Podcast: WHAT DOES YOUR DOCTOR SAY?
Episode: Is this glaucoma?
Leading: Dariusz Litera
Guest: Dr. Sebastian Floryn, ophthalmology specialist
Duration: 12 minutes
Glaucoma can lead to gradual damage to the optic nerve and vision impairment. One of the greatest challenges associated with this disease is its slow progression. Patients may not notice any disturbing symptoms for a long time, which is why early diagnosis is so important.
In this episode of WHAT YOUR DOCTOR SAYS, Dariusz Litera speaks with ophthalmologist Sebastian Floryn about glaucoma, the mechanism of optic nerve damage, the importance of intraocular pressure, the various forms of the disease, and diagnostic and treatment options. The conversation also covers symptoms that should alert patients and prompt them to seek an ophthalmologist's consultation.
Full podcast transcript
[00:00:00] Introduction
Dariusz Litera:
Have you read online that glaucoma damages the optic nerve, gradually leading to vision deterioration and loss? Unfortunately, the disease develops slowly and remains asymptomatic for a long time. Are you worried you might be at risk? Find out what your doctor has to say. And today, your doctor is ophthalmologist Dr. Sebastian Floryn. Good morning, doctor.
Dr. Sebastian Floryn:
Good morning.
[00:00:31] What exactly is glaucoma?
Dariusz Litera:
What exactly is glaucoma?
Dr. Sebastian Floryn:
If we were to use the definition from medical textbooks, it is a set of diseases that gradually lead to damage to the optic nerve and, consequently, to a decrease in visual acuity.
To put it simply and simply, it is a condition that leads to a deterioration of visual acuity and, if left untreated, can unfortunately lead to blindness.
[00:00:57] Who is at risk of glaucoma?
Dariusz Litera:
Are almost all of us exposed to it, or just some?
Dr. Sebastian Floryn:
When it comes to statistical data, it turns out that in our society of almost 40 million people, about one million people suffer from glaucoma, but only 500,000 are aware of it.
Dariusz Litera:
Half don't know.
Dr. Sebastian Floryn:
Half of them don't know it. Some patients only learn about their condition when it may be too late to alleviate the symptoms, ailments, and damage that have developed.
We can't always achieve complete therapeutic success. It all starts with recognizing the problem early enough.
[00:01:30] What factors can contribute to the development of glaucoma?
Dariusz Litera:
What are the causes of glaucoma? What are the causes of this disease?
Dr. Sebastian Floryn:
There are a number of characteristics that predispose to its occurrence. Statistical studies indicate that race is also a determining factor. African Americans are more susceptible to the disease. Regarding gender, women are more likely to be affected. Glaucoma symptoms are significantly more common after the age of 60.
However, it would be an exaggeration to say that someone with a family member who has glaucoma will definitely develop it as well. This isn't necessarily the case.
However, this is a signal to regularly check yourself, check the condition of your eyes and take action early if symptoms appear.
[00:02:09] How does glaucoma damage the optic nerve?
Dariusz Litera:
Glaucoma damages the optic nerve. Let's talk about the mechanism. How does this happen?
Dr. Sebastian Floryn:
The most important thing is that glaucoma damages the optic nerve. A factor that undoubtedly contributes to this is intraocular pressure (IOP), meaning the pressure inside the eyeball, which exceeds the limits considered normal.
The upper limit of safe pressure is defined as 21 millimeters of mercury. Sometimes, a pressure of 24 millimeters of mercury is considered safe. However, any time the pressure exceeds 21 millimeters of mercury, we should be vigilant.
[00:02:50] What happens when an ophthalmologist detects elevated intraocular pressure?
Dariusz Litera:
And every ophthalmologist will then refer us for further diagnostics if during a routine examination he finds that we have elevated intraocular pressure?
Dr. Sebastian Floryn:
Every ophthalmologist who, during an examination, finds that the pressure value considered safe has been exceeded should consider how best to manage the patient and his diagnosis, and then select the optimal treatment for this condition.
[00:03:21] Are there different types of glaucoma?
Dariusz Litera:
Is glaucoma just one specific set of symptoms? Does it present differently? Are there different types?
Dr. Sebastian Floryn:
Glaucoma has certain key symptoms. The most common is a gradual, but not immediately noticeable, decline in visual acuity.
However, it can present in a variety of forms, and for this reason, it is considered an insidious disease. Initially, it may develop asymptomatically, but it can also progress dramatically, including so-called acute glaucoma attacks.
They are very painful, characterized by a sudden, very strong decrease in visual acuity, and in such a situation there is not much time left to think - you need to quickly decide how to treat the patient.
[00:04:09] How are the different forms of glaucoma treated?
Dariusz Litera:
How do we do it then?
Dr. Sebastian Floryn:
Depending on the type of glaucoma a patient has, we tailor treatment to the diagnosis.
About 90 percent of glaucoma cases are open-angle glaucoma. It develops gradually and initially without the patient noticing, in part because they can adapt to a slight and slowly progressive deterioration in visual acuity or a gradual narrowing of the visual field.
However, in the case of angle-closure glaucoma, when we are dealing with the most rapid course associated with sudden closure of the iridocorneal angle, sudden eye pain and a sudden decrease in visual acuity, this is a situation that requires intensive treatment.
Often, conservative treatment alone is not enough and surgery is necessary to save the optic nerve.
[00:05:10] What is the surgical treatment of glaucoma?
Dariusz Litera:
What does this treatment involve and what results should it bring?
Dr. Sebastian Floryn:
The aim of the surgical procedure is to achieve a situation in which the intraocular pressure reaches a value that is safe for the patient, i.e. one that does not lead to rapid and irreversible damage to the optic nerve.
There are many surgical methods, each tailored to the specific case and stage of the disease.
