Glaucoma is a serious, lifelong eye disease that can lead to vision loss if not controlled. But for most people, glaucoma does not have to lead to blindness. That is because glaucoma is controllable with modern treatment, and there are many choices to help keep glaucoma from further damaging your eyes. Treatment cannot reverse damage that has already occurred, but it can prevent further vision loss.
January has been declared as National Glaucoma Awareness Month by Prevent Blindness and other leading eye health organizations. Prevent Blindness seeks to educate the public on the second leading cause of blindness (behind cataracts) by providing free resources via online or by mail through its “Glaucoma Learning Center.” Visit www.preventblindness.org/glaucoma-learning-center for free information on risk factors, symptoms and treatment options.
For example, glaucoma risk factors include:
Age: Those that are 40 and older are more likely to develop glaucoma. The older you are, the greater your risk.
Race: People of African or Afro-Caribbean heritage are more likely to get glaucoma than the rest of the population. They are also more likely to develop glaucoma at a younger age.
Family History: If you have a parent or sibling who has glaucoma, you are more likely to develop the disease.
Diabetes: People with diabetes have a higher risk (40 percent) of developing glaucoma.
Nearsightedness: People who are very nearsighted are at greater risk.
Eye Injury or Surgery: Those who have had eye surgery or eye injuries may develop secondary glaucoma.
Steroid Medication: Steroids may increase the risk of glaucoma when used for extended periods of time.
Prevent Blindness has recently put together free fact sheets to help answer common questions about health insurance, Medicare coverage for glaucoma, the Affordable Care Act and eye care. These may be found at www.preventblindness.org/health-insurance-and-your-eyes.
“Although there is currently no cure for glaucoma, the damaging effects can be reduced if diagnosed and treated early,” said Hugh R. Parry, president and CEO of Prevent Blindness. “Our vision should always be a top priority, and the New Year is a great time for a resolution to make sure our eyes are healthy with a dilated eye exam!”
What is Glaucoma?
Glaucoma is an eye disease that causes loss of sight by damaging a part of the eye called the optic nerve. This nerve sends information from your eyes to your brain. When glaucoma damages your optic nerve, you begin to lose patches of vision, usually side vision (peripheral vision). Over time, glaucoma may also damage straight ahead (central) vision. You may not notice a loss of side vision until you have lost a great deal of your sight. When checking for glaucoma, eye doctors usually look for damage to the optic nerve and any loss of side vision. They may also check your eye pressure.
Glaucoma is often called "the sneak thief of sight." That’s because people usually do not notice any signs of the disease until they have already lost significant vision. Once lost, vision can't be restored. More than 2.7 million Americans age 40 and older have open angle glaucoma, the most common form of glaucoma. At least half don't even know they have it.
What are the Different Types of Glaucoma?
There are many types of glaucoma. Often, the cause of high pressure in the eye can help tell the type of glaucoma and the best treatment for it. The most common types include:
Chronic (Open Angle) Glaucoma ► Chronic (Open Angle) Glaucoma
This is the most common type. In open angle glaucoma, aqueous fluid drains too slowly and pressure inside the eye builds up. It usually results from aging of the drainage channel, which doesn't work as well over time. However, younger people can also get this type of glaucoma.
Normal Tension Glaucoma ► Normal Tension Glaucoma
This is a form of open angle glaucoma not related to high pressure. People with normal tension glaucoma may be unusually sensitive to normal levels of pressure. Reduced blood supply to the optic nerve may also play a role in normal tension glaucoma.
Acute (Angle Closure) Glaucoma ► Acute (Angle Closure) Glaucoma
Those of Asian and Native American descent are at higher risk for this form of glaucoma. It occurs when the drainage system of the eye becomes blocked. It causes a sudden rise in pressure, requiring immediate, emergency medical care. The signs are usually serious and may include blurred vision, severe headaches, eye pain, nausea, vomiting or seeing rainbow-like halos around lights. Occasionally, the condition may be without symptoms; similar to open angle.
Secondary Glaucoma ► Secondary Glaucoma
Secondary glaucoma is the result of another eye condition or disease, such as inflammation, trauma, or tumor. For information about uveitis, an inflammation that can cause secondary glauoma, visit www.preventblindness.org/uveitis.
How Does Glaucoma Damage My Eyes?
Doctors don't know exactly how glaucoma damages the optic nerve. For many people, increased eye pressure seems to play an important role.
