Glaucoma Care and Therapies

Can glaucoma be cured?

There is no definitive cure for glaucoma, but the disease can be slowed down. It is important to undergo regular eye checks to avoid late diagnosis. According to the World Health Organization, 50% of patients do not know they have glaucoma and arrive at the ophthalmologist when the situation is compromised.

Therapies indicated for glaucoma

To slow down the progression of glaucoma, it is primarily essential to decrease intraocular pressure. The therapies to control glaucoma are as follows:

• pharmacological therapy, with the use of eye drops to decrease ocular pressure or damage to the visual field ad hoc. Eye drops must be prescribed under strict medical control;
• parasurgical treatments such as laser. There are several laser treatments to reduce ocular pressure. The glaucoma specialist will be able to recommend the type of laser most suitable in relation to the type of glaucoma;
• minimally invasive surgery treatments, with the latest generation of draining devices. These draining implants allow a controlled outflow of aqueous humor and restore the correct ocular pressure, ensuring an excellent safety profile for the patient in terms of postoperative complications.

Pharmacological therapy

Eye drops for glaucoma

With a diagnosis of Glaucoma, the first and simplest cure to adopt is the prescription of eye drops. Eye drops lower the pressure of the eye and promote its drainage. Eye drops can in some cases have side effects such as burning, tearing, redness of the eyes or alterations in blood pressure and/or asthma attacks and cough

Parasurgical treatments

There are several types of laser treatment for Glaucoma.

• Trabeculoplasty: with this treatment, the outflow of aqueous humor from the inside of the eye is facilitated, thus reducing the pressure of the eye. It can be performed with the micropulsed laser (MLT) or with the selective laser (SLT) and allows the eye’s drainage channels to be freed. The success rate is high and the ocular tone tends to return to normal values. It is important to carry out periodic checks because over time the pressure can rise;
• Yag Laser Iridotomy: with this treatment, new discharge channels are created for the liquid present inside the eyes. This technique is mostly used in narrow or closed angle Glaucoma. For both of these laser treatments, hospitalization is not required. The patient goes to the ophthalmology clinic after the instillation of a few drops of anesthetic eye drops. You sit at the laser device, a lens is applied to the eye and a series of light pulses are directed to the areas to be treated. The intervention is totally painless, the eye does not need to be bandaged and after a check of the ocular pressure the patient can go home.

Minimally invasive surgery treatments

• Draining valves (Ahmed): the draining valves are effective in advanced glaucoma or when trabeculectomy fails. The most widespread valve is the Ahmed valve. They allow through the insertion in the eye of a discharge tube to vent the diseased eye and maintain ocular pressure at acceptable levels.

News in surgical therapy

Surgical therapy in glaucoma is indicated when, despite the treatment of glaucoma with drugs or laser intervention, the pressure remains high and progressive damage to the optic nerve is observed. The latest news for the treatment of glaucoma are:

• Modern miniaturized stents, which are inserted inside the eye to promote the outflow of water from the eye;
• Neuroprotection: the therapeutic strategy that aims to keep neurons alive and improve their functionality. By associating therapy with eye drops with neuroprotection, the patient’s visual functionality is preserved, which is the main goal in the treatment of glaucoma.

Gene therapy

Gene therapy could allow to recover sight – at least in part – in an eye affected by glaucoma. A study, appeared on the pages of the journal Nature Communications in November 2020, highlighted the benefits of a gene therapy strategy, tested on cell cultures and in animal models, on the regeneration of damaged axons of the eye, thus laying the foundations for the development of new therapies against glaucoma.

(Source: Osservatorioterapieavanzate.it)

Prevention and sports activity

The adoption of correct lifestyles is of primary importance for the prevention of glaucoma. Constant physical activity (at least 30 minutes a day) increases the oxygenation of the retina and contrasts the formation of free radicals in the central nervous system, of which the eye is part. Even those who have already contracted glaucoma will benefit from physical activity. Those who move continuously decrease the rate of disease progression by up to 10%.

The most suitable activities are running, swimming, cycling and tennis: aerobic activities improve blood circulation within the eye. Those who already have glaucoma should avoid weight lifting, very strenuous gym workouts and some positions with the head held too low. (For more information:Aisglaucoma.org)

Glaucoma: Attention to Yoga and some Sports

Those affected by glaucoma must pay attention to certain sports and some Yoga positions. Sports activities where the head is lower than the body are associated with an increase in venous pressure in the head. This results in an increase in ocular pressure. Ocular pressure increases particularly during the execution of the downward-facing dog position.

Prevention and nutrition

Even nutrition can help to control the occlusion of the blood vessels that causes glaucoma. Following a healthy and balanced diet is always important. In this case, it is recommended to eat a lot of fruit and vegetables and especially spinach, salad, broccoli and cabbage. Another suggestion is to avoid as much as possible alcohol, caffeine and fizzy drinks. It is essential to drink instead many healthy liquids, such as water or natural juices.

Some simple exercise that helps prevent eye diseases

Small massages, voluntary blinking or fixing the gaze on a point are habits that help prevent visual fatigue and the problems associated with it.

Recommendations by AISG – Italian Association for the study of Glaucoma

AISG recommends the following for the purpose of a prompt and correct diagnosis of glaucoma or risk of developing glaucoma and for the purpose of better disease management.

1. The healthy individual must visit the ophthalmologist at least bi-annually starting from 40 years of age (those who have a positive familiarity for glaucoma will have to start visiting at a young age);
2. myopic people are advised to visit already from 20 years of age, but it is also true that those who are myopic will tend to visit more frequently and earlier especially for visual problems;
3. realize that in the most appropriate management of glaucoma it is necessary to achieve a reduction in ocular pressure that is clinically significant and whose absolute value depends on various factors (stage of the disease, baseline values of ocular pressure, concomitant risk factors, life expectancy of the patient and speed of any worsening of the functional damage of the visual field over time);
4. realize that when glaucoma worsens it means that the ocular pressure is not optimal and must be further lowered, which often involves the need for surgery;
5. remember that today it is possible to try to obtain greater resistance of the nerve structures that are damaged during the course of the disease with specific neuroprotective molecules, whose use, in support of the traditional and necessary hypotensive therapeutic strategy, could help slow down the possible progression of functional damage.

Optical solutions for glaucoma

FONDA has devised a series of technological solutions to help people with glaucoma see better. These solutions include reading glasses, distance glasses, and glasses with high retinal protection lenses.