What is GLAUCOMA? | Optometrist Explains

Heyo Antonio.

There are some things worth sharing, and

I believe the topic of
this video is one of them.

It's about glaucoma.

You may have heard of it when
visiting your optometrist or

you may perhaps have a relative
who is suffering from it.

But what is glaucoma?

And how can I prepare myself for
this disease?

So in this video,
we'll talk about what glaucoma is?

How common it is in the population?

And we'll explore how one
can be prepared for it?

Glaucoma is a progressive
neurodegenerative disease,

meaning that over time nerves or
neurons start to die.

It affects the optic nerve,
which is a large bundle of neurons

that transfer messages
from the eye to the brain.

In a nutshell, think of the eye as
a webcam connected to a computer.

In the case of glaucoma,

the optic nerve which are the wires
in the webcam, degrade over time.

And the information transfer between
the two parties become unreliable.

Although webcams can be easily
replaced our eyeballs are not and

repairing what is already
damaged is near impossible.

So it becomes paramount that we do our
best to preserve the remaining eyesight

we have, especially for
those that are more susceptible.

Glaucoma to this day is the leading
cause of irreversible blindness in

the developed world.

In the US, if you are above the age of 40,

then the likelihood of you having
glaucoma is roughly around 3.5%.

And while 3.5% doesn't sound like a big
number when you consider that irreversible

blindness is on the line, then 3.5%
suddenly feels like a huge number.

That's like saying if you
had a room of 1000 people,

35 individuals in that group will
eventually lose vision from glaucoma.

How about this?

50% of those in developed countries with
glaucoma are unaware of this disease,

meaning that out of the 35
that will lose vision,

only 17 of them are even aware of it.

Glaucoma treatments typically involve
the regular use of glaucoma medications to

lower the eye pressure.

Or as of recently, thanks to
the advancement of modern technology,

minimally invasive surgery
has gained popularity.

How do I know if I have glaucoma?

Are there any major symptoms
I should be aware of?

Surprisingly, for something as destructive
as glaucoma, it has almost no symptoms.

And you'll only notice changes
when it's already too late.

This is because you'll only have
vision changes once as many as 40%

of your ganglion cells have died.

A study in 2013 was conducted among 50
glaucoma patients to see what the world

looked from their perspective.

They were given the following selection
of photos to best describe what they see.

And the results are staggering.

About half of the participants
describe their vision as

having blurred parts in their periphery.

Followed by a quarter of
the participants describing no change

in their vision despite
having mild vision loss.

Which is to say that for those living
with primary open angle glaucoma,

they may not experience
any visual symptoms and

live a perfectly normal life despite
having a confirmed diagnosis.

However, if it goes unnoticed,
the vision loss can be blinding.

This is why it is so important for
us to be able to detect glaucoma and

monitor it, so
that these catastrophes do not occur.

What is the mechanism behind this disease?

Glaucoma is a neurodegenerative disease
like Alzheimer's, Parkinson's that kind.

For some unspecific reason,
the brain degenerates, leading to

either memory loss in Alzheimer's or
motor function in Parkinson's.

Same thing applies for glaucoma, for
some unspecific reason, the retina,

which is an extension of your brain,
degenerates, leading to vision loss.

At school,
we're taught that at the back of our eyes,

we have what is known as the retina.

It captures light and
delivers information to the brain.

The retina comprises of ten different
layers and six different types of cells.

Of those cells, glaucoma damages
the rational ganglion cells which

are located in these three layers,
also known as the ganglion cell complex.

The role of the optometrist or
ophthalmologist is to detect these

changes in the retina and optic nerve
to properly diagnose the disease and

consider treatment if necessary.

Over the years, health professionals have
been blessed with modern technology and

imaging techniques are getting better
at detecting glaucoma by the day.

Two pivotal machines that have
revolutionized the management of glaucoma

are the visual fields, which is a test for
your peripheral vision.

And the optical coherence
tomography machine,

which uses low frequency waves to
map out the retina and optic nerve.

