INTERVIEW Dr. Ștefan Oprea, ophthalmologist specialist: “Glaucoma is passive, because you don't realize that the visual field has narrowed”

Asymptomatic in the initial phase, glaucoma can be prevented by regular ophthalmological examination.

Damage to the optic nerve has serious consequences for the health of the eye. This situation paves the way for glaucoma, an asymptomatic condition in the initial stages. Many patients do not know that they suffer from glaucoma, therefore a large part of them reach the specialist when the disease is already in an advanced stage. What can we do so that this disease does not change our lives? What are the causes and risk factors? What are the manifestations of glaucoma? What about the forms of treatment? “Weekend Adevărul” spoke with Dr. Ștefan Oprea, specialist ophthalmologist, doctor of medicine and university assistant, to learn more about glaucoma and the factors we must pay attention to in order to detect it early.

Weekend The truth': What does glaucoma really mean?

Dr. Stefan Oprea: Loss of nerve fibers, damage to the optic nerve that occurs as a result of increased intraocular pressure. There is often confusion between increased intraocular pressure and glaucoma. Glaucoma is a passive disease in the sense that it does not notify us. It's like blood pressure that can be high, but if it's not high enough to cause symptoms like headaches or dizziness, you live with it and don't realize it. The same phenomenon happens with blood sugar: even if you can't actually feel it, it doesn't mean it's not affecting you on the inside. And in the case of the eye, you don't feel the increased intraocular pressure (within “decent” limits), but later the nerve will be affected. That is why it is important to go to the eye doctor after the age of 40 at least once every two years. If you suffer from increased intraocular pressure, it starts monitoring or even treatment, if the value is too high. If you treat intraocular hypertension in time, you will not get glaucoma. In most cases, glaucoma is asymptomatic, especially in the initial phase of the disease.

What are the causes?

First of all, there are several types of glaucoma – drug-induced, post-traumatic… The most common is primitive open-angle glaucoma. There is also primary narrow-angle glaucoma and congenital glaucoma, which occurs in children. In the case of congenital glaucoma, the parents, guided by the pediatrician, must carefully observe the child's gaze to notice if he is following objects. If there is any kind of suspicion, specialists in the field should be consulted. Another characteristic of this condition is that those who suffer from congenital glaucoma have very large eyes.

Hypermetropia, more prone to glaucoma

And what does primary narrow-angle glaucoma entail?

It occurs especially in the case of hypermetropes, who have smaller eyes. When we look into someone's eyes, we see the iris and the cornea – the transparent part of the eye, and the aqueous humor drains into the angle between them. If the eye is smaller, the angle narrows, so it's harder for fluid to drain and eye pressure can increase. That is why hypermetropes are more prone to a glaucoma attack, which means the total closing of the angle, increasing the tension a lot – normal values ​​range between 10 and 21, and in the case of a glaucoma attack it can even reach 50-60. It is also manifested by redness, severe pain… If we see a patient who has a narrow angle and tension at the upper limit, he may even be indicated for lens surgery. The natural lens has an elliptical shape, and the artificial one, which we put in, has a flat shape. Basically, it creates space. Of course, fitting this type of lens is not a guaranteed solution to the problem, but it can be a real help in this situation. In addition to this method, specific therapies are also added: lowering the tension, permeabilizing the channel through which the liquid drains… In the case of primary open-angle glaucoma, the respective liquid drains with difficulty. The causes are multiple. First, we have an extremely important genetic factor. So if we have parents or relatives with glaucoma, we must go for annual investigations, even more so if you have intraocular pressure at the upper threshold. Thus, annually you must do investigations such as: visual field, OCT of the optic nerve and retina.

Glaucoma can recur even after surgery.  Photo: Shutterstock

Glaucoma can recur even after surgery. Photo: Shutterstock

This type of glaucoma appears to be a complicated condition…

Unfortunately, if it is not identified in time, yes. A nerve fiber once lost is and will remain so. We do not have the ability to “regenerate” nerve fibers, but we can lower the tension and keep the situation as it is. The disease must be carefully monitored, and the patient and the doctor must be responsible. A glaucoma patient is not doomed to vision loss. Vision is lost concentrically – from the periphery to the inside, it narrows like a tube. For this reason, glaucoma is quite insidious, because initially you may not realize that your field of vision has narrowed.

Intraocular tension, a key factor

There is a link between eye pressure and the


Hypotension leads to poor vascularization of the optic nerve and can damage the optic nerve, but not through the same mechanism as intraocular hypertension.

Can headaches or migraines be associated with high intraocular pressure?

Less often, only when the tension is very high.

How can we keep the progression of glaucoma under control?

Once elevated intraocular pressure is identified, monitoring begins, especially if there is a family history. First, that OCT is done, the visual field is analyzed, the tension is measured, the corneal thickness – let's see how the tension is adjusted according to the corneal thickness. So we begin to lower intraocular pressure with one class of substances out of the four that we have available. Later, if with all classes of substances the tension does not decrease, we discuss surgical interventions, with laser. It is usually started with drops, and after 6 months the investigations are done again to see if the pressure has dropped enough. If the results are good, investigations can be done once a year. Through treatment, intraocular hypertension is practically kept under control so that we maintain the quality of the optic nerve at the level it was at when we identified the condition.

Does the patient remain dependent on the drops?

Yes, all my life. Once treatment is stopped, there is a risk of more serious damage to the optic nerve. Also, there are some laser interventions that create a better permeability of that channel through which the liquid is drained, and for a while you get rid of these drops. But not every patient is eligible for such interventions. There are glaucoma specialists and they evaluate patients to see if they are eligible for the procedure. There are several types of surgery. A device is used that is inserted intraocularly near the channel between the iris and the cornea. The intervention lasts 15-20 minutes. A classic but useful treatment option is the trabeculectomy under the scleral flap, which takes a little longer, as some wires are also added, but the procedure is not traumatic for the patient. In about two to three weeks, the patient returns for a follow-up to remove threads that are as thin as human hair.

How long after surgery can the patient read?

Within a few days, a week, but it depends on the severity of the disease and the success of lowering the intraocular pressure, which is not guaranteed by the operation.

Have you also had cases and relapse?

Yes, unfortunately it can relapse. It is not a strictly mechanical operation like cataract surgery. In the case of glaucoma, working with the patient's natural structures, there is a greater risk of recurrence. This type of intervention can also be done in the case of children.

Is there any form of prevention?

The only form of prevention is regular checkups, even if you don't have eye problems.