Glaucoma

Glaucoma is not a single disease, but a group of disorders that manifest themselves differently depending on the mechanisms involved. The most common type is open-angle glaucoma, which accounts for the majority of cases. It progresses slowly, gradually, and painlessly. In this form, the angle between the iris and the cornea remains open, but the drainage system for intraocular fluid (aqueous humor) becomes less efficient, leading to a gradual increase in intraocular pressure and damage to the optic nerve.

Conversely, angle-closure glaucoma is less common but more sudden. It occurs when the iris blocks the eye's drainage system, causing a rapid and painful increase in intraocular pressure. This form is considered an ophthalmological emergency because it can cause vision loss within a few hours. Symptoms include sudden blurred vision, intense eye pain, nausea, and the perception of colored rings around light sources.

There are also specific forms such as congenital 4, which is rare but serious and present from birth, and pigmentary glaucoma, caused by pigments from the iris that detach and block the drainage channels. Finally, there is normal-tension glaucoma, in which the optic nerve is damaged despite normal eye pressure.

In most cases, glaucoma develops without noticeable symptoms. This is particularly true for open-angle glaucoma and normal-pressure glaucoma. Vision loss begins at the edges of the visual field. At first, it goes unnoticed because the other eye compensates. Then, over time, “blind spots” (scotomas) appear.

Closely-angled glaucoma is characterized by sudden and intense symptoms. Patients may experience severe eye pain, blurred vision, headaches, nausea, and see colored halos around lights. This is an acute attack that requires immediate treatment.

Some variants have specific symptoms. Pigmentary glaucoma, for example, can manifest as halos or blurred vision after physical exertion. In normal-pressure glaucoma, the signs are similar to those of open-angle glaucoma, with progressive loss of peripheral vision, despite intraocular pressure within the normal range.

Glaucoma results from progressive damage to the optic nerve, whose function is to transmit light signals from the retina to the brain. In most cases, this damage is linked to increased intraocular pressure caused by poor drainage of the aqueous humor. Normally, this fluid is produced and eliminated in a balanced manner by a drainage system located at the angle between the cornea and the iris. When this mechanism is impaired, pressure increases and eventually damages the nerve fibers. However, eye pressure is not the only factor involved. Some patients develop the disease despite having normal IOP. Others, on the contrary, have high eye pressure without showing signs of glaucoma. These observations highlight the likely role of additional mechanisms, such as poor vascularization of the optic nerve or increased individual sensitivity.
Secondary factors can also cause glaucoma: eye trauma, intraocular inflammation (uveitis), prolonged use of corticosteroids, or certain anatomical abnormalities such as closure of the drainage angle. The exact mechanisms remain complex and multifactorial, involving structural factors of the optic nerve and disturbances in local blood circulation.

Although anyone can be affected by glaucoma, certain conditions significantly increase the risk of developing the disease. Age is a major factor: the risk increases after the age of 40 and becomes particularly pronounced after the age of 60. Family history also plays an important role. Having a close relative with the disease greatly increases the likelihood of being affected.

Ethnicity also influences prevalence: people of African, Afro-Caribbean, or Hispanic descent are at increased risk, with a frequency up to three times higher.

Other factors are associated with glaucoma, such as myopia, thin corneas, diabetes, migraines, and high or low blood pressure. Prolonged use of corticosteroids is also a known risk factor.

The diagnosis of glaucoma is based on a comprehensive ophthalmological examination. A simple screening of intraocular pressure (tonometry) is not sufficient, as some forms of glaucoma can occur even with normal pressure.
The examination includes several complementary steps: measurement of intraocular pressure, inspection of the drainage angle (gonioscopy), direct observation of the optic nerve, testing of the peripheral visual field, analysis of corneal thickness (pachymetry) and, increasingly, imaging of the optic nerve. The challenge is to detect structural and functional changes before symptoms become apparent to the patient. The absence of early signs explains why about half of those affected are unaware of their condition.

