Prof. Dr. Thomas Dietlein
Time bomb with a cerebral booster
Glaucoma is a term that describes a group of eye disorders that in the later stages can damage the nerve cells of the retina and of the optic nerve. This can lead to visual field deficits (scotoma), the typical form of vision loss due to glaucoma. The disease usually runs its course for several years, since the brain is able to compensate for the scotoma for a certain period of time, and shadows in the field of vision only occur much later on. If glaucoma is not identified and treated promptly, it may lead to a slow, progressive deterioration of the optic nerve and even blindness. Glaucoma is the second most common cause of blindness in industrial nations after retinopathy.
Congestion in the eye: danger ahead
The disease starts at the front of the eye. This is where the aqueous fluid is produced that feeds the light-permeable structures of the eye such as the cornea and lens, and is responsible for the development of pressure inside the eye. Intra-ocular pressure is essential, since it and the sclera are responsible for preserving the almost round shade of the eye, which consists mostly of soft tissue and liquids. The aqueous fluid flows to the outside through a tiny channel close to the anterior chamber of the eye, where it is then absorbed by the blood circulation. If this flow is interrupted, or if too much liquid is produced, the results are congestion and an increase in the pressure inside the eye. This over-pressure then damages the delicate optic nerve, which is responsible for passing images from the retina on to the brain. High-pressure glaucoma is by far the most common form of this disease.
Intra-ocular pressure and blood pressure
The second significant risk factor after an increase in intra-ocular pressure is an inadequate blood supply to the nerve fibre cells in the retina and optic nerve, usually the result of vascular dysregulation: the inability of the tiny and tiniest blood vessels to adapt to the change in the organ tissue's requirements for oxygen and nutrients. This disturbance is not usually limited to the eyes. Often these patients will experience a general involvement of the vascular system, with symptoms such as cold fingers, cold feet, an increased tendency to tinnitus and other disturbances of the micro vessels.
High intra-ocular pressure can be tolerated if there is also an increase in blood pressure within the vessels of the head of the optic nerve head, but if the blood flow is low, then low intra-ocular pressure can lead to glaucoma. The combination of high intra-ocular pressure and low blood pressure in the optic nerve head is particularly disadvantageous
Advanced medicine for glaucoma patients
The Centre of Ophthalmology at the University Clinic of Cologne – the Eye Center Cologne – ranks first by a wide margin in the treatment of glaucoma. More glaucoma patients are treated here than anywhere else in Germany. The expertise of the specialists on one hand, and the broad spectrum of diagnostic methods for the early detection of every form of glaucoma plus the latest surgical methods on the other, make the Eye Center Cologne the no. 1 address even for highly complicated cases in which, for instance, treatment with eye drops, tablets or infusions is not sufficient for patients with treatment-resistant glaucoma.