Eyecare Services
Glaucoma
Glaucoma Treatment
What are the different types of glaucoma?
What are the symptoms of glaucoma?
How is glaucoma diagnosed?
What are the risk factors for glaucoma?
Treatment for glaucoma
Glaucoma mainly occurs in adults over the age of 40, but glaucoma can affect children also. Risk factors for glaucoma include a family history of the disease, African-American descent, highly myopic (near-sighted) patients, and diabetic patients.
Yearly examinations with your ophthalmologist will be sufficient to check for glaucoma. If you have any risk factors for glaucoma your ophthalmologist will perform a work-up for glaucoma. The work-up includes checking your eye pressure with a tonometer, checking for damage to the optic nerve, and checking for damage to the drainage system in the eye.
Glaucoma is often treated with medications (eyedrops or tablets). They work by decreasing the eye pressure by either decreasing fluid production in the eye or increasing outflow of fluid from the eye. Other treatment options are available including laser surgery and intraocular filtration surgery. Your doctor will decide which treatment option is right for you.
Glaucoma is a chronic disease and needs to be regarded as such. It is important to keep all appointments with your doctor and to take medication on time. Once diagnosed with glaucoma, patients will need life long care to keep good vision. It is important to understand that glaucoma can not be cured but it can be controlled.
Glaucoma affects an estimated 3 million Americans, with 120,000 blind due to the condition. Elsewhere in the world, glaucoma treatment is less available, and glaucoma ranks as a leading cause of blindness just about everywhere. Even if people with glaucoma do not become blind, vision can be severely impaired.
Glaucoma Treatment
The best way to prevent vision loss from glaucoma is early diagnosis and treatment. See your Eye Doctor at least every two years for a complete examination, including an IOP check. People at high risk for glaucoma due to high intraocular pressures, family history, ethnic background, age or optic nerve appearance may need more frequent checkups.
A test called a visual field may be performed on glaucoma suspects to detect peripheral vision loss. It involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals for your doctor to determine the extent of vision loss.
Glaucoma treatment (for any form) entails decreasing aqueous humor production, increasing fluid drainage or a combination of the two. These treatments will not restore any vision already lost to glaucoma.
There are many types of eye pressure-lowering drops including beta-blockers, alpha-2 agonists, and prostaglandin analogs. Many of the drugs used for glaucoma interact with common medications. Patients should discuss these issues with both the family physician and the eyecare practitioner.
Everyone is at risk for glaucoma. However, certain groups are at higher risk than others.
- People at high risk for glaucoma should get a complete eye exam, including eye dilation, every one or two years.
- The following are groups at higher risk for developing glaucoma.
- African-Americans
- People Over 60
- Family Members with Glaucoma
- Asians
- Steroid Users
- Eye Injury
- high myopia (nearsightedness)
- diabetes
- hypertension
- Central corneal thickness less than .5 mm.
What are the different types of glaucoma?
- open-angle glaucoma
With this most common type of glaucoma, the fluid that normally flows through the pupil into the anterior chamber of the eye cannot get through the filtration area to the drainage canals, causing a build-up of pressure in the eye. Nearly 3 million Americans - half of whom do not know they have the disease - are affected by glaucoma each year. - low-tension or normal-tension glaucoma
While normal intraocular pressure ranges between 12 to 21 mm Hg, an individual may have glaucoma even if the pressure is within this range. This type of glaucoma presents optic nerve damage and narrowed side vision. - angle-closure glaucoma
In angle-closure glaucoma, the fluid at the front of the eye cannot reach the angle and leave the eye because the angle becomes blocked by part of the iris. This results in a sudden increase in pressure and is generally a medical emergency, requiring immediate treatment to improve the flow of fluid. - childhood glaucoma
Childhood glaucoma is a rare form of glaucoma that often develops in infancy, early childhood, or adolescence. Prompt medical treatment is important in preventing blindness. - congenital glaucoma
Congenital glaucoma, a type of childhood glaucoma, occurs in children born with defects in the angle of the eye that slow the normal drainage of fluid. Prompt medical treatment is important in preventing blindness. - primary glaucoma
Both open-angle and angle-closure glaucoma can be classified as primary or secondary. Primary glaucoma cannot be contributed to any known cause or risk factor. - secondary glaucoma
Both open-angle and angle-closure glaucoma can be classified as primary or secondary. Secondary glaucoma develops as a complication of another medical condition or injury. In rare cases, secondary glaucoma is a complication following another type of eye surgery.