One of the most commonly used surgical methods is the creation of a so-called fistula, also known as a trabeculectomy. This procedure involves surgically creating a drainage path for fluid produced within the eyeball, thereby normalizing intraocular pressure.
This creates a safer environment for the optic nerve than when the pressure exceeds safe values. During an acute glaucoma attack, pressure values can be very high, sometimes reaching over 50–60 millimeters of mercury.
[00:06:22] What symptoms may raise suspicion of glaucoma?
Dariusz Litera:
Today, our guest is Dr. Sebastian Floryn. We return to glaucoma, which, as we already know, is an insidious disease.
Is there any way we can outsmart it? Are there symptoms we should be aware of as patients? Are there any visual field limitations or defects that should prompt us to seek medical attention?
Dr. Sebastian Floryn:
There are certain symptoms that may lead us to suspect that something is wrong with our eyesight that may be related to glaucoma.
A very common symptom reported by patients is seeing circles of light. This is known as the halo effect.
Sometimes, a patient is referred to an ophthalmologist because their family notices they're bumping into furniture or failing to see obstacles in their narrowed field of vision. This may raise the possibility that something is wrong with their visual system.
During the visit, we check visual acuity and eye pressure. Then, during a fundus examination, we assess the appearance of the optic disc.
Taking into account all the results obtained, we can initially assess whether we are dealing with suspected glaucomatous damage to the optic nerve or with a so-called increased risk of damage to this nerve.
If we have doubts, we have a number of modern diagnostic methods that allow us to more accurately assess the situation and decide on the optimal treatment for a given patient.
[00:08:02] How long can glaucoma develop before being detected?
Dariusz Litera:
How long can the entire process take before glaucoma is detected in a patient?
Dr. Sebastian Floryn:
Unfortunately, this is a process that can take years.
If we imagine the optic nerve as a cable containing thousands of tiny fibers, then over time, in glaucoma, individual fibers begin to stop working.
Initially, the patient doesn't feel this. However, if the number of fibers that stop functioning exceeds a critical mass, the patient begins to notice a deterioration in vision. Sometimes this occurs more quickly and dramatically, while other times it develops slowly but eventually becomes noticeable.
[00:08:47] Can glaucoma be completely cured?
Dariusz Litera:
Can surgery completely cure glaucoma? Or do procedures need to be repeated?
Dr. Sebastian Floryn:
It must be said here that glaucoma cannot be cured.
Dariusz Litera:
By the way?
Dr. Sebastian Floryn:
We can't say that glaucoma can be cured. All our efforts are aimed at delaying the process of optic nerve damage.
Depending on how quickly glaucoma is diagnosed, the patient may be able to function for many years with a gradual but slight loss of visual acuity and visual field range.
Unfortunately, we cannot currently say that we can cure glaucoma. However, we can slow down the adverse changes associated with optic nerve damage.
Prevention should primarily involve regular monitoring of parameters that may indicate the possibility of glaucoma during ophthalmological visits. This is the best form of prevention for us.
Once glaucoma is diagnosed, we have a number of options to slow the progression of the disease. Most often, we begin with pharmacological treatment.
We have various substances used in the form of drops that are designed to lower intraocular pressure and thus slow down damage to the optic nerve.
[00:10:13] What symptoms of glaucoma should not be ignored?
Dariusz Litera:
Finally, here are three key symptoms we shouldn't miss when it comes to detecting glaucoma and preventing the progression of this insidious disease. Three tips for all of us.
Dr. Sebastian Floryn:
I'll draw on conversations with patients to support this. Among the most frequently reported symptoms, which later turn out to be signs of glaucoma, are: decreased visual acuity, gradual narrowing of the visual field, and a feeling of eye fullness and pain.
These are symptoms that shouldn't be ignored and should be diagnosed promptly to avoid the dramatic progression of glaucoma. Unfortunately, the disease can lead to irreversible damage to the optic nerve, including blindness.
[00:11:13] When should you see an ophthalmologist? End of conversation
Dariusz Litera:
So if we notice such symptoms, we don't delay or hesitate. We make an appointment with an ophthalmologist and have our eyes checked, so that we can, while not completely cure the disease, significantly delay its progression. Today, our guest on WHAT YOUR DOCTOR SAYS was ophthalmologist Dr. Sebastian Floryn. Thank you very much.
Dr. Sebastian Floryn:
Thank you too.
Key takeaways for patients:
- Glaucoma is a group of diseases that lead to gradual damage to the optic nerve and deterioration of vision.
- The disease can develop for a long time without noticeable symptoms.
- One of the factors contributing to optic nerve damage is increased intraocular pressure.
- An acute attack of glaucoma may be associated with severe eye pain and a sudden and significant deterioration in vision.
- Symptoms that should be noted include: decreased visual acuity, gradual narrowing of the field of vision, a feeling of eye fullness and eye pain.
- Patients may also report seeing circles of light, known as a halo effect.
- Ophthalmological diagnostics may include visual acuity testing, eye pressure measurement, and optic disc assessment.
- Glaucoma cannot be completely cured, but treatment aims to slow down the process of damage to the optic nerve.
- Treatment may include drops that lower intraocular pressure, and in certain cases, surgical treatment may also be used.
- Regular eye check-ups allow for the assessment of parameters that may indicate the development of glaucoma.
Information about the authors:
Dr. Sebastian Floryn – ophthalmology specialist, clinical practitioner, dealing with the diagnosis and treatment of acute and chronic eye diseases.
Dariusz Litera – journalist and creator of the medical podcast CO NA TO TWÓJ ELEKARZ, dealing with health communication and patient education.
ATTENTION!
This material is for educational purposes only. It does not replace an individual medical consultation. If you experience any disturbing symptoms or have any concerns about your health, please consult your doctor.