They have become a quick, reliable, and
cost effective method for screening for

neuropathies such as glaucoma.

Several OCT scans across
time also allows you to

calculate the rate of
neuronal degeneration.

If the nerves are degenerating
quicker than normal, and

there are other risk factors
to suggest glaucoma,

then perhaps we must investigate
further as to how this must be managed.

The reason for why these neurons
degenerate is still up for debate.

However, the simplified mechanism of
glaucoma can be seen as a build up of

pressure in the anterior chamber,
leading to the damage of the optic nerve.

But we'll see in a minute
why this isn't 100% true.

To add a spanner into the works, there
are also different types of glaucoma.

And for this reason,
not being seen by an eye doctor can make

it really difficult to diagnose,
especially over the Internet.

The one thing I would like you to take
away from this video is that this

disease exists and that we should all be
ready to tackle it once it does attack.

And I would greatly appreciate it if you
could also show support by liking this

video for the algorithm so
that more people can see it and

subscribing as I guarantee
it'll be worthwhile.

So what are the first steps we
must take to prepare for glaucoma?

The first step is to look
at our risk factors and

have an overall idea as to how
susceptible we are to this disease.

The more risk factors we have,
the more likely we will develop glaucoma.

These risk factors include your age,
a family history of glaucoma,

your genetic background, and
elevated intraocular pressures.

Not to be confused with
high blood pressure,

because that has nothing to do with it.

The existence of any of these factors
might determine an individual's risk to

glaucoma, but they are not necessarily
the cause of the condition.

For example, you may have high
intraocular pressures but

never develop glaucoma at all.

But conversely, although rare,

may go blind despite having
normal intraocular pressures.

Historically, the belief around
glaucoma was that in the population,

older individuals with high intraocular
pressures were more susceptible to

glaucoma.

However, recent studies have also
shown that a large proportion of these

POAGs do not have high
intraocular pressures.

In fact, in Asia, about 76% of those with
glaucoma did not have elevated pressures,

while in Africa,
57 % of those with POAG did not.

And in the Caucasian population, about
a third of glaucoma was not associated

with high intralocular pressure.

Perhaps a stronger determinant
of risk is the family history.

The more family members
you have with glaucoma,

the more likely you will also have it.

A paper published in 1994
states that having a sibling

with glaucoma increases your
odds by almost four times,

while having a parent with glaucoma
increases your odds by 38%.

And a paper in 2007 from
Tasmania concluded that 60% of

patients in their study also had
a family member with glaucoma.

Regardless of how many relatives
you have with this disease,

it is always a good idea to have
your eyes tested at least once.

Optometrists will assess
the various risk factors and

give you a more accurate probability.

Keeping a record of your optic nerve and

eye pressures in the form of
routine eye tests is also crucial.

As gradual changes in the eye can be
monitored through regular intervals,

rather than large changes
across longer time frames.

Can glaucoma be treated?

What treatments are there at my disposal?

Depending on where you are around
the world, diagnosis and

management of glaucoma can be different.

But there are a few solutions
that are available and

they all have a common goal, which is
to lower the intraocular pressure.

These include the use of
glaucoma eye drop medications, or

alternatively, surgery involving lasers or
stents.

Once the pressures are under control,

the rate of neuronal degeneration
should slow down, and ideally stop.

What creates this pressure
in the first place?

You see,
the eye has a system of creating and

draining fluid which helps facilitate
nutrients in the anterior chamber.

The fluid, which is known as aqueous
humor, is created by the ciliary body.

And it makes its way through the pupil
to finally be drained by the trabecular

meshwork.

If the production of fluid exceeds the
drainage, then you have pressure buildup.

The glaucoma eye drop medications help
reduce the production of aqueous humor.

And surgeries are typically aimed
at increasing the drainage outflow.

But there you have it, a very quick
summary of what glaucoma is and

how it should be managed.

If you learned something new or
at least found something useful,

then yay, thumbs up to you.

If you want to thumbs up back then
they'll be greatly appreciated.

Subscribe if you haven't already and
I'll see you in the next video.