What is glaucoma?
Glaucoma is an eye disease that causes damage to the optic nerve, resulting in vision loss. There are several types of glaucoma ranging from congenital to traumatic, but the two main types of glaucoma are primary open-angle glaucoma and acute angle-closure glaucoma.
Primary open-angle glaucoma (POAG) is by far the most common type, accounting for up to 90% of glaucoma cases. POAG develops as the drainage canal of the eye slowly becomes clogged. This prevents the fluid in the eye from draining properly so it will begin to back up which increases the pressure inside of the eye. Over time, this causes damage to the optic nerve which leads to progressive vision loss. Due to the slow progression of POAG, most patients have no symptoms until they reach the advanced stages, so it can only be detected through an eye examination.
Acute angle-closure glaucoma (or narrow angle glaucoma) is far less common than POAG, but it is considered an emergency that requires immediate treatment. In this situation, the drainage canals are suddenly blocked causing a sharp rise in intraocular pressure. These sudden changes cause very noticeable symptoms such as intense eye pain, redness, blurred vision, and nausea. If you experience any of these symptoms, please call us immediately.
Who is at risk for developing glaucoma?
Anyone can develop glaucoma, however, there are certain risk factors that increase your risk of developing it, such as:
- Family history of glaucoma
- Being over the age of 40
- African, Asian or Hispanic descent
- History of certain medical conditions such as high blood pressure, migraines, diabetes or heart disease
- History of long-term corticosteroid use
- History of eye injury or certain types of surgeries
- High nearsighted or farsighted prescription
- High eye pressure readings (intraocular pressure)
- Corneas that are very thin in the center
- Thinning of tissue around the optic nerve
- Asymmetrically sized optic nerves
In most cases, the risk for glaucoma is not truly known until after a full eye examination is completed. Additional testing will then be performed to help our doctors confirm a diagnosis of glaucoma and initiate proper treatment.
What are the symptoms of glaucoma?
Glaucoma typically does not have any symptoms until the advanced stages, which is why it is imperative to have regular eye exams to monitor for change. Patients with advanced stage glaucoma will experience peripheral vision loss that can eventually lead to complete, permanent blindness.
As noted above, remember that patients who have acute angle-closure glaucoma may experience intense eye pain, redness, blurred vision, and nausea. If you experience any of these symptoms please call us immediately, as this condition requires emergent treatment.
How is glaucoma diagnosed?
If you are found to have enough risk factors for glaucoma, you will be considered a “glaucoma suspect” and additional testing will be required to confirm a diagnosis of glaucoma.Our eye examinations include an intraocular pressure check “(IOP check”) at every visit using a rebound tonometer (no puff of air test anymore!) If this pressure is above average (typically between 12-22 mm Hg), our doctors may perform an additional reading in the exam room to verify.
Having a high IOP is not the only indicator of glaucoma. In fact, a high pressure does not always lead to glaucoma and glaucoma can occur even in patients who have average eye pressure.
Another routine test is to examine the optic nerves for any asymmetry or signs of damage or change. This is accomplished using a special lens for viewing into the back of the eye, as well as taking an Optomap image that we can archive and use to monitor for differences over time.
If these tests indicate that you are a glaucoma suspect, more specialized testing will be performed. This involves taking a measurement of your corneal thickness (called pachymetry), a thickness scan of your optic nerves (called an OCT), and a visual field test to monitor for any peripheral vision loss.
Depending on these results, you may be monitored regularly as a glaucoma suspect or may be prescribed a medicated drop to help prevent further damage. Glaucoma testing will be repeated as frequently as necessary, based on your risk factors, the severity of your condition and your response to treatment.
How do you treat glaucoma?
It is important to note that glaucoma has no cure and damage caused by glaucoma is irreversible. The goal of glaucoma treatment is to prevent any further damage and vision loss.
The first line of treatment is to use medicated eye drops to help lower your intraocular pressure in order to reduce nerve damage. These drops may be prescribed to use once at night or multiple times throughout the day, depending on your level of disease. It may also be necessary for our doctors to prescribe more than one type of medication at a time or to try different types to determine which medication works best for you.
In certain cases, laser treatment, surgery or implantation of a drainage shunt may be necessary. These treatments are typically required in certain types of glaucoma, in advanced stages of the disease, in patients who are unable or unwilling to use drops, or in a case where drop treatment has not been effective.
Due to the fact that most cases of glaucoma have no symptoms, it is imperative to follow your treatment and follow up plan as prescribed. Changes can occur quickly even in patients who have been stable on their treatment for years, so regular follow up appointments and testing are necessary to ensure treatment is still effective. Remember, once you develop symptoms that damage is irreversible, so be sure to prioritize your glaucoma care!
If you think you are at risk for glaucoma or simply haven’t had an eye exam within the past year or two, please call us to schedule an appointment! Our doctors are here to help you maintain a lifetime of healthy eyes and clear vision!