Normal pressure glaucoma

Glaucoma is a disease of the eye that is colloquially known as "glaucoma". Most of the diagnosed cases are so-called high pressure glaucomas, which are associated with increased intraocular pressure. But it can also be a Normal pressure glaucoma (also Low pressure glaucoma in which the intraocular pressure is not increased. Normal pressure glaucoma differs significantly in some points from the more frequently observed high pressure glaucoma, which is why it requires special attention.

What is normal pressure glaucoma?

The Normal pressure glaucoma or Low pressure glaucoma is a chronic disease of the eye. If it goes unrecognized, it can lead to severe, irreversible damage to the eye with permanent consequences such as damage to the optic nerve, restricted field of vision and blindness. The disease can occur at any age.

In some cases, glaucoma is also congenital, for example an incorrectly developed chamber angle. Even if high pressure glaucoma is diagnosed much more frequently, namely in 70 to 90 percent of cases, experts now assume that almost every second glaucoma in Europe is normal pressure glaucoma.

Many patients therefore do not know that they suffer from this disease. For this reason, it is often only recognized when serious consequences have already occurred.

causes

In contrast to the much more frequently diagnosed high pressure glaucoma, which is characterized by increased intraocular pressure and can damage the optic nerve in this way, normal pressure glaucoma has other, less obvious causes. Most of these are of a vascular (vessel-related) nature. Various forms of fluctuating, tending to be low blood pressure (hypotension) can trigger normal pressure glaucoma.

Flammer syndrome can also be a cause, a dysregulation of the blood supply.In addition to many other organs, the sensitive small vessels of the eye can be affected. The fluctuations in blood pressure result in an insufficient supply of nutrients to the eye. Sleep apnea patients in particular, who suffer from constant breathing pauses at night, are at risk of developing normal pressure glaucoma.

Symptoms, ailments & signs

Normal pressure glaucoma does not cause any symptoms at first, as both forms of glaucoma do not cause pain. Even during preventive examinations that consist of measuring eye pressure, which are often performed with a so-called tonometer, they are initially not recognized.

All forms of glaucoma can damage the optic nerve and gradually lead to a restricted field of vision or even complete loss of vision. One symptom is therefore the deterioration in vision, which, due to its slow progress, is usually not recognized by the patient himself or is recognized only very late.

Diagnosis & course of disease

Tonometry, in which the patient's intraocular pressure is measured with the aid of a small puff of air that is released into the eye, is only suitable for detecting high pressure glaucoma and is therefore not indicated for diagnosing normal pressure glaucoma. The ophthalmologist also has the option of examining the fundus with the help of ophthalmoscopy.

He can recognize typical glaucoma damage, even if the eye pressure was normal in the tonometry. Typical damage is, for example, dents and hemorrhages from the papillae. Furthermore, perimetry, the so-called visual field examination, can provide important information for making a diagnosis. It can be recognized here whether there are typical failures in the edge area of ​​the field of view.

The measurement of the optic nerve with the so-called Heidelberg tomograph (scanning laser tomography) is also possible. In the case of glaucoma detected late, this can prove to be quite useful. Other diagnostic methods are OCT (optical coherence tomography), GDx (scanning laser polarimetry) and RTA (retinal thickness measurement).

All of these imaging procedures are in the area of ​​individual health services (IGeL) and, with a few exceptions, must be paid for by the patient with statutory health insurance. Since low-pressure glaucoma can be triggered by fluctuating blood pressure, the doctor will often order a 24-hour blood pressure test. For this purpose, the treating ophthalmologist and the patient's general practitioner exchange information by means of a referral.

Complications

Although a person concerned does not feel sick, it is important to take the drops prescribed by the doctor regularly to stabilize the intraocular pressure. If side effects occur, here the Deutsches Ärzteblatt mainly lists changes in taste, lowering blood pressure and drowsiness, the patient should not just stop taking the drug, but always consult his doctor first.

There are many different medications that can lower intraocular pressure, so changing the preparation can often help. A kind of "natural therapy" against normal pressure glaucoma are the so-called "radical scavengers" that are contained in many types of vegetables. Their proportion is particularly high in green tea, dark chocolate and red wine.

Dietary supplements that are often prescribed for people who have glaucoma include calcium channel blockers and magnesium granules. A nutrition-conscious patient can do without it by avoiding salty foods and foods high in animal protein and phosphate. Sunflower seeds, almonds and walnuts have a high magnesium content.

Scientists go so far as to use the statement "sick eye in a sick body" for normal pressure glaucoma. However, this also means that the person affected can do a lot to stabilize his intraocular pressure and the adjacent blood vessels.

When should you go to the doctor?

If the vision changes gradually, a doctor is recommended. In principle, eyesight should be measured at regular intervals. In this way, abnormalities can be noticed as quickly as possible. Since normal pressure glaucoma is rarely noticed in the early stages, participation in the preventive examinations offered is advisable.

If there are complaints and irregularities of the vision in everyday life, these must be examined. Myopia, pain in the eyes or a feeling of pressure inside the head are signs of an existing illness and must be clarified by a doctor. If people or objects are perceived as blurred or if outlines can no longer be seen in the usual quality, a doctor's visit is necessary.

