What is glaucoma?
Glaucoma is a disease of the optic nerve – the part of the eye that carries the images we see to the brain. The optic nerve is made up of many nerve fibers, like an electric cable containing numerous wires. When damage to optic nerve fibers occurs, blind spots develop. These blind spots usually go undetected until the optic nerve is significantly damaged. If the entire nerve is destroyed, blindness results.
Early detection and treatment by your Eye Health Eye Physician is the key to preventing optic nerve damage and blindness from glaucoma.
Glaucoma is a leading cause of blindness in the United States, especially for older people. But loss of sight from glaucoma can often be prevented with early treatment.
What causes glaucoma?
A clear liquid called the aqueous humor circulates inside the front portion of the eye. To maintain a healthy level of pressure within the eye, a small amount of this fluid is produced constantly while an equal amount flows out of the eye through a microscopic drainage system. (This liquid is not part of the tears on the outer surface of the eye).
Because the eye is closed structure, if the drainage angle is blocked, the excess fluid cannot flow out of the eye. Fluid pressure within the eye increases, pushing against the optic nerve and causing damage.
What are the different types of glaucoma?
- Chronic open-angle glaucoma – this is the most common form of glaucoma in the United States. The risk of developing chronic open-angle glaucoma increase with age. The drainage angle of the eye becomes less efficient over time and pressure within the eye gradually increases, which can damage the optic nerve. In some patients, the optic nerve becomes sensitive even to normal eye pressure and is at risk for damage. Treatment is necessary to prevent further vision loss.
Typically, open-angle glaucoma has no symptoms in its early stages and vision remains normal. As the optic nerve becomes more damaged, blank spots begin to appear in your field of vision. You typically won’t notice these blank spots in your day-to-day activities and these spots become progressively larger. If all the optic nerve fibers die, blindness results.
- Closed-angle glaucoma – Some eyes are formed with the iris (the colored part of the eye) too close to the drainage angle. In these eyes, which are often small and farsighted, the iris can be sucked into the drainage angle and block it completely. Since the fluid cannot exit the eye, the pressure inside the eye builds rapidly and causes an acute closed-angle glaucoma attack.
Symptoms may include:
Severe eye pain
Rainbow-colored halos around lights
Nausea and vomiting
This is a true eye emergency. If you have any of these symptoms, call your ophthalmologist immediately. Unless this type if glaucoma is treated quickly, blindness can result. Unfortunately, two-third of those with closed-angle glaucoma develop it slowly without any symptoms prior to an attack.
Who is at risk for glaucoma?
Ophthalmologists considers many types of information to determine your risk for developing the disease.
The most important risk factors include:
Elevated eye pressure
Family history of glaucoma
African or Spanish ancestry
Farsightedness or nearsightedness
Past eye injuries
Thinner central corneal thickness
Systemic health problems including diabetes, migraine headaches and poor circulation
Your Eye Health Ophthalmologist will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a glaucoma suspect. This means your risk of developing glaucoma is higher than normal and you need to have regular examinations to detect the early signs of damage to the optic nerve.
How is glaucoma detected?
Regular eye examinations by your Eye Health Eye Physician are the best way to detect glaucoma. A glaucoma screening that checks only the pressure of the eye is not sufficient to determine if you have glaucoma. The only sure way to detect glaucoma is to have a complete eye examination.
During your glaucoma evaluation, your Eye Health Eye Physician will:
Measure your intraocular pressure (tonometry)
Inspect the drainage angle of your eye (gonioscopy)
Evaluate whether or not there is any optic nerve damage (ophthalmoscopy)
Test the peripheral vision of each eye (visual field testing, or perimetry)
Photography of the optic nerve or other computerized imaging may be recommended. Some of these tested may not be necessary for everyone. These tests may need to be repeated on a regular basis to monitor any changes in your condition.
How is glaucoma treated?
As a rule, damage cause by glaucoma cannot be reversed. Eye drops, laser surgery, and surgery in the operating room are used to help prevent further damage. In some cases, oral medications may be prescribed.
With any type of glaucoma, periodic examinations are very important to prevent vision loss. Because glaucoma can progress without your knowledge, adjustments to your treatment may be necessary from time to time.
SLT Laser (Selective Laser Trabeculoplasty)
A recent advance in ophthalmology is the use of the SLT laser as a first line of defense and an alternative to eye drops in treating glaucoma. SLT laser has been clinically proven to treat glaucoma by safely and effectively reducing intraocular pressure in a brief office procedure that is covered by Medicare!
The SLT laser selectively targets and stimulates certain cells while preserving surrounding tissue. This produces a biological effect in an area of the eye called the trabecular meshwork which stimulates the body’s natural mechanisms to enhance fluid outflow and thereby reduce intra-ocular pressure.
Glaucoma can also be controlled with eye drops taken daily. These medications lower eye pressure, either by decreasing the amount of aqueous fluid produced within the eye, or by improving the flow through the drainage angle.
Never change or stop taking your medications without consulting your ophthalmologist. If you are about to run out of your medication, ask your Eye Health Ophthalmologist if you should have your prescription refilled.
Glaucoma medications can preserve your vision, but they may also produce side effects. You should call us at Eye Health if you think you might be experiencing side effects.
Some eye drops may cause:
A stinging or itching sensation
Red eyes or redness of the skin surrounding the eyes
Changes in pulse and heartbeat
Changes in energy level
Changes in breathing (especially with asthma or emphysema)
Changes in sense of taste
Change in eye color
All medications can have side effects or can interact with other medications. Therefore, it is important that you make a list of the medications you take regularly and share this list with each doctor you see.
Laser surgery in addition to SLT laser
Laser surgery treatments other than the SLT laser may be recommended for different types of glaucoma. In open-angle glaucoma, the drain itself is treated. The laser is used to modify the drain (trabeculoplasty) to help control eye pressure. In closed-angle glaucoma, the laser creates a hole in the iris (iridotomy) to improve the flow of aqueous fluid to drain.
Surgery in the operating room
When surgery in the operating room is needed to treat glaucoma, your ophthalmologist uses fine microsurgical instruments to create a new drainage channel for the aqueous fluid to leave the eye. Surgery is recommended if your ophthalmologist feels it is necessary to prevent further damage to the optic nerve. Surgery in the operating room is typically an outpatient procedure.
What is your part in treatment?
Treatment for glaucoma requires teamwork between you and your doctor. Your Eye Care Physician can prescribe treatment for glaucoma but only you can make sure that you follow your doctor’s instructions.
Once you are taking medications for glaucoma, your ophthalmologist will want to see you more frequently. Typically, you can expect to visit your ophthalmologist every three to four months. This will vary depending on your treatment needs.