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Exfoliative glaucoma

Glaucoma is one of a group of ocular illnesses traditionally characterized by high inner eye pressure (also called intraocular pressure or IOP). However, glaucoma is more precisely defined as an optic neuropathy than as a high pressure illness. Therefore, it comprises a group of illnesses that have progressive optic nerve damage in common and can be provoked by multiple risk factors.

Of all the risk factors that intervene in the development of glaucoma, the main factor is the increase of intraocular pressure. IOP is the result of the balance between the production and elimination of the fluid called aqueous humor that fills the anterior chamber of the eye. The increase in intraocular pressure together with many other risk factors such as severe myopia (shortsightness), race (Afro-American, Black) and family history can cause glaucoma.

Exfoliative glaucoma is produced when the ocular tissue synthesizes an abnormal protein which blocks the trabecular meshwork. The exfoliation of abnormal fibrillar polymer left on the anterior lens, rubs the iris, generating a whitish material that is suspended in the aqueous humor. When the aqueous humor is drained, these particles are deposited in the trabecular meshwork. These block the flow of the aqueous humor causing a build-up of intraocular pressure (IOP). Over time, the increased IOP produces a lesion of the optic nerve and a progressive vision loss, narrowing the vision field (loss of sharpness and clarity of the peripheral area) and, in advanced stages creating “tunnel vision” effect.

There is a greater prevalence of the illness in certain areas of the world; it is a pathology that also increases in prevalence with age. In Spain, the presence of pseudoexfoliative glaucoma is 10% for persons over the age of 60 and is responsible for 25% of the cases of open-angle glaucoma. Exfoliative glaucoma causes a greater loss of the field of vision and more difficulty for the control of the IOP than primary open-angle glaucoma.

The pseudoexfoliation process usually begins about age 40, but the development of the disease and the appearance of symptoms can take a long time. Therefore, the identification of risk factors and, among them, the genetic predisposition, is a great importance for early detection of the disease and to minimize risk.

Prevention

All persons over the age of 40 are recommended to visit an ophthalmologist at least once a year to monitor intraocular pressure and to have a detailed examination of the optic nerve. Vision loss (alteration in the visual field) cannot be recovered, making the early diagnosis very important. Once diagnosed and treated, the main objective is to conserve what vision remains.

It is also important to add the medicinal treatment to the daily routine as soon as possible. The primary care doctor and the distinct specialists should be informed that the patient has glaucoma and of all medicines currently being taken so that the prescribed treatment do not interfere with the glaucoma treatment.

The patient should not hesitate to as the ophthalmologist how to apply the drops so that the medication is more effective. To make daily life more comfortable, it is important to adapt to the necessities of the patient, implicating the family in the treatment.

Gene or region studied

  • LOXL1
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