Glaucoma

What is Glaucoma?

Glaucoma is one of the most common eye conditions in the United States, affecting over 2.5 million people, and one of the leading causes of blindness. It can also occur at nearly any age, although it usually develops in older adults over the age of 45 years-old. While the underlying cause of glaucoma is different for each patient, more often than not it is brought about by unusually high pressure within the eye. This increase in pressure can be caused by a wide range of factors, from high blood pressure to poor oral health to mismanagement of a chronic condition like diabetes.

Primary Types of Glaucoma

There are two primary types of glaucoma: open- and narrow-angle. In open-angle glaucoma, the iris is positioned at such an angle that the aqueous humor, the clear fluid that fills the space in the front of the eyeball, can still drain through the trabecular meshwork. Open-angle glaucoma is generally painless and has a slower on-set, so it will often go unnoticed until the disease is far along. Conversely, patients suffering from closed-angle glaucoma do not have sufficient space between the iris and the cornea for the aqueous humor to drain, rapidly increasing the pressure in the eye. It should be considered an eye emergency if the trabecular meshwork is fully blocked and you should seek treatment immediately.

The symptoms of glaucoma tend to develop very slowly, so much so that often times patients don’t even recognize their vision is declining until the disease is in a very advanced stage. In addition to a loss of vision, common symptoms of glaucoma include:

“Patchy” spots in the peripheral or central vision of one or both eyes
Tunnel vision, especially in the more advanced stages of the disease
Severe headaches
Eye pain
Nausea
Vomiting

Risk Factors and Prevention

Unfortunately, the risk factors for glaucoma are as common as they are significant. They include, but are not limited to:

Long-term use of corticosteroid medications (re: eye drops)
Damage to the optic nerve, either through injury or prior surgery
Existing high intraocular pressure
Being nearsighted
Co-morbidities like heart disease, high blood pressure, diabetes or sickle cell anemia
A family history of glaucoma
Certain demographics, including being over the age of 60 years old and being of African American or Hispanic descent

Unfortunately, it is impossible to fully prevent glaucoma. However, one of the most important things for you to understand is that it is impossible to recover vision loss due to the onset of glaucoma. Therefore, practicing a healthy lifestyle and getting regular eye examinations is one of the best ways to prevent glaucoma from getting worse. If it’s caught early, your doctor has a good chance of slowing the progression of permanent vision loss; if it isn’t, there is far less they can do to stop the vision loss.

Diagnosis and Treatment

Properly diagnosing glaucoma involves an eye care professional measuring the pressure on the inside of your eyes. He or she will also run a series of tests assessing damage to the optic nerve, as well the corneal thickness and the current amount of vision loss you’re experiencing. Finally, they will determine the drainage angle of your eye – which will ultimately help them determine whether you’re experiencing glaucoma or another type of eye condition.

If you have been diagnosed with glaucoma, the most effective treatments involve lowering the pressure on the inside of your eye, This is typically accomplished through prescription eye drop medications, but if you have advanced glaucoma, your eye care professional may recommend laser treatment or even surgery to more adequately relieve the pressure in your eye.

Following treatment, you will still need to get regular checkups, and you’ll likely need to use prescription eye drops for the rest of your life. Glaucoma is very likely to return if you stop doing any of these things, so adherence to prescribed protocols is very important. Again, the damage done by this condition cannot be reversed, so you must proactively monitor your condition moving forward so as to ensure the disease does not progress.

Surgical Treatment of Glaucoma

When non-surgical treatment is unsuccessful at controlling glaucoma, it may become necessary to consider surgical options. If surgical intervention is the best option Center For Sight offers the following procedures.

Selective Laser Trabeculoplasty (SLT) uses a laser to increase the outflow of internal eye fluid by altering the drainage tissue of the eye. SLT is a great option for patients who can’t tolerate eye drops or are not responding well to them.
YAG Laser Iridotomy – Your physician will create a small hole in the iris to enhance its ability to drain intraocular fluid, reducing pressure in the eye.
iStent is a microscopic implantable stent that helps reduce pressure inside the eye by increasing drainage.
Xen Gel Stent is a surgical implant that is designed to increase drainage, reducing intraocular pressure.
Durysta is an implantable device that slowly releases medication to lower intraocular pressure.
Sion Goniotomy is a minimally invasive glaucoma surgery (MIGS) that is used to remove damaged tissue that may be impeding the flow of intraocular fluid, causing pressure to increase in the eye.

What to Expect

It is important to remember that glaucoma surgery seeks to prevent future damage to the eye and will not offer any improvement for damage that has already been done. Continued monitoring is necessary following any procedure to ensure pressure is not building again, which could require you to undergo another procedure.

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