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JORNAL DO BRASIL (*) March 23, 2012 Section: Country / Open Society Myths about Glaucoma Remo Susanna Jr. The study on Glaucoma has already travelled a long way. Its development has occurred in all corners of the world and the availability of resources, scientific interchange and creativity have never been so great as in the recent years. Today the study of Glaucoma is a universal science. The high number of congresses held all around the world allows that colleagues from different origins and with different perceptions about the disease share their experiences, knowledge and creativity to our own benefit and, mainly, to that of our patients. However, many deep-rooted myths still existing among the people make the diagnostic and treatment of the disease difficult, perpetuating its position as the world’s leading cause of irreversible blindness. The most common myths about glaucoma Myth 1: All glaucoma patients have high intraocular pressure It was believed that individuals with intraocular pressures above 21 mmHg had glaucoma, and that intraocular pressures below 21 mmHg were normal. In fact, there are people with intraocular pressure below 21 who have glaucoma (normal tension glaucoma) and others with intraocular pressure above 21 (ocular hypertension) who do not have glaucoma. What determines the presence or not of glaucoma is the aspect of the optic nerve. So, always ask your ophthalmologist how the pressure of your eye and optic nerve are. Myth 2: I can see very well so I do not have glaucoma Most types of glaucoma will only show symptoms in the most advanced stages of the disease. Once lost, vision cannot be recovered. The impairment in one eye is compensated by the other eye and vice-versa, masking the vision loss. In addition, even when the impairment is already advanced, the brain complements the missing image with surrounding images, making the vision loss imperceptible for the individual. (*) Jornal do Brasil is one of Brazil’s most traditional newspapers and the first to have an online edition. Myth 3: You can test your peripheral vision to know whether you have glaucoma or not The most common types of glaucoma damage peripheral vision. Many patients think that they can evaluate this loss by covering one eye and testing their field of vision. Patients frequently state this in the ophthalmologists’ offices. In fact, the field initially lost is not the temporal field (right temple side for the right eye and left temple side for the left eye) but the nasal field (beside the nose, which in most cases is hidden by the individual’s own nose; left side for the right eye and right side for the left eye. Based on this test erroneously made, the patient thinks he/she is in perfect conditions. In fact, it is impossible to test the peripheral vision, especially on the nasal side without the proper equipment and technique only available in ophthalmologists’ offices. Myth 4: Lifestyle does not influence glaucoma Aerobic exercises like swimming, running and fast walking for at least 30 minutes 3 times a week can reduce intraocular pressure by up to 20%. Glaucoma patients should avoid being upside down – like in certain Yoga exercises – which can increase intraocular pressure by approximately 200% (twice the intraocular pressure). Smoking can also increase intraocular pressure. Although marijuana lowers intraocular pressure, its effect is quite short-lived and pressure reduction insufficient. Myth 5: Exams for detection of glaucoma are tiring Not all of them. The one patients complain more about is the visual field test. There are three basic glaucoma exams, each with its variances 1. Ophthalmoscopic exam, in which the doctor examines the eye funds giving special care to the optic nerve. This exam is often accompanied by a stereoscopic photography of the nerve or computerized images to document and best evaluate the optic nerve. Only through documentation of the optic nerve by means of these complementary exams the ophthalmologist will be able to detect structural changes to it, that is, detect the advance of the disease. 2. Measurement of the intraocular pressure which, due to its fluctuation and peaks, should be evaluated by means of a water load test, or minicurve or 24hour tensional curve. It can also be evaluated by means of measurements in different times and on different days. 3. Visual Field Test (perimetry), which is the test patients like least; it consists in a projection of light with different intensities to detect the loss of peripheral vision and, when present, central vision as well. Myth 6: To have the intraocular pressure measured once in the ophthalmologist’s office is sufficient In fact intraocular pressure may vary more than 10 mmHg in 24 hours. That is why it is necessary to measure it several times and/or do the water load test in order to detect the pressure peak, which is considered one of the most important factors for the progress of the disease. These measurements are recommended for suspect glaucoma patients and glaucoma patients, and do not need to be routinely done in individuals considered normal after a careful evaluation of the optic nerve. Myth 7: With the treatment my intraocular pressure is normal This is a dangerous myth. The expression ‘normal pressure’ refers to a statistic value found in the population and not for control of the disease. So, “normal intraocular pressure” may eventually lead to blindness. There is not a magic pressure level for all patients. Some patients require 10 mmHg pressures while others with higher pressures experience no damage to their visual function. This is the concept of target pressure. It is determined on an individual basis by ophthalmologists based on a series of factors like age, life expectation, degree of the glaucoma injury, disease progression speed, etc. Myth 8: Glaucoma always leads to blindness Completely wrong. According to The Glaucoma Foundation, at least 90% of the glaucoma cases would not lead to blindness if adequately diagnosed and treated. Unfortunately, less than 50% of the individuals with glaucoma are diagnosed. Very often, and for different reasons, treatment is not efficient. So, if glaucoma is timely diagnosed, treatment is monitored through measurement of the visual field, optic nerve exams and good intraocular pressure charts, blindness could be prevented in the great majority of people, if not in almost all of them. Myth 9: There are few options of glaucoma treatment There is a great variety of glaucoma treatments available. Medical treatment has progressed a lot with very powerful drugs or drug combinations to reduce intraocular pressure and control its peaks. The use of laser and numerous modern techniques have increased surgical success and greatly reduced complications. Glaucoma remains as the world’s major cause of irreversible blindness and its reputation is sinister because most times it hits both eyes of the individual; its symptoms only appear in the advanced stages of the disease; it is frequent in glaucoma patients’ direct blood relatives, thus binding several family members. With the help from institutions like ABRAG, greater knowledge about the disease by people in general and ongoing progress in diagnostic and treatment, I believe the sinister reputation of this disease is about to end.