Jaskra - dr hab. n. med. Joanna Konopińska

Glaucoma was the topic of the latest program in the "Question for a Specialist" series. Professor Jan Kochanowicz's guest was Dr. Joanna Konopińska, Head of the Ophthalmology Clinic at the Medical University of Białystok. Glaucoma – what does this term mean? Glaucoma is a disease characterized by increased pressure in the eye. Pressure that is above normal damages the optic nerve and causes patients to experience increasingly poor vision. Contrary to popular belief, this is a common phenomenon, as glaucoma is still the most common cause of blindness worldwide. Moreover, in highly developed countries, it is treated significantly earlier than in countries still in its early stages of development. So, does it mean that the pressure in the eyeball increases, and the pressure causes secondary damage to the optic nerve? Exactly. In the case of blood pressure, such elevated values ​​often make us feel better and more energetic. Most people don't even start the day without coffee, which is supposed to stimulate us and raise our blood pressure. Isn't it the same with eye pressure—if it's slightly elevated, we feel better? Unfortunately, no. Most patients don't feel eye pressure fluctuations unless it's extremely high, which causes eye pain and headaches. However, within the range of up to 30 mmHg, patients are unaware that anything is changing in their eyes. What is the normal eye pressure value? And how is it measured? Normal eye pressure ranges from 8 to 21 mmHg. Unfortunately, its measurements have nothing to do with blood pressure, and most family doctor's offices don't allow us to measure our own eye pressure, nor can we do it ourselves at home. There are several methods for measuring eye pressure. The most common method is the air puff method—the patient sits in a special device at the ophthalmologist's office, where a beam of air bounces off the cornea and produces a reading of the pressure inside the eyeball. From my ophthalmology classes back in college, I associate pressure testing with the need for anesthesia, because they placed a device on the eye. This air blast method is probably more modern. Yes, you're probably referring to the Schiotz tonometer, which has now become a thing of the past; you'd probably find it in a museum of the history of medicine. Now we use a non-contact method, which is painless and safe. It can be used on children, adults, and the elderly, and it doesn't cause much discomfort. The air blast is very gentle; the patient doesn't actually feel it. We get the results immediately. However, in clinical trials, in hospital settings, we also use tactile tonometry with a Goldmann device, which does require anesthesia, but the patient is in a sitting position, and the tip of the device is placed close to the eye to measure the corneal deflection. The ophthalmologist then reads the measurement on a special scale. If we have elevated eye pressure, should we be concerned? It's similar to systemic blood pressure; a single elevated reading doesn't mean anything. The patient may be tense or have a thick cornea that distorts the reading. There's also the possibility of ocular hypertension, which doesn't yet cause glaucoma. A single elevated eye pressure reading shouldn't be alarming. However, it's necessary to expand the diagnostic workup, examine the fundus, ask the patient about risk factors, and, depending on the findings, implement further treatment. If these elevated eye pressure values ​​recur, what can the patient do? Do lifestyle changes, such as increased physical activity or diet, have any impact, as they do with hypertension? Can we help ourselves? Not entirely. There are factors that increase eye pressure, including non-pharmacological factors, such as playing brass instruments or wearing a very tight collar, and certain exercises, such as headstands during yoga. Moderate physical activity, on the other hand, will indirectly normalize blood pressure, but it's unlikely to halt the progression of the disease. So how can we lower intraocular pressure? First, we need to determine whether it's necessary. In 20-30% of patients, despite elevated pressure, there are no problems with the optic nerve; in such cases, follow-up visits and a checkup are sufficient. However, if glaucoma damage has already begun and has been diagnosed with a visual field test or OCT scan, the diagnosis must be made very carefully, because it's like with diabetes – once glaucoma is diagnosed, treatment is practically lifelong. What is an OCT scan? It's an optical tomography (OCT) scan of the optic nerve. It's available in virtually every ophthalmologist's office and is covered by the National Health Fund. It involves taking an image... More at www.orthodoxia.pl/pytanie-do-specjalisty/