People with higher than normal intraocular pressure have a higher risk of developing glaucoma, however, this does not mean that all people with high intraocular pressure may develop glaucoma. Glaucoma can develop for many reasons. A liquid called watery moisture is produced inside the vascular membrane of the eye. There is a balanced pressure that occurs when this produced fluid exits the eye. This pressure is actually a necessary condition for maintaining the integrity of the eye. When this fluid is insufficient, it accumulates in the eye, causing increased pressure and damaging the optic nerves.

Glaucoma may be related to genetics. People with a family history of glaucoma are at a higher risk of developing it. In other words, one or more genes may be defective, and these people may become more susceptible to the disease.
People over the age of 40 have an increased risk of developing glaucoma.

Patients with diabetes and hypothyroidism (goiter) are at higher risk of developing glaucoma.
Serious eye injuries can cause increased intraocular pressure. Other risk factors include retinal detachment, eye tumors, and eye inflammation such as chronic uveitis or iritis. Some eye surgeries can also trigger the development of secondary glaucoma.
The incidence of glaucoma has approximately doubled with myopia, which is commonly known as myopia.
Prolonged use of cortisone (in the form of drops, oral medication or skin ointment, etc.) can cause the development of secondary glaucoma.
For people with these characteristics, it is important to have regular eye examinations to detect damage to the optic nerve early.

• Headaches that occur in the morning
• Blurred vision at times
• Glowing rings around lights at night
• Pain around the eyes when watching TV

What factors increase the risk of glaucoma?

• Having a family history of glaucoma (genetic predisposition)
• Age over 40 years old
• Diabetes mellitus
• Severe anemia or shock
• High-low systemic blood pressure (body blood pressure)
• High degree myopia High degree
• hyperopia
• Migraine
• Long-term cortisone treatment
• Eye injuries
• Racial factors

Since the risk of developing glaucoma in people with these characteristics is higher than usual, these people should undergo regular eye examinations to detect damage to the optic nerve early.

The main treatments for glaucoma are:

• Drug treatment
• Laser treatment
• Surgical treatment

If, despite medication or laser treatment, intraocular pressure does not decrease and the disease continues to progress, in most cases the treatment method will be surgical.

Glaucoma is a disease that is easily treated if diagnosed early. In particular, regular eye examinations are crucial for successful treatment for those with a family history of the disease.

Eye drops are often used in the treatment process. The drops used will help keep the disease under control, as they reduce intraocular pressure. They usually start with one type of drop. The most important issue here is that the patient uses the prescribed drops at regular intervals. In order to understand the effectiveness of the drops, after using them for 2-3 weeks, the patient is called back for monitoring to measure eye pressure. At this stage, the effectiveness of the drug is checked and treatment with the same drug or other recommended drops is continued. The patient should inform his doctor about the diseases, in case there are any other medications that he is taking.
Additional methods of examination and diagnosis of glaucoma (H2)
Measuring eye pressure can be easily and quickly performed as part of a general examination. During a comprehensive eye examination, it is imperative to examine the fundus and measure eye pressure. Thanks to these measurements, it is possible to determine whether a patient has a suspicion of glaucoma, even if there are no complaints. Glaucoma is based on the loss of the fibrous layer that forms the optic nerve. For this reason, people with signs of the disease need to undergo an examination of the retinal nerve fibers to detect damage. This uses special light and film methods, as well as a computerized visualization method. Tests such as corneal thickness measurement and visual field test can be performed to determine intraocular pressure.
Is intraocular pressure completely curable?
Glaucoma is an eye disease that can be controlled and stop the progression of the disease. However, a person who is diagnosed with glaucoma should continue to go for monitoring and continue treatment throughout their life.

This is the most common type of glaucoma. It occurs in the elderly (50-60 years old). Due to a decrease in the function of the outflow angle over the years and insufficient outflow of intraocular fluid, intraocular pressure (ocular pressure) increases and causes damage to the optic nerve. Intraocular pressure is usually between 12 and 20 mmHg in healthy people. In patients with glaucoma, this value is usually higher than 20 mmHg. However, in some people with a sensitive ocular nerve structure, damage to the optic nerve can be seen at normal values of intraocular pressure.
People with high intraocular pressure who have not yet developed damage due to glaucoma are considered to have ocular hypertension. Patients with ocular nerve damage due to glaucoma should definitely undergo treatment. Unfortunately, glaucoma does not manifest itself in any way. Since central vision is not impaired in the early stages, patients may not notice vision loss. That's why it's important to get an eye exam at age 40 and once a year after age 50.
Depending on the degree of damage to the optic nerve, regional visual field loss develops first. As the disease progresses, these areas merge, forming large visual field losses. Blindness develops when the optic nerve is completely affected.

