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Glaucoma

Glaucoma is a group of related eye disorders that can cause damage to the optic nerve, which carries information from the eye to the brain. Since glaucoma does not have many initial symptoms, people with glaucoma are often unaware of it.The best treatment is early detection so yearly eye exams are recommended. Currently there is no “cure” for glaucoma but this disease can be managed with the help of an Ophthalmologist or Optometrist.

Types of Glaucoma

  • Primary Open Angle Glaucoma (POAG)is a common type of glaucoma in which the aqueous fluid cannot easily flow through the eye’s own drainage system.This can make the eye pressure increase, which can put additional pressure on the optic nerve. Damage to the optic nerve can lead to blind spots in your vision or in the most severe cases blindness.
  • Narrow Angle Glaucoma is also known as angle-closure glaucoma. This is another type of glaucoma in which the drainage angle is blocked by the iris and the aqueous fluid is unable to exit the eye. This causes a rapid increase in eye pressure and needs to be treated as quickly as possible to minimize damage. If you are experiencing pain in the eye, blurry vision, halos around lights, or nausea see your eye doctor immediately!
  • Normal-tension Glaucoma is a type of open-angle glaucoma that causes visual field loss due to damage of the optic nerve. The cause of normal-tension glaucoma remains unknown. It, however, is believed to be due to poor blood flow to the optic nerve. People of Japanese descent, women, and/or those having a history of vascular disease may have an increased risk of developing this condition.
  • Pigmentary Glaucoma is a rare form of glaucoma that is caused by clogging of the drainage angle of the eye by pigment flakes which break loose from the iris and reduce the rate of aqueous fluid outflow from the eye. With the passage of time, the drainage system can be damaged due to inflammation in the blocked angle.
  • Secondary Glaucoma refers to increased pressure in the eye. The cause of this could be due to the presence of an acute infection in the eye, a tumor, or enlargement of the lens following a cataract.
  • Congenital Glaucoma is a rare condition affecting children.Eighty percent of cases are diagnosed by age one. Children are born with a defect of some kind in the eye drainage system, such as narrow angles. It is more common in boys than girls.

Causes May Include

  • Genetics – Glaucoma often runs in families and scientists have identified genes that are specifically related to optic nerve damage and high eye pressure.
  • Eye injury or disease – Severe eye injuries can be linked to a higher risk for developing glaucoma. Eye tumors, inflammation, and retinal detachment are a few other factors that may increase the risk of acquiring glaucoma.
  • Pigment dispersion – When fine granules or fragments from the iris build up in the drainage channels, they can block the aqueous fluid from exiting the eye.
  • Inflammation of the eye – Can cause anatomical changes in the intraocular circulation of the aqueous fluid which can raise the risk of glaucoma.
  • Steroids – Patients who have undergone long-term treatments of eye drops, and sprays containing steroids may be more susceptible to glaucoma.

Risk factors May Include

  • Eye injury
  • Diabetes
  • Having high internal eye pressure
  • Being over the age of 60
  • Taking cortico steroid medications, especially eyedrops, for a long time
  • Having a family history of the condition
  • Being of African-American or Hispanic descent

Signs and symptoms

  • Severe eye and head pain
  • Hazy or blurred vision
  • Nausea along with severe eye pain
  • The appearance of rainbow-colored circles, or halos, around bright lights
  • Sudden loss of vision

Treatment

  • Eyedrops: Glaucoma treatment often begins with prescription eye drops.These can help decrease eye pressure by decreasing the amount of fluid your eye makes, or by improving the way in which fluid drains from your eye. With any medication there are potential side effects. Speak with your doctor about the possible risks associated with the medication they prescribe. The type of eyedrops that may be used to treat your glaucoma include the following:
  • Prostaglandins: Helps to increase the outflow of the fluid in your eye and thereby reduce pressure in your eye. Examples include bimatoprost orlatanoprost.
  • Beta blockers: Reduces the production of fluid in your eye and can subsequently lower the intraocular pressure in your eye. Examples include betaxolol and timolol.
  • Alpha-adrenergic agonists: Lowers the production of aqueous humor and thus increase the outflow of the fluid in your eye. Examples being brimonidine and apraclonidine.
  • Miotic or cholinergic agents: Increase the fluid outflow from your eye.
  • Oral medicationsIf eye drops do not completely control your eye pressure, your eye doctor may also prescribe oral medications to bring down the intraocular pressure (IOP).
  • Therapies and SurgeriesVarious therapies and surgeries may also be employed to treat glaucoma. At InSight Vision Center, our surgeons use a wide variety of surgical treatments depending on the type of glaucoma you have and how severe the disease is.
  • Laser therapy may be an option for people suffering from open-angle glaucoma.Your doctor would use a laser to open the various clogged channels in the trabecular meshwork (helps to drain the aqueous fluid from the eye).
  • Drainage tubes may be another procedure that is used to treat glaucoma in which a small tube is inserted in your eye to create a new drain and allow the aqueous to exit the eye.
  • Electrocautery is a minimally invasive procedure which removes tissues from the trabecular meshwork by using a small electrocautery device known as a Trabecutome.
  • Microsurgery also known as trabeculectomy. This procedure is used to create a new channel that enables the surgeon to drain the fluid and reduce the IOP.

Other treatment options may include Ex-PRESS shunt implantation, Baerveldt or Ahmed valve implantation, diode laser cyclophotocoagulation, endoscopic laser cyclophotocoagulation, selection laser trabeculoplasty, or laser peripheral iridotomy. Our surgeons continue to implement new techniques and procedures as they are developed.

Prevention

Glaucoma detected at an early stage can be managed with the help of your eye doctor. However, glaucoma detected at later stages may be more difficult to treat. The sooner a diagnosis of glaucoma is made the better the chance are for minimizing vision loss. Annual eye exams in which eye pressure is taken and recorded is the best way to stay aware of your risk for developing glaucoma.

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