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Čo je glaukóm?

Napísal 10. marec 2018

Glaukóm je ochorenie, ktoré vedie k poškodeniu zrakového nervu. Takto poškodený zrakový nerv stráca schopnosť prenosu informácií z oka do mozgu a dochádza k postupnej a nezvratnej strate zraku. 

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Najbežnejšou formou (takmer 90 % všetkých prípadov) glaukómu je primárny glaukóm s otvoreným uhlom. Spôsobuje ho zvýšenie vnútroočného tlaku, ktorý spomaľuje odtok komorového moku z prednej očnej komory. Býva často bez príznakov, a preto sa zväčša odhalí až v pokročilom štádiu.

Glaukóm so zatvoreným uhlom vzniká zúžením uhla medzi dúhovkou a rohovkou, v dôsledku čoho komorový mok ťažko odteká a náhle sa zvyšuje tlak v oku. Pacient s týmto typom glaukómu môže pociťovať bolesť hlavy, očí, pocit na vracanie, vidieť v noci dúhové kruhy okolo svetiel a môže mať tiež rozmazané videnie.

Štyri kľúčové informácie o glaukóme:

1.     Nič vás pred ním nevaruje. Neprezrádzajú ho žiadne symptómy. Zvýšený očný tlak nepociťujete ako bolesť. Strata zraku začína pri periférnom videní, čo si môžete podvedome nahrádzať pootočením hlavy. Nevšimnete si vôbec nič, až kým nie je strata zraku závažná. Najlepšie, čo môžete urobiť, je nechať sa vyšetriť a vaša liečba sa môže začať okamžite.

2.     Zatiaľ sa nedá vyliečiť. Rovnako, lekári nedokážu „opraviť“ poškodený zrak. Pomocou liekov a operácie sa však dá zastaviť postupujúca strata videnia. Primárny glaukóm s otvoreným uhlom je chronické ochorenie, preto ho lekári musia monitorovať až do konca života pacienta. Prvý krok na to, aby ste si zachovali zrak, je navštíviť očnú ambulanciu.

3.     Glaukóm sa týka všetkých. Môže sa objaviť u kohokoľvek, od batoliat až po seniorov. Navyše je dedičný, ak sa vyskytol v minulosti u niekoho z rodiny, máte až 9-násobne vyššie riziko, že ho dostanete tiež.

K rizikovým faktorom patrí tiež:

  • zvýšený vnútroočný tlak spôsobený poruchou regulácie tvorby komorového moku či upchatím odtokových kanálikov pre komorový mok
  • vek nad 40 rokov
  • cievne ochorenia, cukrovka a vysoký krvný tlak
  • ťažké zápaly či vážny úraz oka
  • užívanie kortikosteroidov
  • závažná krátkozrakosť
  • centrálna hrúbka rohovky <0,5 mm

Ak ste v rizikovej skupine, mali by ste si nechať spraviť kompletné vyšetrenie u očného lekára každý jeden, dva roky.

4.     Neliečený glaukóm je druhou najčastejšou príčinou slepoty. Nanešťastie približne 10% ľudí s glaukómom aj napriek liečbe stratí svoj zrak.

Diagnostikovali vám glaukóm, na čo by ste sa mali lekára spýtať?

  • Ako novodiagnostikovaný pacient by ste mali počítať s tým, že vám očný lekár skontroluje zrak každý týždeň/mesiac, až kým sa tlak nedostane pod kontrolu. Aj potom však budete chodiť na pravidelné prehliadky niekoľko krát do roka.
  • Riaďte sa pokynmi lekára, lebo ani tie najnovšie vedecké poznatky a lieky vám nepomôžu, keď nebudete počúvať odborníka.
  • Pýtajte sa na všetko, čo vás zaujíma – liečba, výsledky, vedľajšie účinky. Ak vám nesadne predpísaná liečba, oznámte to lekárovi ihneď, aby vám našiel niečo vhodnejšie.
  • Pýtajte sa napríklad:

Základ:

  •  Aký typ glaukómu mám?
  •  Môžete povedať, či niečo konkrétne u mňa spôsobilo glaukóm? Ak áno, čo to bolo?
  •  Ako bude sa bude naďalej vyvíjať môj zrak?
  •  Čo mám povedať rodine a okoliu?
  •  Aká je prognóza?

Liečba:

  • Aké sú možnosti liečby?
  •  Čo je pre mňa najvhodnejšie? Prečo?
  •  Aké sú riziká a vedľajšie účinky?
  •  Čo by sa stalo, ak by som liečbu ignoroval/a?
  •  Beriem ešte iné lieky. Sú navzájom kompatibilné?
  •  Ako dlho ma budete liečiť?
  •  Ako zistím, že liečba funguje?
  •  Ako často budem chodiť na kontroly?

Životný štýl:

  •  Mala by som obmedziť nejakú stravu?
  •  Aké cvičenie by mi mohlo pomôcť?
  •  Mal by som byť opatrnejší pri práci alebo šoférovaní?
  •  Akým aktivitám by som sa mal úplne vyhnúť?

Liečba:

  • Dnes máme k dispozícii len liečbu, ktorá znižuje vnútroočný tlak. Dá sa to medikamentózne, laserom alebo operáciou. Liečenie potrvá celý život. Lekári vedia dostať glaukóm pod kontrolu, ale nevedia ho vyliečiť.
  • Lekár vám pravdepodobne predpíše očné kvapky, niektoré sa užívajú raz za deň, iné častejšie.
  • Ukazuje sa, že laser je rovnako efektívny ako očné kvapky. Je to jednoduchá, rýchla a nie veľmi bolestivá metóda, ako dostať očný tlak pod kontrolu, u niektorých pacientov až na päť rokov.
  • Operácie väčšinou podstupujú pacienti s ťažším štádiom zeleného zákalu, ale vďaka tomu, že terapia sa stále vyvíja, dnes je operácia bezpečná aj pre pacientov v skoršej fáze. Pri operácii, ktorá sa spravidla robí v lokálnej narkóze, sa vytvorí umelý odtok pre komorový mok.
  • Výber liečby závisí od viacerých faktorov, ktoré sú individuálne u každého pacienta.

Oslepnem?

Pravdepodobne každému pacientovi preletí táto otázka v hlave, keď si vypočuje diagnózu. Našťastie, u väčšiny je odpoveď záporná. Správna diagnostika, nastavenie liečby a prístup k nej, ako aj následný monitoring stabilizuje väčšinu pacientov. Pacienti by však mali disciplinovane užívať predpísané očné kvapky.

Viac informácií nájdete na stránke: www.mojeoko.sk

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