Glaucoma – the silent thief of sight

Heralding from the fishing town Akranes on Iceland, Gauti Jóhannesson moved to Sweden and Umeå after he finished school. He had his eyes set on the Medical Programme, and it was during his medical studies that his interest in the eye disease glaucoma began.

“During my studies, I did a project in glaucoma together with a docent who, at the time, was completely engulfed in the subject. It whetted my appetite, so the cooperation grew and in 2006 I was offered a doctoral studentship.”

Efficient neuroprotective therapies

Fast forward to the present day, Gauti Jóhannesson is a practicing medical doctor in Umeå and is also driving a research program with the goal of finding an efficient neuroprotective therapy for glaucoma – this means finding a treatment that can protect the visual nerve from the damaging effect of elevated pressure that is caused by glaucoma.

“Despite decades of research, we still don’t know exactly what causes the disease,” Gauti Jóhannesson says.

The greatest individual risk factor is elevated eye pressure

“However, what we do know is that the greatest individual risk factor is elevated eye pressure. The only available treatment is to lower the eye pressure but in many cases this is not enough”

Besides finding a cure for glaucoma, Gauti Jóhannesson’s research also aims to try to understand the causes behind it and to map how common the disease is. What has been established is that there are several risk factors for development and progression of glaucoma, and that the disease is very rare in persons under the age of 50.

“An enormous problem with glaucoma is that you don’t experience any symptoms until you are in a late stage of the disease. So some patients have already lost a large part of their field of vision before they know that they have the disease.”

Disease severity varies

Glaucoma often begins slowly and without warning, but how badly a patient may be effected often varies from being relatively harmless, where a patient never really notices a severe loss in vision, to much more serious cases in which patients need intensive treatment and care to slow down the progression of the disease.

“Glaucoma treatment is a balancing act. Patients with a milder form of glaucoma need less controls and treatment, but we need to be really alert to the more severe cases where more aggressive treatment is needed. In all cases, the only available treatment is to lower the pressure in the eye and this can help alleviate problems, but there is no cure.”

Opticians play a crucial role in picking up glaucoma as they measure eye pressure when performing an eye test.. If an optician notices elevated eye pressure, they immediately refer the person to an eye clinic, where the existence of glaucoma will be investigated.

After the age of 50, it is recommended to have your eye pressure checked regularly.

“From a health-economy perspective, it is not justifiable to screen all persons over 50 for glaucoma. However, if a close family member has glaucoma you should get tested more regularly. Glaucoma is extremely rare under the age of 40, but once you have turned 50 it would be wise to have your eye pressure checked from time to time.”

In order to gain a deeper knowledge of the disease, Gauti Jóhannesson uses magnetic resonance imaging to investigate the blood flow to the eye. This is to see if the blood flow is different in glaucoma patients and to see how the blood flow is affected by pressure changes in the eye.

“However, it is not just elevated eye pressure that leads to glaucoma. There is something referred to as ‘normal-tension glaucoma’ too. In these cases, damage takes place even at ‘normal’ pressure levels. So, regardless of what standard levels we establish, some cases will always go undetected. Hence, vigilance and awareness are essential to preserve sight in those at risk of developing glaucoma”

Research cooperation

Beside his own research, Gauti Jóhannesson also collaborates with Professor Christina Lindén in Umeå and Professor Boel Bengtsson in Malmö, where they study if intensive initial treatment gives a better outcome for glaucoma patients than more gradual step-wise increase in treatment.

Additionally, Gauti Jóhannesson has also initiated a collaboration with researchers at Karolinska Institutet (KI) and the St Erik’s Eye Hospital, Stockholm which is still in the planning phase but is hoped to lead to a real breakthrough.

“Assistant Professor Pete Williams, KI has discovered that a substance called nicotinamide can protect the retinal ganglion cells in the optic nerve from damage in glaucoma in animal models. Consequently, we now want to investigate if the same thing applies in patients. Showing that this works in practice would provide a whole new treatment option for glaucoma”