Your eye produces a watery fluid (aqueous humor), which goes into the eye and drains out. When your eye is healthy, the fluid drains through a mesh-like pathway and into the bloodstream. Aqueous fluid is produced by the ciliary body. It flows through the pupil and behind the clear cornea. Finally, it drains away through the trabecular meshwork.
For some people, fluid can't drain properly because of a faulty drainage system. Drainage that once worked well may gradually slow down as you get older. A sink that becomes clogged backs up with water. When there is no place for excess fluid to go, pressure inside the eye builds up.
This increased eye pressure may damage the optic nerve over time. Slowly, the nerve fibers that are essential for vision die.
For others, glaucoma damages the optic nerve without increased pressure. These people may be unusually sensitive even to normal levels of pressure. Their glaucoma may also be related to problems with blood flow in the eye. Doctors continue to study eye pressure and other possible causes of glaucoma.
Different people experience glaucoma differently. Usually, glaucoma affects side vision (peripheral vision) first. Late in the disease, glaucoma may cause "tunnel vision." In this condition, the person can only see straight ahead. That's why someone with glaucoma can have good straight ahead (central) vision. However, even central vision can be seriously damaged.
How Do Eye Doctors Check for Glaucoma?
There are three major signs that a person may have glaucoma:
•Optic nerve damage
•Increased eye pressure (elevated intraocular pressure).
•Vision loss(visual field loss)
Your eye doctor will check your eyes using some of these tests:
Ophthalmoscopy The doctor will place a few drops in your eye to open or dilate the pupil. This allows the doctor a clearer view to inspect the optic nerve at the back of the eye.
An alternative to the Dilated Eye Exam: Medina Vision and Laser Centre has an Optomap machine, which can see up to 75% of the inside of the eye without having to dilate the eye. This machine is painless, takes only a few moments of looking into a lens, and physically records the image of the eye for later comparisons.
Credit: National Eye Institute, National Institutes of Health
Photography or Optic Nerve and Retinal Imaging or laser scanning may be used to show the appearance of the optic nerve inside your eye. This may also involve dilating your eye.
To learn more about our Optomap Exam, visit: http://www.youtube.com/watch?v=PaLrF4Jg-h0
Tonometry measures pressure in the eye. Medicine drops are used to numb the eye. An instrument gently presses on the outside of your eye. Pressure is shown as a number followed by the abbreviation "mm Hg." This stands for "millimeters of mercury," a standard measure for pressure. An average pressure is about 16 mm Hg. Still, a higher than average number doesn't always mean you have glaucoma. Since the thickness of the cornea (the front window of the eye) may affect the pressure reading and the risk of glaucoma progression, your doctor may measure this as well. Pressure can also be measured by non-contact tonometry, also known as the air puff test.
Perimetry evaluates your visual field. This tests your vision all around your field of view to see if any areas are missing. It usually involves staring straight ahead at a light and trying to see lights that appear around the sides of your view. This is generally done with a computerized system.
Gonioscopy After numbing the eye, the doctor gently places a special lens on the surface to examine the area in the front of the eye that drains fluid. Gonioscopy allows a more accurate diagnosis of the type of glaucoma.
How Do Eye Doctors Treat Glaucoma?
Glaucoma can usually be treated and controlled using medicine(s), laser surgery, glaucoma surgery or a combination of these treatments. Medicines (eye drops) are typically the first step in treatment, but laser surgery may be just as effective as a first choice. Your treatment is up to you and your doctor. In this section, you will learn about your options for treatment.
Treating Glaucoma With Medicines
Eye doctors use many medicines to treat glaucoma. These drugs lower pressure inside the eye. Often, people with glaucoma must take these medicines for life to control the pressure and limit vision loss.
An introduction to glaucoma medicines
Glaucoma medicines are usually in the form of drops, but also come in pills or ointment. They work to lower the amount of aqueous fluid produced and/or improve fluid drainage in the eye.
All glaucoma medicines may cause side effects, some of which can be uncomfortable. A few side effects can be quite serious, but those side effects are not common.
The glaucoma medicines listed below are grouped by the way they work. Some of the possible side effects are also listed. Not every drug in a category will have all the possible side effects listed. Your doctor can tell you which side effects are possible with the medicines you use.
Remember, you and your doctor must work together to determine the best medicines for you.
