Glaucoma is a group of related diseases that lead to damage of the optic nerve (the cable that connects the eye to the brain), potentially leading to permanent defecits in your field of vision. Glaucoma most commenly develops at higher-than-normal eye pressure, but some types of glaucoma can develop even at normal or low eye pressure. Early stage glaucoma does not cause visual symptoms, and it is not until more advanced stages that patients have noticeable vision loss. Fortunately, most patients with glaucoma fall into the mild-moderate stages of the disease and usually do not progress to blindness. The best way to prevent disease progression is early detection, so a screening exam is recommended every for every adult by age 35-40, and even earlier if there is a strong family history.
request an appointmentRisk Factors for Glaucoma
While older age is the biggest risk factor, several other factors increase the risk of developing glaucoma, including:
- Being of particular descent, such as African-American or Asian
- Having a family history of glaucoma
- Having elevated intraocular pressure
- Having poor vision or other eye disorders or injuries
- Having certain medical conditions, like diabetes
- Taking certain medications, such as corticosteroids for prolonged periods
Patients with risk factors for the disorder should be especially vigilant about having regular eye examinations.
Causes of Glaucoma
While glaucoma is still incompletely understood, most cases are caused by disfunction in the natural drain of the eye (causing the pressure to elevate). Additionally, some patient’s may have more “fragile” optic nerves that are more prone to damage even at normal pressures.
Types of Glaucoma
There are several types of glaucoma. The two main catergoris are primary open-angle glaucoma, in which fluid drains too slowly from the drainage channels (trabecula) of the eye, and angle-closure (narrow-angle) glaucoma, which occurs when the drain becomes mechanically blocked. Other types of glaucoma, which occur much more rarely, include:
- Normal Pressure Glaucoma
- Pigmentary Glaucoma
- Pseudoexfoliation Glaucoma
Symptoms of Glaucoma
It is important to remember that patients with early stage glaucoma are asymptomatic. When symptoms occur, they vary depending on the type of glaucoma and can occur in one eye or both eyes. The symptoms of open-angle glaucoma include:
- Dim or blurred vision
- Gradual loss of peripheral vision
- Tunnel vision (at advanced stages)
Rarely, patients with narrow angle glaucoma can experience a sudden rise in pressure, causing pain and rapid vision changes.
Diagnosis of Glaucoma
The diagnosis of glaucoma is made after a comprehensive medical examination of the eye and a review of the patient’s medical history. Tests are conducted to confirm the diagnosis. Testing may include some of the following:
- Eye pressure measurement
- Dilated eye examination
- Visual field test
- Optic nerve scan (OCT)
Treatment of Glaucoma
There is no cure for glaucoma and vision loss from glaucoma is not reversible, so treatment focuses on lowering eye pressure in an attempt to stabilize the disease and prevent further vision loss.
Eye Drops
Several eye drops are available to lower eye pressure. Side effects of the medication may result in redness, stinging, irritation or blurred vision. Regular use of the medication is needed to keep the eye pressure under control.
Selective Laser Trabeculoplasty (SLT)
SLT is a painless procedure done in the office during which a low amount of laser energy is applied to the eye’s internal drain to improve its natural fluid outflow and thereby lower pressure. The procedure takes 3-5 minutes. It is commonly done as first line treatment for glaucoma and is a way of minimizing or eleminating your need for drops. It may also be done after drops have been started as a tool to further lower the pressure or reduce your number of drops. You may be light sensitive and slightly blurry right after the laser but this usually resolves after the first day. There are no restrictions/limitations after the laser and most people are comfortable enough to drive themselves home.
Surgery
Various surgeries exist to lower eye pressure. Traditional incisional surgeries (trabeculectomy and tube shunts) are usually reserved for severe disease as they are longer and carry a longer recovery perioed and higher risk of complications. More recently, safer and quicker surgical techniques to lower eye pressure have been developed, and are often combined with cataract surgery. These procedures fall under the category of Minimally Invasive Glaucoma Surgery (MIGS).