Glaucoma

Dr. Marco Lombardo and his staff offer a service of diagnosis and treatment to patients suffering from ocular hypertension and glaucoma. The screening and diagnosis of glaucoma is made through a complete eye examination and the execution of tonometry, corneal pachymetry, gonioscopy, computerized photographs of the optic nerve and computerized visual field testing. Patient care is offered in a personalized way, defining for each patient the most appropriate treatment.

Ocular Pressure

The consistency of the human eye is ensured by the intraocular pressure. The aqueous humor is a clear fluid, continuously produced by the ciliary body, which runs between the posterior chamber and the anterior chamber of the eye, coming in last filtered through the chamber angle. The loss of the balance between production and filtration of aqueous humor is responsible for ocular hypertension.
Normal values ​​of eye pressure are in the range of 16 ± 4 mmHg (Framingham Eye Study). Tonometer values ​​above 22 mmHg should be carefully evaluated.

What is Glaucoma?

Glaucoma is an ocular syndrome characterized by severe vision loss associated with degeneration of the optic nerve in the presence or not of high intraocular pressure. It occurs more frequently after age 40 and is the second leading cause of legal blindness in the western world.

There are different forms of glaucoma, in relation to age, type of onset, known causes. The open-angle glaucoma is the most common presentation of  the disease, followed by narrow-angle glaucoma, juvenile glaucoma and secondary glaucoma.
The most important risk factor of glaucoma is ocular hypertension; the risk increases with the increase of intraocular pressure (Baltimore Eye Survey). Other risk factors include genetic, the co-existence of vascular disorders such as diabetes, high blood pressure, retinal vein thrombosis and prolonged corticosteroid therapy.

A real symptomatology is “absent” in most cases. The evolution of the disease is insidious. The progressive damage of the optic nerve fibers results in a gradual amputation of the visual field (the field of view is the space that each eye can embrace with a look) with a significant reduction of its autonomy until optic atrophy with loss of visual function.

 

Paesaggio normale
Paesaggio Glaucoma
Simulated vision in advanced glaucoma. The field of view is restricted to a central area.

Diagnosis and treatment

The examination of the retina and optic disc with the measurement, in several sessions of control, a high pressure in the eye are unquestionably the diagnostic tests necessary to make a correct diagnosis of glaucoma. The measurement of corneal thickness (pachymetry) is an indispensable tool for glaucoma screening that must be associated with tonometry to confirm the measurements. The assessment of the state of health of the optic nerve requires the examination of the visual field by computerized automated perimetry.

Escavazione ottica glaucoma

Glaucomatous optic nerve

The purpose of glaucoma treatment is to reduce eye pressure. There are many drugs that can be administered in eye drops, which are effective in reducing intraocular pressure. It will be an eye specialist to manage the therapy in relation to the patient and the evolution of the disease.

Glaucoma is a chronic disease and as such requires a prolonged topical drug therapy. Surgery becomes necessary only if the drug therapy is not able to lower the intraocular pressure or to prevent the progression of optic nerve damage. The surgery has seen in recent years a plethora of new techniques less invasive than the trabeculectomy with an increasing use of “outflow valves”.

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