What is glaucoma?
Glaucoma is a group of diseases that can lead to permanent damage of the optic nerve. They share in common the fact that there is a gradual deterioration, sometimes, but not always linked to an elevated and unhealthy level of fluid pressure inside of the eye. This unhealthy level of fluid pressure can lead to loss of vision and even blindness if not treated appropriately.
Glaucoma is a common but poorly understood eye disease. It has several forms which all can lead to vision loss and blindness if left untreated. Only an eye doctor can determine if you have glaucoma based on the results of several tests. Treatment can include eye drops, pills, laser treatments, and surgery. Treatment should be considered a lifelong process. Frequent follow-up visits, often several per year, are needed to make sure the disease remains controlled. Your eye doctor will make sure that you are completely informed of all facets of your care including all treatment options at each visit.
What are the symptoms of glaucoma?
People with chronic open angle glaucoma may have no symptoms until severe damage has been done to the optic nerve. Glaucoma has been called the silent thief of sight due to this fact.
Some symptoms that can be associated with glaucoma include blurry vision, poor night vision, poor peripheral vision, missing spots in vision or bumping into things on the side. Acute or narrow angle glaucoma may cause headaches with exercise, headaches in the morning or just after sunset, pain in the eye associated with smoky vision and halos around lights.
You should visit your family eye doctor if any of these symptoms develop to rule out glaucoma and other eye conditions.
What causes glaucoma and who is at risk?
Age – Everyone older than 60 years of age is at increased risk for glaucoma, however, African Americans become more at risk after the age of 40.
Race – African Americans are more at risk to glaucoma.
Family History – Glaucoma may have a genetic link so if a close family member has glaucoma, you have a higher risk of developing glaucoma over your lifetime.
Physical Injury to the Eye – Direct injury to the eye can damage the fluid drainage area and lead to glaucoma. Other risks include chronic inflammation in the eye, retinal detachment, eye tumors, and certain previous eye surgeries.
Near Sightedness – Having blurry distance vision without glasses or contacts increases the risk for developing glaucoma.
Prolonged Steroid Use – Steroids have been linked to the development of cataracts and glaucoma. The direct cause remains unknown.
Eye Abnormalities/Medical Conditions – This can lead to abnormal levels of pigment or abnormal substances being released inside of the eye. This leads to a clogged fluid drainage area and an increased eye pressure that can lead to glaucoma.
How is glaucoma treated?
Treatment of glaucoma, once started, should be considered a lifelong process. Treatment can help prevent the progression of the disease. Glaucoma is treated by medicine, laser treatments or surgery.
Medicine – Medicines used to treat glaucoma include eye drops and pills. All medicines can cause side effects and can interact with other medicines that you may be taking. Your eye doctor will determine which type of treatment is best suited for you based on the medical conditions that you may have, medications that you are taking, and any and all other eye conditions that may be present.
Eye drops are the mainstay of glaucoma treatment today. They are better tolerated and have fewer side effects than pill forms. Eye drops work by either causing the eye to make less fluid or by helping the eyes drain fluid easier. Some eye drops have a combination effect. There are several classes of eye drops and your eye doctor will determine which the best is for you. Eye drops are generally used 1 to 4 times daily.
Pills are rarely used to treat chronic glaucoma but are often used to treat acute or temporary glaucoma. They can rapidly reduce pressure but the side effects limit their use in chronic glaucoma.
Laser Treatments – Trabeculoplasty is a laser procedure used to alter parts of the fluid draining area of the eye. This allows for better drainage of fluid and lower eye pressure. The effect from trabeculoplasty can diminish over time. Certain types of trabeculoplasty are repeatable.
Lasers can also be used to treat and prevent acute, closure glaucoma. The laser is used to cut or burn a small hole in the colored part of the eye. This allows the iris to rest back and thus open the drainage area of the eye to a more normal configuration.
Glaucoma Surgery – When eye drops and laser treatments fail to control eye pressure and damage progresses, surgery is an option. Surgery removes part of the meshwork to create a new drainage channel for the eye. This may result in a small bump underneath the upper lid that usually causes no discomfort. A drainage implant may also be an option to help lower eye pressure.
After surgery, there continues to be a need for pressure checks and to make sure the eye remains healthy. There is a lifetime risk for the new drainage area to fail. Since the walls of the new drainage area are thin there is the risk for infection and spontaneous leak of fluid that requires immediate attention.