaucoma are the factors that significantly worsen the prognosis.

Laser treatment is more universal. Laser trabeculoplasty, for example, helps the vast majority of patients with open-angle glaucoma. At the same time, you don`t need to be afraid of possible adverse systemic side effects or undesirable interactions with other medications – they just don`t exist. Since 2019, in the UK they have begun to recommend laser surgery for glaucoma as the first-line treatment for almost all patients with the emerging disease.

Traditional glaucoma surgery can help in cases where other methods proved powerless. However, reduced patient safety and a relatively high incidence of complications (compared with the laser method) make us wonder if resorting to the surgery is really a good choice.

If we study the global trends of the past 15-20 years, we will see that the development of pharmaceutical and laser industry and technology has led to a reduction in the number of conventional glaucoma surgeries. This is a great example of how the development and implementation of new safe and effective technologies completely change the principles of health care delivery. And Okomedikas Clinic is ready to provide these changes both in terms of equipment and training of our medical personnel.