Medical experts talk about popular science | Doctors and patients work together to fight glaucoma

Glaucoma is the world's leading irreversible blinding eye disease and a lifelong disease. China has the largest number of glaucoma patients in the world. The blindness rate of glaucoma is 11.1%-22.6%. If it can be diagnosed early, intervened early, and followed up long-term, it can delay or block progressive optic nerve damage for many glaucoma patients, reduce the blindness rate, and improve the quality of life of patients. Therefore, the diagnosis, treatment and management of glaucoma are extremely important, and defeating glaucoma requires doctors and patients to work together. The following is some knowledge about glaucoma.

| What is glaucoma

Glaucoma is a group of diseases with characteristic optic atrophy and visual field loss as common features, and pathological increase in intraocular pressure is its main risk factor. In other words, glaucoma first causes damage to the visual field. Therefore, clinically, some patients have a central visual acuity of 1.0, but their visual range has been narrowed.

| Symptoms of glaucoma patients

The clinical symptoms of glaucoma are related to its different types and stages. Acute angle-closure glaucoma attacks will cause severe eye pain, headaches and a sharp decrease in vision, while open-angle glaucoma may not have any symptoms in the early stages and will not be discovered until the late stages when vision is severely reduced. This requires us to screen high-risk groups.

| People who need glaucoma screening

High-risk groups include those with high intraocular pressure, advanced age, high myopia, high hyperopia and family history. In addition, conditions that cause insufficient blood supply to the optic nerve, such as high blood pressure, diabetes and high blood lipids, are also risk factors for glaucoma. It is recommended that high-risk groups take the initiative to go to the hospital for screening every year.

Basic checks to be carried out

1. Intraocular pressure: It can be measured with a tonometer. The normal value of intraocular pressure is 10-21 mmHg. Generally speaking, the higher the intraocular pressure and the longer it lasts, the greater the risk of optic nerve damage. However, in clinical practice, high intraocular pressure is not necessarily glaucoma, and normal intraocular pressure may also be glaucoma. Therefore, the diagnosis cannot be made based solely on intraocular pressure values, but also requires a comprehensive judgment based on the fundus, visual field, and chamber angle.

2. Fundus: Methods for detecting changes in the optic disc of glaucomatous eyes include direct ophthalmoscope, slit lamp pre-lens, fundus photography, etc. Changes in the optic disc of glaucomatous eyes are the objective basis for diagnosing glaucoma. A photo of the optic nerve can help you know about glaucoma early.

3. Visual field: Visual field can be checked with a perimeter. Visual field changes are the gold standard for diagnosing glaucoma. The MD value of the visual field test results can be used as an indicator for diagnosis, staging, and follow-up.

4. Angle of chamber: The instruments for checking the angle of chamber include gonioscope, UBM and AS-OCT. The opening or closing of the angle of chamber is the basis for diagnosing open-angle glaucoma and angle-closure glaucoma.

| Treatment of Glaucoma

Treatments for glaucoma include medication, laser, and surgery, with the goal of lowering intraocular pressure to the target intraocular pressure and preserving visual function. Some glaucoma patients may need long-term medication even after surgery. During the treatment or follow-up of glaucoma patients, the intraocular pressure is controlled at a level where optic nerve damage no longer progresses and visual field loss no longer worsens. This intraocular pressure is commonly referred to as the target intraocular pressure. The target intraocular pressure is not fixed, but personalized and can be adjusted during the follow-up process.

| Management of Glaucoma

Glaucoma, like hypertension, diabetes and other diseases, belongs to the category of chronic disease management. After diagnosis, it requires lifelong treatment and follow-up. Medical staff should urge patients to follow up regularly, and patients are required to actively manage themselves. Patients should maintain a good attitude, follow the doctor's advice, follow up regularly, and record changes in intraocular pressure and visual field and medication under the doctor's guidance (see the figure below) to detect changes in the condition in time and assist doctors in defeating glaucoma.

Intraocular pressure recording

Visual field recording

Author | Zheng Yajuan

Director of Glaucoma Department, Ophthalmology Center, Second Hospital of Jilin University, professor, chief physician, doctoral supervisor. New Century Excellent Talent of the Ministry of Education, member of Glaucoma Group of Ophthalmology Branch of Chinese Medical Association, and chairman of Ophthalmology Branch of Jilin Provincial Medical Association. He has been engaged in ophthalmology medical treatment, teaching, and scientific research for 27 years. He studied in Japan and fully understood the current status and development trend of glaucoma diagnosis and treatment at home and abroad. He actively carried out early diagnosis and new technologies and treatments for glaucoma, and adopted different surgical methods for different types of glaucoma, which greatly improved the success rate of surgery.

| Discipline Introduction

The Glaucoma Department of the Ophthalmology Center of the Second Hospital of Jilin University was established in 2004. It is the earliest glaucoma specialty in the province. It has advanced concepts of diagnosis and treatment of specialized diseases and an excellent medical team. It is the first to carry out early diagnosis and examination of various glaucoma, and systematically investigate, track and treat early glaucoma, normal-tension glaucoma, ocular hypertension and suspected glaucoma. It was the first in the province and even in the Northeast to carry out the composite trabeculectomy with adjustable sutures and anti-metabolite drugs, and to carry out trabeculotomy for the treatment of congenital glaucoma, phacoemulsification cataract extraction + intraocular lens implantation combined with gonioscopic goniolysis for the treatment of angle-closure glaucoma, gonioscopic goniotomy for the treatment of pediatric glaucoma, ciliary body photocoagulation for the treatment of refractory glaucoma, anti-VEGF intraocular injection combined with glaucoma drainage valve implantation for the treatment of neovascular glaucoma, and multi-channel surgery for the treatment of refractory glaucoma. Different surgical methods are used for different types of glaucoma, which greatly improves the success rate of surgery, reduces surgical complications, and protects and improves the patient's visual function. Medical management WeChat public account: Northeast Region Youth Club.