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What is Glaucoma?
Glaucoma refers to a group of diseases that have common features including a pressure in the eye (intraocular) which is too high for the health of an individual eye, damage to the eye’s optic nerve, and visual field (sight) loss. Most types of glaucoma affect both eyes at the same time. There are usually no symptoms or warning signs that glaucoma is present. However, early diagnosis and treatment is the key to successfully managing glaucoma and ideally occur before significant damage occurs.
Symptoms
In many ways we should think about glaucoma as we do high blood pressure (hypertension). Neither disease typically causes any symptoms and both harm our bodies without our being aware it is happening. Both of these diseases can cause severe problems if untreated . . . glaucoma can cause partial or complete blindness and high blood pressure can cause stroke and heart attack.
Glaucoma has been called the “sneak thief of sight” because the typical glaucoma sufferer feels no pain or discomfort and is unaware that vision is being lost until the disease is very advanced when central vision is affected. Unfortunately, by the time central vision is affected a great deal of surrounding or peripheral vision has already been lost. With the way our two eyes and brain work we simply do not detect the early loses of peripheral vision in glaucoma. The only way these early changes are detected is through very sophisticated testing from your eye doctor. While the overwhelming majority ( perhaps 95 % ) of patients with glaucoma have one of the common “silent” forms there are very rare cases of “acute glaucoma” which occur with severe eye pain, headache, and perhaps vomiting and the appearance of “haloes” around lights. Any such severe eye problem should cause you to immediately contact your eye doctor.
The front part of the eye is filled with a clear fluid (aqueous humor). This fluid is continually produced within the eye where it circulates and eventually drains out. This fluid is what determines the eye’s pressure and it is easily measured by your eye doctor.
Glaucoma is commonly thought to be a disease of “high eye pressures.” However, it is important to stress that there is no particular “pressure” at which a person automatically has glaucoma. The pressure which your doctor measures in your eyes is just one of the factors which must be considered in deciding whether or not you have glaucoma. Each person’s eyes are different and depending upon other factors such as your age, family history and general health, a particular “pressure” which might not be a problem for others might be too high for your eyes.
Quite simply the eye’s pressure is determined by the internal production and drainage of fluid which comprise a basic “plumbing system.” Like any “plumbing system” if the drain becomes blocked or too much fluid is produced for the “drain” to handle the system backs up and the pressure inside goes up. If a pressure is determined to be too high and is not reduced and maintained at a healthy level for a particular individual it will eventually damage the eye’s optic nerve . . . the pathway by which images are brought to the brain so that “seeing” as we think of it can occur. Uncontrolled, this damage can produce partial and even complete blindness.
Treatment
The diagnosis of glaucoma involves much more than the measurement of “eye pressures.” The optic nerve is carefully examined and photographed with computerized scans. The peripheral vision is evaluated with sophisticated computerized visual field testing instrumentation.
Once diagnosed glaucoma is treated aggressively with the goal of stabilizing any vision loss which may have occurred and preventing further damage. The first line of therapy is usually the use of various medications in the form of eye drops. These drops may have differing specific affects from reducing fluid production within the eye to enhancing its drainage. It may be that a single type of drop has enough effect to adequately help a given patient while other patients may require multiple types of medication and changes over time.
For those patients for whom medication does not provide adequate control of the disease several types of laser and surgical procedures are available. Selective Laser Trabeculoplasty (SLT) for open angle glaucoma and Laser Peripheral Iridotomy (LPI) for angle closure glaucoma are office based procedures that are often effective in assisting glaucoma control. Traditional surgical procedures including trabeculectomy, glaucoma tube shunt implants and diode laser cyclophotocoagulation are employed when deemed necessary. Recently Microinvasive Glaucoma Surgeries (MIGS) are done in conjunction with cataract surgery to provide additional glaucoma control. MIGS are usually performed in conjunction with cataract surgery.
It is important to recognize that glaucoma, like diabetes and high blood pressure, requires lifelong medical care and treatment. Although glaucoma is the second leading cause of blindness in the United States, for the vast majority of glaucoma sufferers, timely diagnosis and treatment allow useful and satisfactory vision to be retained throughout life. Glaucoma affects approximately 5 % of all elders and occurs 5 – 6 times as often in Blacks as it does in whites. It is important to remember that a family history, parents, grandparents, brothers or sisters with glaucoma, increases the likelihood that you may suffer the same problem and so it is especially important to obtain thorough yearly eye examinations.