The main goal of glaucoma treatment is to preserve vision by slowing or stopping the progression of optic nerve damage. Since the damage that has already occurred is irreversible, treatment aims to maintain the remaining visual function. Treatment is based primarily on reducing intraocular pressure, regardless of its initial level.

Medications

The first line of treatment generally consists of eye drops. Prostaglandins are often preferred because of their effectiveness and ease of use, with only one daily instillation. They increase the drainage of aqueous humor and help reduce eye pressure. Beta-blockers and carbonic anhydrase inhibitors work by decreasing the production of intraocular fluid, while alpha-adrenergic agonists combine these two mechanisms.

Laser (trabeculoplasty)

When eye drops are not enough, other options are available. Laser trabeculoplasty aims to improve natural drainage by acting directly on the trabecular meshwork. This technique can be used as a first-line treatment or in addition to drug treatments. The effects of laser treatment are not always long-lasting and may diminish after a few years.

Surgery

In resistant or advanced cases, surgery is considered. Trabeculectomy, which involves creating an artificial drainage channel, and the insertion of drainage implants are among the standard procedures. More recently, minimally invasive techniques (MIGS) have emerged as an attractive alternative, offering an improved safety profile, although they are often less effective than more invasive surgeries.

Glaucoma progresses slowly but steadily if left untreated. Vision loss begins with peripheral damage, which often goes unnoticed because the other eye compensates. Gradually, the visual field narrows, forming tunnel vision, before leading to complete vision loss in advanced cases. This irreversibility highlights the importance of early diagnosis and monitoring. In addition to blindness, other complications may arise from the disease or its treatments, including adverse effects related to eye drops (redness, irritation, respiratory problems for beta-blockers) or surgery (risk of infection, ocular hypotension, or secondary cataracts).

There is currently no way to prevent glaucoma from developing. However, the progression of the disease can be slowed through regular screening, particularly for those at risk. Close monitoring allows glaucoma to be diagnosed before significant vision loss occurs. Recommendations include a comprehensive eye exam every 1 to 2 years after age 40 for people at increased risk (family history, ethnic background, diabetes, nearsightedness). Research is also focusing on neuroprotective agents, measuring their impact and protective capacity for different substances (such as Ginkgo Biloba and Omega 3, among others).

Certain situations require immediate consultation. Sudden eye pain, accompanied by sudden blurred vision, the appearance of colored halos around lights, nausea, or vomiting, typically corresponds to an angle-closure glaucoma attack. In general, any unexplained loss of peripheral vision, rapid changes in the visual field, or the perception of fixed dark spots should prompt a consultation. People with a family history or known risk factors should be particularly vigilant and undergo regular check-ups.

The ophthalmologists at Hôpital de La Tour offer glaucoma treatment using the latest diagnostic technologies and therapeutic protocols that comply with international recommendations. Patients receive personalized care from experienced ophthalmologists and have access to the full range of treatments available, including eye drops, laser therapy, and surgery, with the possibility of taking neuroprotective drugs.

Can glaucoma be cured?

No, there is currently no cure. Treatments can control eye pressure and slow down the progression of the disease, but any damage that has already occurred is irreversible.

Does glaucoma cause pain?

Open-angle glaucoma, the most common type, progresses without pain. However, a closed-angle glaucoma attack is accompanied by intense eye pain, blurred vision, and nausea.

Can you have glaucoma with normal eye pressure?

Yes. Some people develop glaucoma despite having intraocular pressure that is considered normal. This is called normal-pressure glaucoma.

What tests are used to screen for glaucoma?

The diagnosis is based on a comprehensive examination including measurement of eye pressure, observation of the optic nerve, visual field testing, and imaging tests.

What happens if I don't treat my glaucoma?

Without treatment, the disease leads to progressive loss of the visual field, then tunnel vision and, in advanced forms, complete blindness.

Does glaucoma affect one eye or both?

Glaucoma is usually bilateral, but it can affect the eyes asymmetrically, which delays the perception of symptoms.