What are the symptoms of glaucoma?
Most people who have glaucoma do not notice any symptoms until they begin to lose some vision. As optic nerve fibers are damaged by glaucoma, small blind spots may begin to develop, usually in the side or peripheral vision. Many people do not notice the blind spots until significant optic nerve damage has already occurred. If the entire nerve is destroyed, blindness results.
One type of glaucoma, acute angle-closure glaucoma, does produce noticeable symptoms because there is a rapid build-up of pressure in the eye. The following are the most common symptoms of this type of glaucoma. However, each individual may experience symptoms differently. Symptoms may include:
- blurred or narrowed field of vision
- severe pain in the eye(s)
- haloes (which may appear as rainbows) around lights
- nausea
- vomiting
- headache
The symptoms of acute angle-closure glaucoma may resemble other eye conditions. Consult a physician for diagnosis immediately if you notice symptoms, as this type of glaucoma is considered a medical emergency requiring prompt medical attention to prevent blindness.
How is glaucoma diagnosed?
In addition to a complete medical history and eye examination, your eye care professional may perform the following tests to diagnose glaucoma:
- visual acuity test - the common eye chart test (see above), which measures vision ability at various distances.
- pupil dilation - the pupil is widened with eye drops to allow a close-up examination of the eye's retina.
- visual field - a test to measure a person's side (peripheral) vision. Lost peripheral vision may be an indication of glaucoma.
- tonometry - a standard test to determine the fluid pressure inside the eye.
What are the risk factors for glaucoma?
Although anyone can develop glaucoma, some people are at higher risk than others. The following are suggested as risk factors for glaucoma:
- race
Glaucoma is the leading cause of blindness for African Americans. - age
Persons over age 60 are more at risk for developing glaucoma. - family history
People with a family history of glaucoma are more likely to develop the disease. - high intraocular pressure
Persons with an elevated (greater than 21 mm Hg) intraocular pressure (IOP) are at an increased risk.
The National Eye Institute, part of the National Institutes of Health, recommends that anyone in these risk groups receive an eye examination with dilated pupils every two years.
What is a risk factor?
A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.
Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.
But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.
Treatment for glaucoma:
Specific treatment for glaucoma will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
While glaucoma cannot be cured, early treatment can often control it. Treatment may include:
- medications
Some medications cause the eye to produce less fluid while others lower pressure by helping fluid drain from the eye. - conventional surgery
The purpose of convention surgery is to create a new opening for fluid to leave the eye. - laser surgery (also called laser trabeculoplasty)
There are several types of surgical procedures that can be performed with a laser that are used to treat glaucoma, including: - trabeculoplasty
In this, most common type of laser surgery to treat open-angle glaucoma, a laser is used to place "spot welds" in the drainage area of the eye (known as the trabecular meshwork) which allows fluid to drain more freely. - iridotomy
In this procedure, the surgeon uses the laser to make a small hole in the iris - the colored part of the eye - to allow fluid to flow more freely in the eye. This is usually used to treat acute angle closure glaucoma or patients at risk for acute angle closure glaucoma. - cyclophotocoagulation
A procedure that uses a laser beam to freeze selected areas of the ciliary body - the part of the eye that produces aqueous humor - to reduce the production of fluid. - tube shunt
This implantable drainage device creates an artificial pathway in the eye. It is made from a miniature, stainless steel tube, and can be implanted in less than five minutes. A tube shunt is usually selected after it is determined that a patient cannot benefit from conventional surgical treatments.
In some cases, a single surgical procedure is not effective in halting the progress the glaucoma, and repeat surgery and/or continued treatment with medications may be necessary.