GLAUCOMA

Glaucoma is a disease that damages your eye’s optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve.

With open-angle glaucoma, there are no warning signs or obvious symptoms in the early stages. As the disease progresses, blind spots develop in your peripheral (side) vision.

Most people with open-angle glaucoma do not notice any change in their vision until the damage is quite severe. This is why glaucoma is called the “silent thief of sight.” Having regular eye exams can help your ophthalmologist find this disease before you lose vision. Your ophthalmologist can tell you how often you should be examined.

Some people have no signs of damage yet but have higher than normal eye pressure (called ocular hypertension) or suspicious looking optic nerves.  These patients are considered "glaucoma suspects" and have a higher risk of eventually developing glaucoma. Some people are considered glaucoma suspects even if their eye pressure is normal. For instance, their ophthalmologist may notice something different about their optic nerve. Anyone who is considered a glaucoma suspect should be carefully monitored by their ophthalmologist. An ophthalmologist can check for any changes over time and begin treatment if needed.

Risk factors

Some people have a higher than normal risk of getting glaucoma. This includes people who:

• are over age 40
• have family members with glaucoma
• are of African, Hispanic, or Asian heritage
• have high eye pressure
• are farsighted or nearsighted
• have had an eye injury
• use long-term steroid medications
• have corneas that are thin in the center
• have thinning of the optic nerve
• have diabetes, migraines, high blood pressure, poor blood circulation or other health problems affecting the whole body

Talk with an ophthalmologist about your risk for getting glaucoma. People with more than one of these risk factors have an even higher risk of glaucoma.

How do we diagnose Glaucoma?

The only sure way to diagnose glaucoma is with a complete eye exam. A glaucoma screening that only checks eye pressure is not enough to find glaucoma.

During a glaucoma exam, your ophthalmologist will:

• measure your eye pressure
• inspect your eye's drainage angle
• examine your optic nerve for damage
• test your peripheral (side) vision with a visual field test
• take a picture or computer measurement of your optic nerve called an OCT
• measure the thickness of your cornea

Treatment

Glaucoma damage is permanent—it cannot be reversed. But medicine and surgery help to stop further damage. To treat glaucoma, your ophthalmologist may use one or more of the following treatments.

Eye drops: 

Glaucoma is usually controlled with eyedrop medicine. Used every day, these eye drops lower eye pressure. Some do this by reducing the amount of aqueous fluid the eye makes. Others reduce pressure by helping fluid flow better through the drainage angle.

Glaucoma medications can help you keep your vision, but they may also produce side effects. Some eye drops may cause:

• a stinging or itching sensation
• red eyes or red skin around the eyes
• changes in your pulse and heartbeat
• changes in your energy level
• changes in breathing (especially if you have asthma or breathing problems)
• dry mouth
• blurred vision
• eyelash growth
• changes in your eye color, the skin around your eyes or eyelid appearance.

Never change or stop taking your glaucoma medications without talking to your ophthalmologist. If you are about to run out of your medication, ask your ophthalmologist if you should have your prescription refilled.

Laser Surgery:

There are two main types of laser surgery to treat glaucoma. They help aqueous drain from the eye. These procedures are usually done in the ophthalmologist’s office or an outpatient surgery center.

• Trabeculoplasty (SLT). This surgery is for people who have open-angle glaucoma. The eye surgeon uses a laser to make the drainage angle work better. That way fluid flows out properly and eye pressure is reduced.
• Iridotomy (LPI). This is for people who have angle-closure glaucoma. The ophthalmologist uses a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.

Surgery:

Some glaucoma surgery is done in an operating room. It creates a new drainage channel for the aqueous humor to leave the eye.

• Trabeculectomy. This is where your eye surgeon creates a tiny flap in the sclera. He or she will also create a bubble (like a pocket) in the conjunctiva called a filtration bleb. It is usually hidden under the upper eyelid and cannot be seen. Aqueous humor will be able to drain out of the eye through the flap and into the bleb. In the bleb, the fluid is absorbed by tissue around your eye, lowering eye pressure.
• Glaucoma drainage devices. Your ophthalmologist may implant a tiny drainage tube in your eye. The glaucoma drainage implant sends the fluid to a collection area (called a reservoir). Your eye surgeon creates this reservoir beneath the conjunctiva. The fluid is then absorbed into nearby blood vessels.