Q: What is glaucoma?
Glaucoma is the leading cause of blindness in people over 60 years old. It is a set of disorders that damage the optic nerve, most commonly due to fluid build up in the anterior (front) portion of the eye. As nerve tissue is lost, vision is subsequently lost. There are many types of glaucoma: the most common being primary open-angle glaucoma and acute angle-closure glaucoma.
Primary open-angle glaucoma= the most common form of glaucoma, caused by slow clogging of the drainage angle, causing increased IOP.
Acute angle-closure glaucoma= occurs abruptly due to a rapid increase of pressure in the eye as the depth between the cornea and iris decreases.
Q: What causes glaucoma?
As aqueous humor fluid flows into the eye, the same amount should flow out through the drainage angle where the cornea and iris meet. This process keeps intraocular pressure (IOP) of the eye stable. If the drainage is not working properly, fluid builds up, and consequently the pressure rises, damaging the optic nerve.
Q: Who gets glaucoma?
Risk factors include:
- Anyone over age 40
- African-Americans age 35 and older
- Hispanic Americans over age 60
- Japanese are most likely to have normal-tension glaucoma.
- Family history of glaucoma
- If you have diabetes or high blood pressure
- If you are extremely myopic (near-sighted)
- Adults constantly using a steroid inhaler to control asthma
- Eye Injury can cause glaucoma immediately after the injury or years later.
Q: How is glaucoma harmful to vision?
The optic nerve sends signals from the eye to the brain, so as the nerve fibers die and fail to send signals, you will develop blind spots starting in the peripheral (side) vision. As glaucoma progresses, it can affect central vision as well.
Q: Will I go blind from glaucoma?
Over time, primary open-angle glaucoma will cause permanent loss of vision and without treatment can cause total permanent blindness within a few years.
Angle-closure glaucoma is an emergency condition because severe vision loss can occur quickly.
Q: How can I tell if I have glaucoma?
In primary open-angle glaucoma, there are no obvious symptoms in early stages. As the disease progresses, blind spots develop in the peripheral vision.
With angle-closure glaucoma, however, symptoms of an attack may include blurred vision, halos, headaches, red eye, or eye pain. Nausea and vomiting are likely.
Comprehensive exams on a periodic basis allows us to determine if you are at risk for developing glaucoma. Early diagnosis and intervention is critical to ensure a lifetime of good vision.
Q: How is glaucoma detected?
All types of glaucoma are detected and diagnosed by a complete eye examination. Checking pressure alone is not sufficient to diagnose glaucoma. We will first check visual acuity and perform tonometry to check IOP. Dilation and retinal imaging for the evaluation of the optic nerve and retina/nerve fiber layer is then performed. Additional testing, including a visual field assessment, will also be initiated.
Q: How is glaucoma treated?
Glaucoma is most commonly controlled with eyedrop medication that lowers the pressure by either reducing the amount of fluid made by the eye or by enabling better fluid outflow through the drainage angle.
Surgery can also help the aqueous fluid drain from the eye. In primary open-angle glaucoma, trabeculoplasty, trabeculectomy, or minimally invasive glaucoma surgery (MIGS) can relieve pressure. In the case of an angle closure attack, however, a quick peripheral iridotomy (PI) laser procedure is performed.
Q: Will my vision be restored after treatment?
Glaucoma damage is permanent and cannot be reversed. Medicine and surgery can help stop further damage.
Q: Can glaucoma be prevented?
While there are no known ways of preventing open-angle glaucoma, vision loss or blindness can be prevented by early detection and reduction of IOP to prevent damage to the optic nerve. Narrow angle glaucoma is treatable through laser peripheral iridotomy which can prevent damage. It is important to follow up with your doctor as he or she recommends, especially if you are at risk.
Dr. Caryn Nearnberg