This disease is called the "thief" that steals our vision quietly. There are about 20 million such patients in my country.

According to a "Guide to Chinese Glaucoma" published by the Ophthalmology Branch of the Chinese Medical Association, the number of people suffering from primary glaucoma in the world in 2020 exceeded 76 million, and in my country it reached more than 21 million, of which 5.67 million were blinded. Zhou Dan, a master's tutor at Harbin Medical University and director of the Ophthalmology Center of the First Affiliated Hospital of Dongguan, Guangdong Medical University, pointed out in an interview with the media that because glaucoma is hidden, the early symptoms are not obvious, and the knowledge of this eye disease is not widely known, it is very easy to be ignored. About 90% of patients in my country fail to take the initiative to go to the hospital for treatment. Whether you can see a doctor and screen in time often determines whether your vision can be effectively restored.

Reflections on two typical cases In mid-to-late March this year, Director Zhou received two glaucoma patients in succession, and the final diagnosis and treatment results were very different. Among them, Mr. Zhang, who was in his early 40s, went to the hospital quickly because he found that his vision was a little blurred. After measurement, his intraocular pressure in both eyes was above 40 mmHg; then after a number of examinations such as visual field, nerve fiber layer thickness, fundus photography, and gonioscopy, he was diagnosed with "chronic angle-closure glaucoma". Because it was in the early stage of the disease and had not yet caused serious visual function damage, the timely use of eye drops such as beta-adrenergic antagonists reduced the production of aqueous humor, so that Mr. Zhang's intraocular pressure quickly dropped to normal and remained in a stable state.

66-year-old Ms. He had long-term swelling and pain in her right eyeball, but she never took it seriously, thinking it was caused by migraine; recently, she gradually developed a series of symptoms such as vision loss, headache, nausea, and vomiting. After a detailed examination by Professor Zhou, it was found that Ms. He's right eye had entered the "absolute stage of angle-closure glaucoma", which means that her eye disease has been prolonged and has developed to the late stage and is basically irreversible; and because her intraocular pressure is too high, normal instruments cannot measure it at all. Although Ms. He's right eye is completely blind, surgery must be performed, otherwise the long-term high intraocular pressure will make her miserable, and she may even have to remove the eyeball to solve the pain in the end.

How does glaucoma wreak havoc? Why does glaucoma, which occurs quietly, completely "steal" the patient's vision in the later stages? Professor Zhou explained in a simple way that glaucoma is caused by the gradual increase in intraocular pressure (IOP), which causes damage to the optic nerve, resulting in an increasingly narrow field of vision, and cruelly depriving the patient of "brightness"; clinically, optic disc atrophy, depression, visual field defects and decreased vision are common characteristics, with or without pathological increase in intraocular pressure. Some people are found to have higher intraocular pressure than normal during physical examination, but the optic nerve and visual field have not caused damage to the visual function of glaucomatous eyes, and they are followed up once every six months, and their visual function is still not affected. This type of person is called ocular hypertension, and long-term follow-up is required to promptly detect whether it has progressed to glaucoma.

As the world's number one irreversible blinding eye disease, the incidence of glaucoma "rises with age", accounting for about 0.68% of the general population, 2.3% of the population over 40 years old, and 4-7% after 65 years old. The two most common types of glaucoma are primary and secondary. Primary glaucoma is more common in the elderly, with a prevalence of about 0.21-1.75%; while secondary glaucoma can occur in all age groups. Director Zhou Dan pointed out that due to the "low-key behavior" of glaucoma, more than 90% of glaucoma patients in developing countries know nothing about their hidden disease, and have never even heard of glaucoma. At this stage, optic nerve damage and visual field damage caused by glaucoma cannot be cured. Early detection, early diagnosis, and early treatment may "put the brakes" on the process of visual field damage, thereby preventing the progression of the disease, preserving useful vision to the maximum extent, and maintaining normal life and work.

Analyzing the common causes of glaucoma, Professor Zhou Dan summarized the following six points:

First, open-angle glaucoma and some chronic angle-closure glaucoma are difficult to detect without any "significant changes". By the time they become a fait accompli, the patient has already developed to the late stage or has lost vision.

Second, they have a superficial understanding of the harm of glaucoma, or do not care about it at all, and do not feel regret until their visual field is reduced;

Third, they never measure their intraocular pressure, nor take medication on time, especially they don’t know what state their intraocular pressure is controlled to after taking eye drops;

Fourth, they are afraid of illness and surgery, which turns minor illnesses into major ones;

Fifth, many patients mistakenly believe that glaucoma has been completely eliminated after surgery and neglect follow-up observation and regular monitoring;

Or you only pay attention to observing the intraocular pressure without paying attention to whether the visual field has changed, which results in the visual field being "narrowed" again, and then the problem resurfaces and all previous efforts are wasted.

Zhou Dan introduced that glaucoma screening includes examinations of intraocular pressure, fundus, visual field, chamber angle, corneal thickness, optical coherence tomography scanner, etc. Once diagnosed, lifelong treatment and follow-up are required.

Comprehensive prevention and treatment can achieve remarkable results. So far, the "claws" of glaucoma cannot be cut off completely, but early medication can help reduce optic nerve damage and control the disease from evolving into visual impairment or blindness. The selection of drugs should follow the principles of safety, tolerability, effectiveness and economy. During his more than ten years of studying for a master's and doctoral degree at Harbin Medical University and working in ophthalmology, Dr. Zhou Dan has completed more than a thousand difficult surgeries such as glaucoma trabeculectomy, iridotomy, drainage valve implantation, and minimally invasive trabeculotomy, and has accumulated rich clinical experience. He believes that if the maximum dose of medication still cannot subdue the "bridle" of soaring intraocular pressure, relevant minimally invasive surgery must be adopted, especially for patients with angle-closure glaucoma. Surgery can "dredge" the narrow or occluded anterior chamber angle and give patients a "bright life."

Here, Director Zhou Dan introduced that under normal circumstances, the intraocular pressure of a person ranges from 10 to 21 mmHg. The intraocular pressure changes continuously within 24 hours, but the fluctuation is less than 8 mmHg. If it exceeds this value, it is easy to cause optic disc microcirculation disorder, which will bring glaucoma uninvited. Therefore, it is necessary to reject all behaviors that increase intraocular pressure, maintain a positive and optimistic attitude, prevent excessive mood swings, and promptly eliminate negative emotions such as nervousness, anxiety, and fear; it is also necessary to pay attention to developing good habits of eye hygiene from an early age, not reading under strong light for a long time, and not playing electronic products for a long time; it is also necessary to adjust daily life, arrange work and work and rest reasonably, relax moderately, eat light and nutritious food, avoid smoking and drinking, stay away from strong tea and coffee, and ensure adequate sleep.

It is also understood that in order to implement the concept and purpose of "attaching importance to follow-up of glaucoma and preventing visual function damage", under the active advocacy of Director Zhou Dan, the Ophthalmology Department of Dongguan First Hospital Affiliated to Guangdong Medical University established the "Glaucoma Home" in April this year, aiming to provide continuous and systematic diagnosis and treatment services for middle-aged and elderly glaucoma patients or suspected glaucoma patients, as well as people with ocular hypertension, including perioperative care, stable period monitoring, long-term postoperative follow-up and disease prevention and control education, one-on-one expert consultation, etc.; at the same time, establish archives and communication channels to keep abreast of changes in the patient's condition, formulate standardized and personalized medical plans and nursing guidance for each patient, facilitate timely communication and exchanges in the event of emergencies, and take intervention measures to save vision and retain light.