“If you are seeing as if through a tunnel, the disease is already advanced,” explained Dr. Martina Milkovska, FEBO, in an interview with Telegraph newspaper.
“The greatest satisfaction comes when a patient says they have received care and achieved world-class results here.”
– Dr. Milkovska, according to statistics, between 70,000 and 80,000 people in Bulgaria suffer from glaucoma, yet it is believed that half of them remain undiagnosed. What are the symptoms of one of the most severe eye diseases?
– Glaucoma is an insidious disease because in its early stages it is completely asymptomatic. The patient sees clearly and has no pain, redness, or other complaints, but there is a gradual loss of nerve fibers and a progressive narrowing of peripheral vision. When patients themselves notice that they are “seeing as if through a tunnel,” the disease is already advanced and the damage is irreversible. That is why regular preventive eye examinations after the age of 40 are extremely important.
– How do you diagnose glaucoma at VISION Eye Clinic?
– At our clinic, we diagnose glaucoma using state-of-the-art equipment that allows us to detect the disease at its earliest stages. We perform intraocular pressure measurements, examination of the optic nerve, computerized perimetry to analyze the visual field, and highly specialized tests such as optical coherence tomography angiography (OCTA) for detailed analysis of the retinal nerve fiber layer. The combination of these examinations provides a comprehensive picture of the condition and helps us establish an accurate diagnosis.
– What modern treatments do you apply for this disease, often referred to as the “silent thief of sight”?
– The main goal of treatment is to lower intraocular pressure to a level at which the optic nerve is no longer damaged. We usually begin with medical therapy—eye drops that are applied daily. In appropriate cases, selective laser trabeculoplasty (SLT) can be used as a first-line treatment or as an adjunct to eye drops. It is a painless, gentle procedure that improves the outflow of intraocular fluid and often reduces the need for medication. If the disease continues to progress despite this, we proceed with other types of laser or surgical treatment.
– Can a person have glaucoma without having high intraocular pressure? How are such cases managed?
– Yes, this is known as normal-tension glaucoma. In this form, the optic nerve is damaged despite intraocular pressure values being within normal limits. In such cases, particular attention is paid to vascular factors such as low blood pressure, migraine, and circulatory disorders. Treatment is again aimed at lowering intraocular pressure, but it is often combined with measures to improve ocular perfusion and careful monitoring of the patient’s overall vascular status.
– What is the treatment approach for patients who suffer from both glaucoma and cataract?
– This is a common combination, especially in older patients, and it requires an individualized approach. Generally, there are two possible strategies. If intraocular pressure is stable and well controlled, cataract surgery is performed first, and if necessary, glaucoma intervention is undertaken at a later stage. When intraocular pressure is high and uncontrolled, the first step is to reduce it. Only after the pressure levels have stabilized can cataract surgery be safely performed. This approach achieves optimal results and helps preserve vision in the long term.
– Dr. Milkovska, you have completed numerous courses and specializations abroad, yet you chose to practice here. Why?
– Bulgaria is the place where I want to be useful. I believe that the experience and knowledge gained abroad have real value only when they are brought back home—where they are most needed. In my view, every capable young professional has a responsibility to try to realize their potential in their own country. For me, the greatest satisfaction comes when a patient tells me that they have received care and achieved results at a world-class level here. That gives meaning to my work and motivates me to strive to become better every day.
