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Exclusive interview / Dr. Anton Titov MD and Professor Dr. Francesca Cordeiro, leading retinal disease, glaucoma, neurodegeneration, macular degeneration, retinal detachment and early Alzheimer's diagnosis eye test expert.
Let's start the conversation with glaucoma. Glaucoma results in increased pressure in the eye, it is often a silent disease until people go blind. But when people with glaucoma develop blindness, it's a significant disability. What is responsible for causing blindness in glaucoma? when pressure in the eye is increased...
- So, the concept of high pressure being the cause has changed over the time. We now say that the pressure being elevated in the eyes is a risk factor, It's not a criteria, by which you say your patient has glaucoma. So, we think it's now more of a neuropathy, a nerve disease, where the pressure can modulate how the patient is affected. And what happens is the nerve cells of the eye, in glaucoma, which are specialized nerve cells called the retinal ganglion cells, these are the cells that die over time, and that's what leads to vision loss that develops.
- How does blindness develop in glaucoma? What are the first symptoms that people with glaucoma notice? What is the symptoms that people notice overall if they're having this increased pressure in the eye?
- So, the thing about glaucoma is there are no symptoms and that's why it's called "the silent thief of sight" because patients don't recognize they have it, because there's no way of knowing you have it, because your brain compensates, special compensatory mechanisms are filling in that we know a lot more of nowadays and what that means is where you cannot see things the brain patches, fills up those patches of lost vision. So, as a patient you wouldn't know you have the disease and that's one of the reasons why there is increasing evidence, for example, that patients with glaucoma tend to be involved in road traffic accidents. There's great research being done around the world which shows quite clearly, that because your brain is filling things in, you may miss, for example, a child running through a court. If it happens to be in one of the areas that your brain has filled in, but you have not actually been able to see. So, what has to be done when you're talking about a disease that is asymptomatic and that is silent, is you have to find ways of picking it up for the patient and that is where screening comes in. So, in this country one of the things that is offered to patients because we know that if you have a family history of the disease, especially if you're a first-degree relative [with glaucoma], you are at much greater risk of glaucoma than if you didn't. So, those patients who have first degree relatives, those relatives are offered free sight tests. And what the sight tests do is in addition to measuring pressure, which as I said, is a risk factor, it's not actually a diagnostic criteria. They look to see if there are nerve changes at the back of the eye. You may be familiar that when you're going to the optician or your optometrist, they look at the back of your eye with what's called the ophthalmoscope, you know, they go very close to your eye. What they are looking at there is the visible structures of the nerve that supplies vision, to see if there's any damage to the back of the eye. And then, in addition to that, if they're able to, they will do some imaging, where they will look to see if the nerve fiber layer of your eye is thinned. But also, they will do what is called a visual field test, and the visual field test still is the gold standard function test for for glaucoma. And it's a little bit like playing Space Invaders [game]. You're positioned in a globe and the machine lights up at different places around this globe, randomly. And you rely on the patient pressing the button every time that they are aware that there is some light that's flashing or coming into their field of vision. So, those ways of screening for the disease is the way we try to detect the disease. But it is very difficult to detect and often, and this is the real issue that we have, is you present, more than anything else, with a loss of vision. So, in other words, you're already a long way down this decline of your vision loss, much nearer to blindness than if you had a symptomatic disease, where you will be presenting to your ophthalmologist much earlier, and actually, when you will possibly have better chances of stopping blindness occurring in the first place.
Exclusive interview / Dr. Anton Titov MD and Professor Dr. Francesca Cordeiro, leading retinal disease, glaucoma, neurodegeneration, macular degeneration, retinal detachment and early Alzheimer's diagnosis eye test expert.
Let's start the conversation with glaucoma. Glaucoma results in increased pressure in the eye, it is often a silent disease until people go blind. But when people with glaucoma develop blindness, it's a significant disability. What is responsible for causing blindness in glaucoma? when pressure in the eye is increased...
- So, the concept of high pressure being the cause has changed over the time. We now say that the pressure being elevated in the eyes is a risk factor, It's not a criteria, by which you say your patient has glaucoma. So, we think it's now more of a neuropathy, a nerve disease, where the pressure can modulate how the patient is affected. And what happens is the nerve cells of the eye, in glaucoma, which are specialized nerve cells called the retinal ganglion cells, these are the cells that die over time, and that's what leads to vision loss that develops.
- How does blindness develop in glaucoma? What are the first symptoms that people with glaucoma notice? What is the symptoms that people notice overall if they're having this increased pressure in the eye?
- So, the thing about glaucoma is there are no symptoms and that's why it's called "the silent thief of sight" because patients don't recognize they have it, because there's no way of knowing you have it, because your brain compensates, special compensatory mechanisms are filling in that we know a lot more of nowadays and what that means is where you cannot see things the brain patches, fills up those patches of lost vision. So, as a patient you wouldn't know you have the disease and that's one of the reasons why there is increasing evidence, for example, that patients with glaucoma tend to be involved in road traffic accidents. There's great research being done around the world which shows quite clearly, that because your brain is filling things in, you may miss, for example, a child running through a court. If it happens to be in one of the areas that your brain has filled in, but you have not actually been able to see. So, what has to be done when you're talking about a disease that is asymptomatic and that is silent, is you have to find ways of picking it up for the patient and that is where screening comes in. So, in this country one of the things that is offered to patients because we know that if you have a family history of the disease, especially if you're a first-degree relative [with glaucoma], you are at much greater risk of glaucoma than if you didn't. So, those patients who have first degree relatives, those relatives are offered free sight tests. And what the sight tests do is in addition to measuring pressure, which as I said, is a risk factor, it's not actually a diagnostic criteria. They look to see if there are nerve changes at the back of the eye. You may be familiar that when you're going to the optician or your optometrist, they look at the back of your eye with what's called the ophthalmoscope, you know, they go very close to your eye. What they are looking at there is the visible structures of the nerve that supplies vision, to see if there's any damage to the back of the eye. And then, in addition to that, if they're able to, they will do some imaging, where they will look to see if the nerve fiber layer of your eye is thinned. But also, they will do what is called a visual field test, and the visual field test still is the gold standard function test for for glaucoma. And it's a little bit like playing Space Invaders [game]. You're positioned in a globe and the machine lights up at different places around this globe, randomly. And you rely on the patient pressing the button every time that they are aware that there is some light that's flashing or coming into their field of vision. So, those ways of screening for the disease is the way we try to detect the disease. But it is very difficult to detect and often, and this is the real issue that we have, is you present, more than anything else, with a loss of vision. So, in other words, you're already a long way down this decline of your vision loss, much nearer to blindness than if you had a symptomatic disease, where you will be presenting to your ophthalmologist much earlier, and actually, when you will possibly have better chances of stopping blindness occurring in the first place.
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