Eye doctors use many medicines to treat glaucoma. These drugs lower pressure inside the eye. Often, people with glaucoma must take these medicines for life to control the pressure and limit vision loss. Read More
Glaucoma Laser Surgery
Some people may need eye surgery to control their glaucoma. Lasers are very useful for treating glaucoma because they avoid cutting and have a lower chance of complications (compared to glaucoma surgery).
There are three common laser procedures:
A peripheral iridotomy is most often used to treat narrow angle or angle closure glaucoma. The laser beam creates a tiny hole in the colored part of the eye (the iris). This lets the pressure in front of the iris become the same as the pressure behind the iris. As a result, the iris moves away from the drainage angle and the aqueous fluid can resume draining normally.
People usually don't feel any pain with these procedures, although some report a slight stinging. Most patients take it easy the day of their treatment, but go back to their normal routine the following day.
Many people need to keep taking medicines even after laser surgery.
Laser surgery is usually successful, but there are some risks. These include a temporary, generally short-term increase in eye pressure, temporary inflammation of the eye, and possibly a slightly increased risk of developing cataracts.
If medicine or laser surgery does not relieve eye pressure, a patient may need glaucoma surgery. There are several options.
Filtering surgery creates a new path through the eye's tissues to let fluid drain from the eye.
In the most common filtering surgery, called a trabeculectomy or a sclerostomy, the surgeon makes a small opening in the white part of the eye (the sclera) to create a new outflow path. The fluid then flows through the new opening and creates a bleb, which is like a small bubble or reservoir on the surface of the eye. The bleb holds the fluid while it is slowly absorbed into the surrounding tissue. The upper eyelid usually hides the bleb, so it's not noticeable to you or others.
Most people who have this procedure no longer need medicine after surgery. Some people treated still need medicine, but they have better pressure control after the surgery. About 15 percent do not benefit from filtering surgery.
An alternative type of glaucoma surgery may occasionally be performed in which the tissues over the drainage area are thinned but not fully penetrated. This procedure may produce fewer complicatons than trabeculectomy, but also may be less effective in achieving low intraocular pressures.
Drainage implant surgery
Drainage implant surgery is sometimes performed when a person is not suited for filtering surgery or when earlier filtering surgery has failed. Depending on the kind of implant used, the surgery is called valve, shunt or seton surgery.
In these procedures, the surgeon inserts a tiny tube through the sclera into the front part of the eye behind the iris. This tube becomes a path for fluid to drain away. The other end of the tube is attached to a tiny reservoir that acts like the bleb to hold fluid until it is absorbed into the surrounding tissue. The reservoir is placed on the surface of the eye, back between the eye muscles, so it is not visible.
Right after filtering or drainage implant surgery, a person may have a temporary decrease of vision. Vision usually improves over several weeks to its previous level. It also takes time to recuperate from either form of surgery. For example, in the weeks after surgery, people often must avoid getting water into their eyes, reading, bending, lifting heavy objects and driving.
Canaloplasty is a newer procedure to lower pressure that is performed within the eye wall but that does not actually pentrate the eye. While this procedure is safer that filtering surgery, it does not provide as profound a reduction in IOP.
Minimal Invasive Glaucoma Surgeries
Minimal Invasive Glaucoma Surgeries are a set of newer FDA approved procedures that lower pressure. These approaches currently include Trabectome and the iStent. Both of these approaches work by bypassing the blockage in the drain of the eye to help fluid flow through the natural drain and do not require "artifical" pathways for fluid drainage to areas outside the eye. Like canaloplasty, the procedures are less risky than filtering surgery but do not provide as profound a reduction in IOP. More long-term data is needed to determine how well they work beyond the first few years. Use of Minimal Invasive Glaucoma Surgeries is still being debated among glaucoma specialists but may have application is specific patients.
Laser Cyclophotocoagulation is used for severe cases of glaucoma. It eliminates tiny areas of the ciliary body that make aqueous fluid. This "turns down the faucet." Laser cyclophotocoagulation requires a numbing block to the eye to prevent pain with the procedure.
Risks of glaucoma surgery
Glaucoma surgeries have some possible risks, such as:
A higher chance of getting cataracts
Infection or leaking of the incision
Too low pressure
Hemorrhages inside the eye
Unfortunately, the new drainage path can close, causing pressure in the eye to rise again. Filtering surgery can be repeated with good results. Also, drainage implants are often successful in patients whose filtering surgery has failed. The medicines that reduce inflammation and control scar formation after surgery have helped increase the success of glaucoma surgeries.