This is a less common type of glaucoma. This usually occurs in hypermetropic eyes, which are smaller in structure, when the iris tissue (the colored part of the eye) is located very close to the outflow angle and covers this angle.
Since the outflow of intraocular fluid is blocked when the outflow angle is closed, the intraocular pressure rises sharply to 40-50 mmHg. This condition is quite painful. At the same time, nausea and vomiting may occur, and vision becomes blurred. This condition, which requires urgent treatment, can lead to permanent blindness. In some patients with angle-closure glaucoma, angle closure may develop gradually over many years.

Anyone can develop glaucoma, and early diagnosis is the only way to prevent vision loss due to the disease. If there is no significant damage in the field of vision due to glaucoma, the patient may not notice the disease. For this reason, it is important to have annual eye exams and perform tests at regular intervals. Approximately 2.5 out of 100 people have a risk of glaucoma (intraocular pressure), especially over the age of 40, and the overall risk of glaucoma increases with age. Glaucoma can be detected at an early stage with a thorough eye examination. For this reason, annual eye examinations are very important.
How is glaucoma diagnosed?
Measurement of intraocular pressure (IOP):
IOP can be measured using various methods. These are air measurements, applanation measurements, and measurements performed using devices such as Tonopen and Icare. In healthy people, the IOP in 98% of cases is 22 mmHg or lower. The pressure difference between the two eyes is usually below 4 mmHg. Measuring IOP alone does not indicate that a person has glaucoma.
Measurement of corneal thickness (pachymetry):
It helps the doctor decide whether to start treatment for certain patients. The average thickness of the cornea in healthy people is about 530 microns. In patients with a large corneal thickness, the eye pressure value may be higher than normal in the form of a false increase, or the eye pressure may be underestimated in patients with a corneal thickness of less than 500 microns.
Gonioscopy:
Examination of the angle of the anterior chamber, that is, the area where the ocular fluid flows into the capillaries and where the reticular structure of the "shell of the eye" is located, is an important part of the study of glaucoma. Changes such as clusters, adhesions, constrictions, ruptures, and new vascular formations will determine diagnosis and treatment.
Computerized field of view measurement:
It is important in the diagnosis and follow-up of glaucoma. It determines the loss of vision due to nerve cells affected by glaucoma, which a person does not suspect. Depending on the stage of the disease, certain areas of the visual field may be subjected to a more detailed examination. In addition, by analyzing tests conducted at regular intervals, it is possible to determine whether there has been progress in consistent visual field tests over the years. In recent years, visual field testing results can be combined with tests such as optical coherence tomography (OCT), mentioned below, to perform structural and functional analysis. In this way, it is possible to diagnose and monitor the disease much more accurately.
Analysis of the optic nerve head, nerve fiber layer, and macular area:
We can very accurately detect glaucoma-related changes, especially in the optic nerve head, retinal nerve fiber layer, and macular area using OCT. Using the various functions of this method, we can diagnose glaucoma at a very early stage, before loss of visual field occurs and the patient has no complaints. We can also very accurately determine whether the disease is progressing in diagnosed cases and, accordingly, reschedule our treatment. Using the angiography function of the same method, we can examine the density of capillaries in areas that may be affected by glaucoma.
Methods of visualization of the anterior segment:
Detecting changes in formations in the anterior part of the eye, which we call the anterior segment, is also of great importance for the diagnosis and monitoring of glaucoma patients. We can evaluate important parameters such as the angle of the anterior chamber, the tilt of the iris, and the depth of the anterior chamber using the anterior segment OCT test. We can also examine formations located a little further away, which cannot be assessed using OCT, using ultrasound biomicroscopy (UBM).
Other tests:
During diagnosis and follow-up of glaucoma patients, tests such as B-mode orbital ultrasound, angiography, electrophysiological tests, microperimetry, and general anesthesia examination (especially for infants) can be performed, if necessary.

