Glaucoma

Glaucoma is a very complex disease to diagnose and even more elusive than its diagnosis is its treatment. In a nutshell, glaucoma is defined as the loss of optic nerve tissue most commonly caused by high eye pressure.
You can see here that the optic nerve runs out of the back of the eye and goes straight to the brain. The nerve is fed with blood and oxygen from the vessels that run through its center. This is where high eye pressure presents a problem.

GLAUCOMA


The eye is constantly producing and circulating a clear aqueous humor that moves through drainage canals of the anterior chamber angle in the front of the eye near the iris. When this clear fluid is unable to escape, often due to a blockage, fluid builds in the eye and increases pressure on the optic nerve, which is known as Glaucoma. Glaucoma, if left untreated, can lead to vision loss.

The vision loss will generally be experienced in the form of peripheral vision loss, which may not be noticeable to the patient until significant optic nerve damage has already occurred. If a glaucoma diagnosis is not made and the eye is left untreated, the damaged optic nerve will result in loss of central vision as well. For this reason, glaucoma is one of the leading causes of blindness, particularly among older patients. The early signs of glaucoma should be taken very seriously, and followed closely by your eye doctor.

There are two forms/types of glaucoma:

Open-Angle Glaucoma – This is the most common type of glaucoma and causes gradual, painless vision loss.  Though its cause is unknown, people with a family history of glaucoma and those of certain ethnicities tend to be of higher risk.

Angle Closure Glaucoma – Unlike open-angle glaucoma, angle closure glaucoma does cause sudden, noticeable symptoms, such as headaches, blurry vision, eye pain, and nausea. Angle closure glaucoma occurs when the drainage canals become blocked and requires immediate medical treatment.

Glaucoma is fairly common, especially in the Baby Boomer generation.  Although elevated eye pressure is a common risk factor of glaucoma, it does not necessarily equate to a glaucoma diagnosis. In addition to high eye pressure levels, there are several other factors that would qualify you as having a higher risk of glaucoma, prompting close attention by your eye doctor.

 

Glaucoma Risk Factors

Age greater than 60
Thin cornea
Family history of glaucoma 
Nearsightedness
Past blunt force eye injuries
African American, Asians and Hispanics
High blood pressure
Diabetes
Steroid use, includes both oral and intranasal

Required Medical Diagnosis

Glaucoma requires a comprehensive ophthalmological evaluation to diagnose. Because glaucoma is an extremely time-sensitive disease, early detection and diagnosis will allow treatment initiation earlier in the course, before any significant vision loss occurs.


In order to determine your risk for glaucoma, your doctor will first discuss your eye health and history with you at length. He or she may ask questions about family history, ancestry, any past eye injuries, personal medical history, and medication use.

Diagnostic testing is helpful in diagnosing and managing glaucoma, and is performed both at initial diagnosis and throughout the disease course to monitor response to treatment.

Visual Field (VF) testing is conducted by looking at a fixed point in a visual field machine.  The patient clicks a button when he or she sees a blinking light in various areas on the screen.  The test measures how far up or down and left and right and is a useful tool to monitor glaucoma over time.

Ocular Coherence Tomography (OCT) imaging captures high-resolution, three-dimensional images of the inner eye to help diagnose and monitor glaucoma and other eye diseases.

Gonioscopy also may be performed to visualize the eye’s drainage system.  This procedure uses special lenses and a microscope to directly see the canal at the periphery of the iris.

TREATMENT OPTIONS


Glaucoma is a serious condition that, if left untreated, can result in permanent vision loss. While most cases of glaucoma cannot be prevented, early detection and treatment lead to better vision preservation.

Treating glaucoma involves medications to lower the eye pressure, often in in the form of eye drops.  Occasionally oral medications are helpful to accomplish this goal. When medical therapy fails, there are numerous laser and surgical options available.  Often surgery is combined with medication to effect the best visual outcome and disease control possible.