Glaucoma

Glaucoma is a disease that affects the optic nerve in the back of the eye.

 

What Is Glaucoma?

Glaucoma is a disease that causes progressive damage to the optic nerve in the back of the eye. Over time, this can cause irreversible vision loss. The optic nerve carries information from your retinal cells to your brain, where images are interpreted. Elevated pressure in the eye is the strongest risk factor for someone to develop glaucoma.

Glaucoma

Glaucoma does not typically cause any symptoms, even while damage is being done. Glaucoma risk is higher in those with a family history, so if you have a relative who has known glaucoma, unexplained poor vision, or uses eye drops for high eye pressure, be sure to have an eye exam to rule out glaucoma. Glaucoma is also more prevalent in African and Hispanic Americans. African-Americans are usually affected earlier in life and can present with a more aggressive disease compared to  Caucasians. Early detection and treatment are the key to preventing vision loss due to glaucoma.

The most common type of glaucoma, open angle glaucoma(OAG), occurs when there is poor outflow of fluid inside the eye. This leads to an increase in the intraocular pressure, which can lead to progressive loss of optic nerve cells and eventually vision loss.

There is no cure for glaucoma – yet. However, medication and/or surgery(both incisional and laser)can slow or prevent vision loss. The appropriate treatment depends upon the type of glaucoma and many other different factors, best determined by your physician.

Types of Glaucoma

 

There are two major types of Glaucoma: open-angle glaucoma, and angle-closure glaucoma.

OPEN-ANGLE GLAUCOMA

When there is dysfunction in the eye’s natural outflow system, fluid (aqueous humor) will build up and create high pressure inside the eye. This is the most common type of glaucoma.Open-angle glaucoma is painless and does not typically cause vision loss in the early stages. Regular eye exams are necessary in order to find signs of early damage to the optic nerve.

ANGLE-CLOSURE GLAUCOMA

Angle-closure glaucoma is primarily due to obstruction rather than dysfunction of the natural outflow in the eye. Depending on the anatomy of your eye, you may be at risk for angle-closure glaucoma. The end result is poor outflow of fluid and a rise in eye pressure. Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma.

Symptoms of angle-closure glaucoma attack:

  • Vision is suddenly blurry
  • Severe eye pain
  •  Halos around lights
  • Nausea/vomiting
  • Headache

Angle-closure glaucoma may occur suddenly (acute angle-closure glaucoma) or gradually(chronic angle-closure glaucoma). Acute angle-closure glaucoma is a medical emergency.

Are You at Risk?

People Over 60 are six times more likely to get glaucoma

Glaucoma is the leading cause of blindness among African-Americans. It is six to eight times more common in African-Americans than in Caucasians

Family history increases risk of glaucoma four to nine times.

Eye injury, chronic steroid use, poorly-controlled diabetes, and previous surgery are other risk factors that may increase the risk for glaucoma.

How Will My Physician Treat My Glaucoma?

Glaucoma treatment should be catered to each individual’s level of disease and ability to administer and tolerate medications.

Several topical eye medications can be used, in addition to laser or incisional procedures as deemed necessary by your doctor.

Regularly scheduled eye exams are required to assess response to treatment and disease stability.

Laser procedures may be used as first-line treatment, in combination with drops, when drops alone have failed to control your pressure. These procedures are usually done in the BVA office.

Glaucoma surgical treatment has shifted tremendously in the last ten years from more invasive procedures such as trabeculectomy and tube shunts to more micro-invasive devices. Many glaucoma specialists have adopted this “interventional” approach for earlier surgical intervention, especially with the proven success of these safer MIGS (micro-invasive glaucoma surgery) procedures. The belief is that if we can augment patients’ own physiological tissues by “stenting” to enhance their outflow, then we can prevent or delay the need for more invasive surgeries that oftentimes “bypass” patients’ natural outflow systems. Many of these procedures are performed at the time of cataract surgery. These procedures are usually performed in a hospital or surgery center.

How Will My Physician Test for Glaucoma?

TONOMETRY TEST

Measures the inner pressure of the eye. The doctor or technician will use a special device, called a tonometer, to measure the eye’s pressure. Numbing drops are used to keep you comfortable. The pressure is an important vital sign of the eye that is measured at every visit and is important in both diagnosis and management of glaucoma.

OPHTHALMOSCOPY

Examines the health of the inside of the eye, especially the optic nerve and retina. Dilating drops will be instilled to allow the doctor a larger more complete view of the inside of your eye. The drops will take about 20 minutes to fully take effect. In a darkened room, the doctor will use a bright light to magnify and view your eye using an ophthalmoscope.

PERIMETRY (VISUAL FIELD)

Maps the boundaries of your field of vision from peripheral (side vision) to central. During this test, you will be asked to look straight ahead and to indicate with a ‘clicker’ when you see a blinking light of varying brightness in your peripheral vision. Glaucoma or other neurological diseases can be detected by characteristic patterns of change to a normal field of vision.

GONIOSCOPY

An exam technique that allows the doctor to view the angle anatomy where the iris meets the cornea to see if there is normal flow of eye fluid or signs of other disease processes. A narrowing of this angle may result in increased eye pressure and risk of glaucoma.

OPTICAL COHERENCE TOMOGRAPHY

Optical Coherence Tomography uses light-wave reflection and back scattering to create a computerized image of the retinal nerve fiber layer. This allows precise measurement of distinct tissue layers of the eye. OCT allows for more precise diagnosis and management of early glaucomatous disease before any vision loss may occur.

PACHYMETRY

A test using a handheld ultrasound device that measures the thickness of the cornea. Corneal thickness helps determine the accuracy of your eye pressure readings and also helps assess risk for glaucoma.