If the person concerned notices that their eyesight is reduced in direct comparison to that of those around them, they should consult a doctor. If minor accidents occur in everyday life, this can be related to reduced vision. There is cause for concern, as the disease usually increases as the disease progresses. Headaches, sleep disorders, inner restlessness or behavioral problems indicate inconsistencies in the organism. The symptoms should be discussed with a doctor so that research into the cause can be initiated.

Treatment & Therapy

The treatment of normal pressure glaucoma consists primarily in the search for the actual cause and its therapy. This requires close cooperation between the ophthalmologist and the treating general practitioner or internist. A high-salt diet can lead to an increase in the blood pressure level, which is currently a common treatment approach, depending on the underlying disease.

However, this is not suitable for all patients, especially not if there are other underlying diseases. While the therapy of high pressure glaucoma generally consists of lowering the intraocular pressure with eye drops, this method is sometimes also used for normal pressure glaucoma, even if the intraocular pressure is generally not increased here.

This is because a lower eye pressure leads to a better supply of nutrients to the eye. Medicines that are often prescribed here are miotics that constrict the pupil and thus widen the vessels so that the pressure-generating aqueous humor can drain away. Prostaglandin derivatives, known among other things by the trade name Latanoprost (R), also improve the fluidity of the aqueous humor.

You can find your medication here

Outlook & forecast

The excessive internal pressure in the eye can have various causes. These are decisive for the further course of the disease and the prognosis. Both healings and chronic developments are conceivable. Comprehensive medical care should be obtained under all circumstances, as otherwise your eyesight will deteriorate further and the general risk of accidents will be significantly increased. In addition, the causal disorder must be treated, as life-threatening changes can occur here.

In most patients, internal pressure is normalized with drug therapy. Lifelong treatment is often necessary because normal pressure glaucoma has become chronic. Discontinuation of the medication consequently leads to relapse. If the symptoms arise due to sleep apnea, it must be clarified whether this can be completely cured. With the alleviation of the symptoms of the underlying disease, a decrease in the health complaints for the impaired vision is also possible.

Complete freedom from symptoms can therefore be achieved depending on the underlying disease. In the case of diseases of the circulatory system and thus irregularities in blood pressure, it must be treated medically. As soon as the values ​​are in the normal range, the internal pressure of the eye returns to normal. However, the symptoms can be expected to return as soon as a blood pressure problem occurs again.

prevention

Normal pressure glaucoma is very difficult to prevent. Targeted prophylaxis can hardly be carried out here. The prevention therefore lies in the observation of the possible underlying causes. Sleep apnea patients, patients with fluctuations in blood pressure and those with Flammer syndrome are particularly at risk and should be regularly monitored by an ophthalmologist.

Regular glaucoma prevention by the ophthalmologist is also a good option, but this is not covered by the statutory health insurance, the costs are borne by the patient. An accumulation of glaucoma within the family is another risk factor for developing glaucoma yourself, which is why intensive preventive care is advisable here too. The better the patient is informed about their underlying disease, the easier it is to diagnose normal pressure glaucoma.

Aftercare

If normal pressure glaucoma is treated surgically, careful follow-up care is required. The intensive follow-up treatment usually takes about two weeks. Eye drops are usually administered. Sometimes the patient also receives eye injections near the eyeball or eyeball massages.

Even after an outpatient operation for glaucoma, the patient is observed until he is able to make his way home. However, he is not allowed to sit behind the wheel of a car himself. If he uses public transport, it is recommended that someone else accompany him. Alternatively, you can also take a taxi.

The ophthalmologist prescribes an eye ointment or eye drops for follow-up treatment. It is important to use them consistently and regularly. In some cases, a pain reliever is also taken for the first few days after the procedure.

The follow-up check-ups also play an important role in follow-up care. The patient receives an appointment for the next examination on the day of the operation. This deadline should be strictly adhered to. The eye bandage is usually removed.

As part of the follow-up examinations, the ophthalmologist will check the healing process. Among other things, the postoperative findings and visual acuity are checked. As a result of the operation, the eye initially reacts particularly sensitively to mechanical damage. Therefore, the patient should temporarily refrain from using shampoos, soap or skin creams.

You can do that yourself

Anyone diagnosed with normal pressure glaucoma should first make lifestyle changes. In addition to regular exercise, which regulates intraocular pressure, a vitamin-rich diet is recommended. Fruit, vegetables and the like stimulate blood circulation in the eyes, which can improve eyesight again. Smokers should stop smoking and, if possible, completely avoid nicotine in order to avoid further eye strain.

If, despite all measures, the complaints increase, medical advice is required in any case. The doctor may be able to give further tips or prescribe a suitable preparation to alleviate the visual problems and improve the patient's well-being in the long term. Finally, possible triggers for the development of normal pressure glaucoma must be found. The eye condition can occur due to eye strain, such as that affecting office workers and people with excessive exposure to pollutants. Excessive sun exposure and dehydration are also possible causes that need to be identified and corrected.

Normal pressure glaucoma itself cannot be cured, but the risk of going blind from the disease can be greatly reduced. Those who wear suitable visual aids in addition to the measures mentioned, optimally support drug therapy.