There are three main ways to treat glaucoma.
Medical treatment
First, the patient's eye pressure decreases either by reducing the production of fluid in the eye or by increasing its output. Medications are used for these two methods. These medicines are drops that are applied at regular intervals every day and are used throughout life. Since each patient reacts differently to these drops and side effects may occur, your doctor will select the right medicine for you and monitor the result. It is very important that patients taking medications are monitored at intervals that their doctor deems appropriate, because over time, a decrease in response to medications may develop. In this case, it may be necessary to change the medicine, add another one, or resort to additional methods such as laser and surgical treatment.
Laser treatment
In the treatment of glaucoma, a laser beam is first used to treat an acute glaucoma crisis and prevent the development of glaucoma in the other eye. Then, in cases of chronic glaucoma, a laser is applied to the outflow filtration channels to facilitate the outflow of fluid forming in the eye. These two methods of laser treatment are outpatient and are not performed in the operating room. Another area of laser application in the treatment of ocular pressure is the application of a laser to the white area around the colored part of the outer part of the eye. The goal is to reduce the production of ocular fluid by destroying the area inside that part that secretes ocular fluid. This treatment is performed in the operating room, usually under local anesthesia, and the patient can go home the same day.
Surgical treatment
If the patient's eye pressure does not decrease, and the disease continues to progress despite medication or laser treatment, a surgical treatment method is usually used. Depending on the stage of glaucoma and the condition of the eye, the doctor uses one of the various surgical methods.

Most often, operations are performed to drain the ocular fluid into the vessels outside the eye. The first of these, called trabeculectomy, is an operation in which new thin channels are created in the wall of the eye so that fluid that cannot be sufficiently removed from the eye can be filtered into vessels outside the eyeball. This surgical method, which is mainly used under local anesthesia and sometimes under general anesthesia, has been the most commonly used for many years, and its results and complications are well known. Its effectiveness is also quite high. Although this is considered one method of surgery, the surgeon may make changes to this surgical method depending on the condition of the eye in question. This operation can also be performed together with cataract surgery. There are also modern implants designed to drain fluid from the eyes in this way. The functions of the aforementioned channels are performed by very thin tubes made of different materials, the ends of which are placed inside the eye.

Some new techniques, also called minimally invasive surgical techniques, include various techniques with or without implants, in which the water in the eye is directed into the eye's own excretory duct system. When using these methods, the healing of the eye may be faster, but their effectiveness may not always be as high as with trabeculectomy. In appropriate cases, very satisfactory results are obtained. Your doctor will inform you about the advantages and disadvantages of the method he will use at the preoperative decision-making stage. Another common use of these methods is their use in conjunction with cataract surgery.

In a method called Seton or tube surgery, eye pressure is controlled using implants, which are part of a thin tube in a silicone structure placed inside the eye and part of a reservoir placed between layers outside the eyeball that allow ocular fluid to escape into the capillaries outside the eye. These implants are made of an eye-compatible material and have a compatible design, meaning they are permanently embedded in the eye.

Another method of glaucoma surgery is to reduce the production of fluid in the eyes. Previously, this was done by the cryodestruction method, also known as the freezing method. Recently, this has been done using a diode laser. The laser is applied to the white area around the colored part of the outer part of the eye. The goal is to reduce the production of ocular fluid by destroying the area inside that part that secretes ocular fluid. This treatment is performed in the operating room, usually under local anesthesia, and the patient can go home the same day.

Glaucoma, although rare, is also found in infants, and it is immediately treated surgically. Operations other than adult glaucoma operations are performed. If there is no response to treatment, one or more of the above-mentioned methods can be used.

In rare types of glaucoma with a different eye anatomy, the above operations may be combined with additional interventions. Sometimes operations such as vitrectomy and keratoplasty can be combined with glaucoma surgery.
Laser glaucoma treatment and operations performed at Dunyaguez hospitals are listed below:

• Laser trabeculoplasty
• Laser iridotomy
• Laser iridoplasty
• Examination of newborns for glaucoma/observation under general anesthesia
• Ab-interno surgery for pediatric glaucoma
• Ab-externo surgery for pediatric glaucoma
• Trabectomy surgery
• Transluminal trabeculotomy by gonioscopy
• Channeloplasty
• Xen Implantation Surgery
• Deep sclerectomy
• Viscocanalostomy
• Trabeculectomy
• Kahook Double Blade Surgery
• Tube Implantation (Ahmed valve surgery)
• Cyclocryodestruction
• Diode laser cyclodestruction
• Revision of the bubble
• Combined cataract and glaucoma surgery
• Various combined operations in complex cases

People who have had glaucoma surgery should have regular glaucoma monitoring.