Eye pressure, medically known as glaucoma, is a serious eye disease that causes damage to the optic nerve as a result of intraocular pressure rising above normal levels. This disease, which progresses silently and usually shows no symptoms for a long time, can lead to permanent vision loss and even blindness if not diagnosed and treated in time. Although glaucoma is more common in individuals over the age of 40, it can occur in all age groups. Genetic factors, systemic diseases such as diabetes and hypertension, eye trauma, and long-term use of cortisone are among the factors that increase the risk of glaucoma. Intraocular pressure rises because of insufficient drainage of the fluid called “aqueous humor,” which is produced inside the eye and continuously renewed. This imbalance in the outflow of the fluid gradually puts pressure on the optic nerve, leading to irreversible vision loss. For this reason, glaucoma is also called the “silent thief.” The rate of diagnosis of glaucoma in Turkey is low because patients often live with the disease for years without experiencing complaints. At this point, regular eye examinations are of vital importance. Op. Dr. Diclehan emphasizes that the early diagnosis of glaucoma is the most effective step in preventing vision loss.
Glaucoma is not a single type of disorder. There are various types of glaucoma with different clinical presentations. In each type, intraocular pressure increases for different reasons, and treatment approaches are planned accordingly. The most common type is “open-angle glaucoma.” In this form, the drainage system of the intraocular fluid works slowly, but the patient does not notice this condition for a long time. Vision loss develops gradually and is usually diagnosed when the disease has advanced. Another type is “angle-closure glaucoma.” In this form, the intraocular fluid cannot be drained suddenly and pressure rises rapidly. This condition manifests itself with severe symptoms such as sudden headache, eye pain, blurred vision, and nausea. If not treated urgently, it can cause permanent damage. “Congenital glaucoma” is a rare but serious type of glaucoma seen in infants. It is genetically transmitted and usually diagnosed in the first months of life. There is also a type called “secondary glaucoma.” In this form, glaucoma develops due to another disease or medication use. For example, eye trauma, inflammatory eye diseases such as uveitis, or long-term use of steroids can trigger this type. Op. Dr. Diclehan states that correctly identifying the types of glaucoma plays an important role in the treatment process and that treatment should be planned individually.
Because glaucoma usually progresses silently, it does not show clear symptoms in the early stages. This leads to the disease progressing unnoticed. However, in some cases, symptoms may be observed. In open-angle glaucoma, patients usually face a gradually narrowing field of vision. Peripheral vision decreases first, followed by central vision. This process often develops over years, and patients may not notice this change. In angle-closure glaucoma, symptoms appear suddenly. Complaints such as sudden eye pain, headache, seeing halos around lights, blurred vision, eye redness, and nausea may occur. This type of glaucoma requires urgent intervention because the optic nerve can be damaged in a very short time. In congenital glaucoma seen in infants, symptoms such as eye enlargement, excessive tearing, sensitivity to light, and constant eye rubbing may be observed. Op. Dr. Diclehan states that glaucoma gives late symptoms and therefore regular eye examinations are of great importance.
A series of advanced eye examinations and tests are performed to diagnose glaucoma. The first step is usually the measurement of intraocular pressure. Eye pressure is measured with devices called tonometers. However, high eye pressure alone is not sufficient to diagnose glaucoma. The structure of the optic disc (optic nerve head) is examined in detail. If the optic nerve is damaged, cupping is observed in the optic nerve head. A visual field test (perimetry) is used to evaluate the patient’s peripheral vision. In advanced stages of glaucoma, significant narrowing in the visual field is detected. At the same time, an advanced imaging method called OCT (optical coherence tomography) is used to measure the thickness of the optic nerve fibers. This method helps determine whether the nerve cells are damaged and to monitor the progression of the disease. Op. Dr. Diclehan emphasizes that glaucoma is evaluated not only by high intraocular pressure but also by the presence of optic nerve damage, and that comprehensive examination is therefore essential.
The main purpose of eye pressure treatment is to control intraocular pressure and minimize or stop the damage to the optic nerve. Treatment is determined individually and varies according to the type, stage of glaucoma, and the patient’s lifestyle. In the first stage, treatment usually begins with eye drops. These drops either reduce the production of intraocular fluid or facilitate its outflow. Regular use of drops is of great importance for the success of treatment. In cases where drops are insufficient, oral medications can be added. In advanced glaucoma or resistant cases, laser treatment can be applied. Laser trabeculoplasty lowers pressure by opening the drainage channels of eye fluid. In angle-closure glaucoma, a small hole is made in the pupil with laser iridotomy, and fluid flow is restored. In cases where all these methods are insufficient or the disease progresses rapidly, surgical treatment comes into play. Among glaucoma surgeries, the most common is trabeculectomy. In this method, a new fluid drainage channel is created in the eye to control pressure. In addition, modern methods such as glaucoma drainage implants and MIGS (minimally invasive glaucoma surgery) are also used. Op. Dr. Diclehan states that in glaucoma treatment, a one-size-fits-all approach is not appropriate and a personalized roadmap should be determined.
Unfortunately, glaucoma is an irreversible disease. Once the optic nerve is damaged, this damage cannot be repaired. However, with early diagnosis, this damage can be stopped, and the patient’s remaining vision can be preserved. For this reason, detecting glaucoma in its early stage is of vital importance. Individuals with a family history of glaucoma are advised to have an eye examination at least once a year. Even if intraocular pressure is not high, glaucoma may develop in some individuals, a condition called “normal-tension glaucoma.” Therefore, pressure measurement alone is not sufficient. A visual field test and optic nerve evaluation should also be performed. Op. Dr. Diclehan states that the majority of his patients apply late and therefore experience permanent vision loss, whereas with early diagnosis these risks can be largely prevented.
Compliance with treatment and lifestyle is very important for patients diagnosed with glaucoma. The treatment process is long-term and, in some cases, lifelong. Patients must use their eye drops regularly, not skip doctor check-ups, and not make medication changes other than those prescribed. In addition, stress can have a negative effect on eye pressure. Therefore, stress management, regular sleep, and healthy nutrition are important for glaucoma patients. Caffeine and salt intake should be limited, and regular exercise should be done. Exercises such as yoga that involve head-down positions should be avoided because such positions can increase intraocular pressure. Op. Dr. Diclehan emphasizes that glaucoma patients should be conscious not only about treatment but also about lifestyle habits, as this is effective in the success of treatment.
There is a significant lack of knowledge about glaucoma treatment in Turkey. Many patients do not have sufficient information about glaucoma, and diagnosis is usually made after the disease has advanced. However, thanks to awareness campaigns in recent years and the widespread use of advanced imaging techniques, early diagnosis of glaucoma has started to increase. Especially in well-equipped eye clinics in major cities, special units for glaucoma have been established, and patients are followed with a multidisciplinary approach. Op. Dr. Diclehan states that Turkey has reached European standards in glaucoma treatment, but more public awareness is needed to expand early diagnosis.
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