Glaucoma: screening, treatment and follow-up

What is glaucoma?

Glaucoma is a chronic optic neuropathy characterised by progressive deterioration of the optic nerve fibres, leading to irreversible loss of the peripheral visual field. In France, about 1 million people have primary open-angle glaucoma (POAG), nearly half of whom are unaware of their diagnosis — the disease progresses without pain or perceptible signs for many years.

The main mechanism is elevated intraocular pressure (IOP), which compresses the nerve fibres at the optic nerve head. Glaucoma can, however, occur at normal pressure. Associated risk factors include age, family history, high myopia, diabetes and African or Afro-Caribbean origins.

The main forms

Late symptoms: why screening changes everything

Chronic open-angle glaucoma progresses without pain or noticeable loss of vision for years. The damage begins in peripheral vision: because the two eyes overlap and the brain “fills in” the missing areas, the deficit goes unnoticed for a long time. Central vision and acuity — the kind tested by reading letters — remain normal until an advanced stage. It is precisely this silence that makes screening decisive: in France, nearly half of those affected are unaware of their diagnosis.

By the time the first signs become perceptible — trouble moving around, bumping into things on the side, difficulty driving at night — some of the optic nerve fibres have already been destroyed, and that loss is permanent. Treatment does not restore lost vision: it aims to halt progression. Detecting the disease early, before any impact, remains the only way to preserve the visual field over the long term.

Risk factors: are you concerned?

Glaucoma can affect anyone, but certain profiles justify greater vigilance and earlier screening:

In diabetic patients, neovascular glaucoma is a possible complication of advanced diabetic retinopathy: retinal and pressure monitoring are then closely linked.

From what age, and how often, should you be screened?

In the absence of any risk factor, a first screening check-up is recommended around the age of 40, followed by regular review as part of ophthalmic follow-up. With a family history, high myopia or an at-risk origin, screening should start earlier and be more frequent.

Once the diagnosis is made, the monitoring schedule is adapted to the stage of the disease and its rate of progression. It relies on measuring intraocular pressure, analysing the visual field and optic nerve OCT, compared over time. Glaucoma detected early, well monitored and well treated allows, in the vast majority of cases, functional vision to be kept for life.

Diagnostic work-up and follow-up in Cachan

The Cachan practice is equipped with a complete technical platform for the screening, diagnosis and follow-up of glaucoma. The examinations are carried out on site during the same consultation.

Treatment options

1. Medical treatment

Pressure-lowering eye drops are the first-line treatment in most cases: prostaglandins, beta-blockers, carbonic anhydrase inhibitors, alpha-2 agonists. They reduce production or improve outflow of the aqueous humour. The treatment is lifelong and regular use is essential.

2. SLT laser — Cachan and Paris 13

Selective laser trabeculoplasty (SLT) can be offered as a first-line treatment or in addition to eye drops. It acts on the pigmented cells of the trabecular meshwork to restore drainage of the aqueous humour, without tissue destruction. The LiGHT study (6-year follow-up) confirmed the non-inferiority of SLT compared with eye drops as a first-line treatment (Ophthalmology 2023 — DOI 10.1016/j.ophtha.2022.09.009).

3. Combined cataract + glaucoma procedure

For patients with treated glaucoma who also have a cataract, a combined procedure can be offered during a single surgical operation: phacoemulsification (PKE) combined with the Elios laser. The Elios is a non-thermal excimer laser that creates 10 microchannels in the trabecular meshwork to restore physiological outflow towards Schlemm’s canal, without an implant. In a study with 8-year follow-up, the procedure achieved an IOP reduction of more than 20 %, and up to 80 % of patients were free of eye drops at 1 year (Riesen et al. Graefes Arch Clin Exp Ophthalmol. 2022).

This indication is assessed case by case during the pre-operative consultation, taking into account the stage of the glaucoma, the number of eye drops currently used and the target pressure goals.

Living with glaucoma day to day

Glaucoma treatment — most often eye drops — cannot be felt day to day, which makes regularity all the harder to maintain. Yet its effectiveness depends entirely on daily use, at a set time and without interruption. Respecting the intervals between several eye drops and the instillation technique is an integral part of the treatment: do not hesitate to raise it again at your consultation if the burden becomes hard to bear.

With early or moderate, well-controlled glaucoma, most activities, including driving, remain possible; it is advanced involvement of the visual field that may, in time, raise questions. The key remains regular follow-up — not the treatment alone: it makes it possible to adjust management before any worsening. Glaucoma is managed over time, like a chronic disease.

Frequently asked questions about glaucoma

References