Glaucoma
The Silent Thief of Sight: Understanding Glaucoma
Glaucoma is a leading cause of blindness in people over forty — yet almost all blindness due to this insidious condition is preventable.
Glaucoma is not an infection, nor is it contagious. It is a condition in which pressure created by the fluid in one or both eyes builds to an abnormally high level. Ultimately, this pressure causes damage to the delicate visual structures of the eye and, left untreated, blindness often results.
When Does Glaucoma Occur?
Glaucoma develops when the aqueous humor (normal fluid contained in the front part of the eye) does not drain properly, causing pressure in the eye to rise.
Nerve fibers and blood vessels in the optic nerve are compressed and can be damaged or destroyed. As a result, visual messages are not adequately transmitted to the brain, causing impaired vision and, ultimately, blindness.
Types of Glaucoma
The most common type of glaucoma, chronic glaucoma, is virtually painless. In fact, most people with chronic glaucoma are not even aware that they are being robbed of their sight since the visual loss is so gradual. In most cases, there are no warning signs before vision is lost. “Tunnel vision” — seeing only a small area in the center of vision — develops and gradually narrows.
By the time vision problems develop, irreversible damage may already have occurred.
A less common form of glaucoma, acute glaucoma, is marked by sudden, severe pain in and around the eye. Vision is sharply decreased, and, in many cases, nausea and vomiting are experienced. Emergency treatment (usually laser or traditional surgery) is required to alleviate the pressure and prevent further damage.
In addition to these two forms of the condition, glaucoma can also occur as a result of inflammation of, or injury to the eye. In rare instances, infants are born with the condition.
Open-Angle Glaucoma
Open-Angle Glaucoma (OAG) is the most common type of glaucoma and occurs when the drainage angle that is formed by the iris and cornea remains open and does not drain fluid as well as it should. The open channel eventually reacts similar to a clogged drainage pipe and causes a rise in inner eye pressure. Optic nerve damage results, producing symptoms such as decreased peripheral or cloudy vision, colorful halos around lights, and sometimes eye pain or a feeling of eye swelling. OAG is often hereditary and causes blind spots in your vision that progress over time. Individuals of African American descent are particularly at risk due to a history of genetic variations such as mutations in the myocilin gene along with thinner corneas and larger optic nerves. Patients with OAG should completely avoid steroids as well as decongestive and blood thinning medications.
Angle-Closure Glaucoma
Angle-Closure Glaucoma (ACG) is a condition in which the iris bulges and results in blocking the drainage angle of the eye. This prevents fluid from circulating through the eye – causing a buildup of eye pressure. In many cases, patients need emergency care in order to prevent vision loss. Angle Closure Glaucoma can be acute, chronic, or intermittent. Acute ACG is a medical emergency symptomatic of sudden vision loss, nausea/vomiting, and blurred vision or pain in the eyes. Chronic ACG stems from symptoms that develop over time and lead to eventual vision loss. Intermittent ACG is the most subtle, which means that patients might not notice symptoms consistently. It is important to seek medical attention if you are experiencing any unusual symptoms such as vision changes, sharp eye pain, blurry vision or a feeling of swelling in the eyes.
Congenital Glaucoma
Congenital Glaucoma is a defect in the development of the eye’s drainage system in a child. This can be caused by a genetic mutation in babies or young children (primary), or through an eye injury, another eye disorder, or diseases such as diabetes, lupus, or uveitis (secondary). Additionally, medications that treat asthma, antidepressants, and serotonin inhibitors can complicate symptoms related to congenital glaucoma. Congenital Glaucoma tends to run in families through genetic mutations. Gone untreated, it can lead to irreversible vision loss resulting from permanent damage to the optic nerve. Some patients with congenital glaucoma might require surgical intervention through a trabeculectomy or goniotomy which opens the tissue in the eye and allows fluid to flow more freely and relieve eye pressure. Microsurgery can also be performed to create a drainage canal in the eye as well as an implanted drainage device if needed. If you notice excessive tearing or blinking, changes in eye size/appearance, or if your child is constantly closing their eyes and complaining of eye pain, please seek medical attention as soon as possible.
Secondary Glaucoma
Secondary Glaucoma can result from an eye injury or if a patient has experienced a medical condition such as advanced cataracts, diabetes, or the use of steroids or drugs that can cause inflammation. Much like other forms of glaucoma, secondary glaucoma increases pressure in the eye and can lead to optic nerve damage and vision loss. Additional complications to the eye’s drainage system can stem from metabolic disorders, syndromes (Pseudoexfoliation, Sturge-Weber, Lowe’s, etc.), and medications such as corticosteroids, antidepressants, sulfa drugs that treat bacterial infections, and blood pressure medications. Your physician will likely recommend some lifestyle changes such a healthy diet plan and vitamin regimen, minimizing caffeine intake, and increasing fluid intake along with exercise.
Early Detection
Glaucoma can silently steal your vision without warning. Fortunately, there is something you can do to protect your eyesight. Especially if you are over forty, it is critical to have regular eye examinations. Because chronic glaucoma seldom causes symptoms, early detection and treatment are the only ways to prevent permanent loss of vision.
During your eye examination, inform your physician if other members of your family have glaucoma. This is extremely important because the condition tends to be hereditary. Also, inform your doctor of any medications you are currently taking. After completing the routine exam, specific tests will be conducted to confirm the presence of glaucoma. These tests can identify glaucoma long before the onset of symptoms by measuring the pressure in the eye, checking the side (peripheral) and central vision, and examining the interior structures of the eye.
Treating Glaucoma
If chronic glaucoma is diagnosed, the condition will be closely monitored during regular examinations. The treatment of choice for this form of glaucoma includes eyedrops and oral medication which, if regularly used, are often all that is necessary to control the damaging pressure. In cases where these medications cannot successfully control the pressure, surgery (either laser or traditional) is required.
Acute glaucoma initially affects only one eye and is usually accompanied by painful symptoms, as mentioned above. Immediate medication is administered to temporarily relieve the pressure, followed by appropriate surgery. An attack of acute glaucoma occurring in the other eye is common and can be successfully prevented with laser treatment.
If you have glaucoma, remember to:
- Inform your other health professionals of medication you are taking for glaucoma.
- Keep an emergency identification card in your wallet stating that you are being treated for glaucoma.
- Take extra medication with you when you are away from home.
- Inform your ophthalmologist of any side effects from your medication.
- Encourage adult members of your family to have regular eye checkups.
Guard your sight
You can protect yourself from glaucoma. With regular eye examinations and painless eye pressure checks, glaucoma can be detected early and treatment administered to save your eyesight. Take these simple steps to foil the silent thief of sight!
iStent® Trabecular Micro-Bypass Stent
If you need cataract surgery and you have glaucoma, don’t worry. Frantz EyeCare is proud to introduce the latest advancement in glaucoma patient care, iStent® Trabecular Micro-Bypass stent. The iStent® helps patients reduce or even eliminate the need for prescription eye drops to control their intraocular pressure (IOP).
Xen® Gel Stent
The Xen® Gel Stent is a surgical implant designed to lower high eye pressure in open-angle glaucoma patients where previous surgical treatment has failed and/or medications alone were insufficient. The Xen® Gel stent creates a small channel in the eye to drain fluid and help to lower eye pressure.