Treating Glaucoma with Laser Surgery Details
Some people may need eye surgery to control their glaucoma. Lasers are very useful for treating glaucoma because they avoid cutting and have a lower chance of complications (compared to glaucoma surgery). Read More
details about these surgeries can be found at http://www.preventblindness.org/glaucoma-surgery
Taking Eye Drop Medications
About the NLO technique
When an eye drop is placed in the eye, some of it exits through the tear drainage system called the nasolacrimal duct, located at the corner of the eye near the nose. The drug then passes through the sinuses, and is quickly absorbed into the bloodstream. Unpleasant side effects can occur when the drug reaches other parts of the body, such as the heart, liver or kidneys. Side effects from some eye medications can include asthma, low blood pressure, high blood pressure, changes in heart rhythm, depression or nervousness.
A simple technique, called nasolacrimal occlusion, or NLO, can prevent the drug from flowing into the drainage duct. That keeps more medicine in your eye and makes the drug more effective. The step-by-step instructions on how to apply the NLO technique can be found at: http://www.preventblindness.org/taking-eye-drop-medications
Living With Glaucoma
You must work with your eye doctor if you have glaucoma. Eye doctors know how to treat glaucoma, but they have to work with you to find the best way to treat your disease.
What you do makes a difference
• Remember to take notes. Write down your questions
so you can make the most of your eye doctor visits.
• Explain to your eye doctor how the medicines you are taking affect you.
• Tell all of your other doctors about your eye medicines and all other drugs you're taking.
• Read more about glaucoma and how to live with it.
• Tell the eye doctor about any changes in your physical condition, any changes in your medicine or any
Getting more involved in your treatment
Even if surgery or drugs lower pressure in your eye, it's still possible to lose vision. Therefore, you and your doctor must carefully monitor the disease.
Since you will be visiting your eye doctor regularly, take time and care in choosing a person who you are comfortable with. Your doctor should understand that your questions and concerns are important. A doctor who is willing to work with you, listen to your concerns and provide the best treatment, plays a large part in your success against glaucoma.
You have to help save your sight
You may need medicines every day for the rest of your life. Find support and encouragement from your family, friends and others. Sometimes it helps to talk to people who have experienced the same thing. It can help you to discuss side effects, share ways to remember your medicines and celebrate getting your glaucoma under control.
Unfortunately, there are a few people whose eyesight will continue to get worse, despite doing all the right things to control their glaucoma. Doctors aren't sure why this happens, but research in this area continues.
The future holds great promise for treating glaucoma. New medicines are being developed. Other treatments may soon become available. In the meantime, take heart in knowing that you're doing everything possible to treat your glaucoma successfully. The doctor/patient team approach, support from others and promising scientific discoveries will help you look forward to a bright future.
Questions for your eye doctor
You will have many questions as your doctor diagnoses and treats your glaucoma. It's helpful to keep a list of these questions, especially if they come to mind in between your eye appointments. Write all your questions down and bring the list with you, then discuss them with your doctor. Here are some questions many people have:
• What do these medicines do?
• How much will they cost? Will my insurance help pay
for them? (These may be questions for your insurance company, not your doctor.)
• What are the possible side effects of my medicines?
• Can I do anything to lower the chance of side effects or reduce the effects?
• What should I do if I miss a dose?
• Will I need surgery? What are the benefits and drawbacks of laser surgery? Of glaucoma surgery?
• What will my vision be like after surgery?
• How long will recovery take? How will I need to change my usual activities? Will I be able to drive? Go to work?
• Would I still need medicine after surgery? The same doses?
• How often will I need return visits?
• What is the latest research on glaucoma and its treatment?
• Are there any other treatments that may be right for me at this stage of my disease?
Medicare benefits and your eyes
Eye Health is Important!
As you age, your risk for vision impairment and vision loss grows. Because some vision-threatening conditions are not readily noticeable, it is important that you preserve your vision by maintaining a healthy lifestyle and having an eye exam through dilated pupil every 1-2 years or as recommended by your eye doctor. Half of all blindness can be prevented through early detection and treatment.
Medicare beneficiaries, especially those at risk for or diagnosed with a variety of diseases, are entitled to a number of vision-related services. It is especially important for people with diabetes, a family history of glaucoma, or those who have suffered an eye disease or injury to be aware of and utilize these benefits. The link for more information is: http://www.preventblindness.org/medicare-benefits-and-your-eyes
All information for this article is from the Prevent Blindness Organization, the Optomap company and the National Institute of Health. Brought to you by Medina Vision and Laser Centre