Glaucoma Green Star usually begins insidiously

Green Star: Glaucoma is often recognized too late

05/21/2014

Almost a million people in Germany live with a cataract. Patients have an elevated intraocular pressure, but usually they do not notice it. If glaucoma is recognized too late, the disease can lead to blindness.

Almost a million people in Germany affected
Nearly one million people are according to the Professional Association of Ophthalmologists (BVA) affected by glaucoma, popularly called the Green Star. At around 1.3 million, an early stage can be seen. One of the sufferers of the disease is Dennis Riehle from Konstanz, in which the usual „Quick look left, fast right and over“ Crossing the road no longer worked. He had to turn his head strongly when looking to the right and concentrate very much. „To this day, I feel insecure on a street and I am afraid that I overlook something“, so the 29-year-old according to a message from the news agency dpa.

Increased intraocular pressure as the main cause
In the case of a cataract, the nerve fibers and cells of the optic nerve and the retina are damaged. For those who suffer from the disease, it seems that part of the field of vision is erased. The problem with this is that sufferers initially hardly notice such failures and that they appear creeping and initially on the outer visual field. Professor Hans Hoerauf of the BVA explained: „The brain fills in the gaps in the picture.“ The failures become more and more with time. An elevated intraocular pressure is the main reason for the green star. It takes a certain internal pressure to maintain the shape and visual function of the eye. According to the Eye Center Mühlheim, this pressure is generated by a balance between produced and outflowing aqueous humor. In the course of life, however, this system becomes less permeable and the optic nerve more sensitive. The production of the aqueous humor remains the same, but the drainage is hampered. Intraocular pressure increases and therefore the risk of glaucoma increases with age.

Different risk factors
In the past, one could only see the increased intraocular pressure starting at 21 mmHg (abbreviated for the unit of measurement mm of mercury column) as a trigger. This is now considered outdated, as well as patients who have a pressure below this limit, suffering from glaucoma. In addition, some people who have a higher value do not develop glaucoma. „You should also be vigilant when first or second degree relatives such as parents, siblings or grandparents suffer from glaucoma“, so Hoerauf. For Dennis Riehle, for example, all grandparents had a Green Star. Short-sighted persons from minus five diopters and people with diabetes mellitus are also at risk. Risk factors also include abnormal blood pressure (especially low blood pressure or high blood pressure fluctuations) and circulatory disorders. Circulatory disorders of the optic nerve may be manifested, for example, by migraine or tinnitus. In most cases there is not just one single cause that damages the nerve fibers of the optic nerve.

Glaucoma early diagnosis by the ophthalmologist
Hoerauf says: „Every 40 years, every four years, the glaucoma early detection should be performed by the ophthalmologist every four years.“ Those with a family history should have the check-up done once a year from the age of 30. The ophthalmologist not only measures the intraocular pressure, but also looks closely at the optic nerve head. If he suspects glaucoma, further investigations of the nerve fiber layer thickness and corneal thickness are useful. The latter plays an important role in the measurement of intraocular pressure, as a thicker cornea simulates too high a pressure and a thin cornea too low. However, these pain-free checkups are not paid by the health insurance. „It is in your interest to recognize glaucoma as early as possible“, Angelika Ostrowski from the German Association for the Blind and Visually Impaired in Berlin.

Green cataracts can lead to blindness
If a cataract is not detected and treated in time, optic nerve damage may progress and lead to blindness. Already incurred damage can not be cured but the chances of stopping the disease are good. Glaucoma is treated with eye drops that lower intraocular pressure. Active ingredients are prostaglandins, carbonic anhydrase inhibitors or beta-blockers, which can also be combined depending on the patient. However, many sufferers are allergic to drugs or preservatives in the funds. This was also the case with the patient Riehle. He remembers: „The eyes turned bright red, and it burned insanely.“ By the time he found a remedy that he tolerated, he tried four eye drops. It also happens that despite the tried and tested agent, the intraocular pressure still does not decrease, as some drip ignorant wrong. „You should ask the ophthalmologist to show it to you“, recommends Ostrowski. Ophthalmologist Hoerauf advises: „After the drop you should not blink with your eyes for half a minute, but close your eyes best.“

In some cases, surgery may be useful
One should also hold the tear-nasal passage, at the nose-nose directly at the eye. „This is how the drops work better“, Hoerauf explained. In addition, Ostrowski recommends adhering to the given times of the drop. „Also, one should keep the checkups at the doctor in mind.“ If the medication is not effective, surgery may be considered. In the case of the Konstanzer Riehle the intraocular pressure with the drops could indeed be lowered significantly; he nevertheless declared: „No one can tell me how things will go on. Forecasts are not possible.“ The 29-year-old is involved in a self-help group for the German Association of Glaucoma Self-Help. Give yourself tips on how to deal with the restrictions. „I got a different understanding of seeing“, said Riehle. (Sb)