Glaucoma is a leading cause of preventable vision loss and blindness in adults in the United States and Canada and the second leading cause of blindness in the World.
What is Glaucoma?
Glaucoma is actually a group of eye diseases that cause damage to the optic nerve due to an increase in pressure inside the eye or intraocular pressure (IOP). When detected in the early stages, glaucoma can often be controlled, preventing severe vision loss and blindness. However, symptoms of noticeable vision loss often only occur once the disease has progressed. This is why glaucoma is called “the sneak thief of sight”. Unfortunately, once vision is lost from the disease, it usually can’t be restored.
Treatments include medication or surgery that can regulate the IOP and slow down the progression of the disease to prevent further vision loss. The type of treatment depends on the type and the cause of the glaucoma.
Prevention is possible only with early detection and treatment. Since symptoms are often absent, regular eye exams which include a glaucoma screening are essential, particularly for individuals at risk of the disease. While anyone can get glaucoma, the following traits put you at a higher risk:
- Age over 60
- Hispanic or Latino descent, Asian descent
- African Americans over the age of 40 (glaucoma is the leading cause of blindness in African Americans, 6-8 times more common than in Caucasians.)
- Family history of glaucoma
- People with severe nearsightedness
- Certain medications (e.g. steroids)
- Significant eye injury (even if it occurred in childhood)
Signs and Symptoms of Glaucoma: Due to a buildup of pressure in the eye, glaucoma causes damage to the optic nerve which is responsible for transmitting visual information from the eye to the brain. How does glaucoma affect your vision?
Types of Glaucoma: There are a number of types of glaucoma, some more acute than others. Learn about the common types of glaucoma and the differences between them.
Diagnosis and Treatment of Glaucoma: Early detection and treatment of glaucoma is essential to stopping or slowing the disease progression and saving vision. Treatment can include medicated eye drops, pills, laser procedures and minor surgical procedures depending on the type and stage of glaucoma.
Signs and Symptoms of Glaucoma
The intraocular pressure caused by glaucoma can slowly damage the optic nerve, causing a gradual loss in vision. Vision loss begins with peripheral (side) vision, resulting in limited tunnel vision. Over time if left untreated, central vision will also be affected which will increase until it eventually causes total blindness. Unfortunately any vision that is lost from the optic nerve damage cannot be restored.
What are the Symptoms?
Typically, glaucoma sets in without any symptoms. At the early onset of the most common type of glaucoma “open angle” glaucoma, vision remains normal and there is no pain or discomfort. This is why the disease is nicknamed the “sneak thief of sight”.
An acute type of glaucoma, called angle-closure glaucoma, can present sudden symptoms such as foggy, blurred vision, halos around lights, eye pain, headache and even nausea. This is a medical emergency and should be assessed immediately as the intraocular pressure can become extremely high and cause permanent damage within hours.
Types of Glaucoma
The primary forms of glaucoma are open-angle and narrow-angle, with open-angle being the most common type.
Primary open-angle glaucoma (POAG) gradually progresses without pain or noticeable vision loss initially affecting peripheral vision. By the time visual symptoms appear, irreparable damage has usually occurred, however the sooner treatment starts the more further vision loss can be prevented. When untreated, vision loss will eventually result in total loss of side vision (or tunnel vision) and eventually total vision loss.
Normal-tension glaucoma or low-tension glaucoma is another form of open-angle glaucoma in which the intraocular pressure remains within the normal level. The cause of this form of glaucoma is not known, but it is believed to have something to do with insufficient blood flow to the optic nerve, causing damage. Individuals of Japanese descent, women and those with a history of vascular disease or low blood pressure are at higher risk.
Angle-closure glaucoma can be a sudden increase in eye pressure causing severe pain, blurred vision, halos, nausea and headaches. The pressure is caused by a blockage in fluid at the front of the eye which is a medical emergency and should be treated immediately. Without prompt treatment to clear the blockage vision can be permanently lost.
Congenital glaucoma is an inherited form of the disease that is present at birth. The babies are born with a defect that slows the normal drainage of fluid out of the eye and are usually diagnosed by the time they turn one. In these cases there are typically some noticeable symptoms such as excessive tearing, cloudiness or haziness of the eyes, large or protruding eyes or light sensitivity. Surgery is usually performed with a very high success rate of restoring full vision.
Secondary glaucomas are complications that develop from eye surgeries, injuries or other medical conditions such as cataracts, tumors, or a condition called uveitis which causes inflammation. Uncontrolled high blood pressure or diabetes can result of another serious form called neovascular glaucoma.
Pigmentary glaucoma is a rare form in which pigment from the iris sheds and clogs the drainage of fluid from the eye resulting in inflammation and damage to the eye and drainage system. .
Treatment of glaucoma is dependant upon the severity and type of glaucoma present.
Glaucoma Diagnosis and Treatment
During a routine comprehensive eye exam to check for glaucoma, your eye doctor will dilate your eye to examine the optic nerve for signs of glaucoma and will also measure the intraocular pressure (IOP) with an instrument called a tonometer. Tonometry involves numbing the eye with drops and then gently pressing on the surface of the eye to measure the pressure. Since your IOP can fluctuate throughout the day and glaucoma can exist without elevated IOP this is not enough to rule out the disease. If there are signs of the disease, further testing will be performed.
Visual Field Test
A visual field test is designed to detect any blind spots in your peripheral or side field of vision. You will be asked to place your head in front of a machine while looking ahead and indicate when you see a signal in your peripheral field of view.
Your doctor may also measure the thickness of the cornea with an ultrasonic wave instrument in a test called pachymetry or use imaging techniques such as digital retina scanning or optical coherence tomography (OCT) to create an image of your optic nerve to look for glaucoma damage.
Treatment for glaucoma depends on the type and severity of the disease and can include medication such as eye drops or pills or laser or traditional surgery.
Medication and drops to lower IOP are often the first resort for controlling pressure-related glaucoma. These drops may have some uncomfortable side effects, but compliance with the treatment plan is essential for preserving vision and halting the progression of the disease.
Surgical procedures are designed to control the flow of fluids through the eye by either decreasing the amount of fluid produced or improving the drainage. Your doctor may decide that a combination of surgery and medication will be the most effective in many cases.
It cannot be stressed enough that the most effective treatment for glaucoma happens when the disease is detected and treated early before significant vision loss occurs. Any vision that is lost can not be restored. This is why the best prevention is awareness by knowing your risks and taking responsibility by having your eyes examined on a regular basis.
Frequently Asked Questions Regarding Glaucoma
Q: Do you test for glaucoma during a regular eye exam?
Dr. Young: Yes. During a regular eye examination, we look for several different factors which can show symptoms of glaucoma.
We look at the optic nerve. That is the most important thing when we are trying to rule out the presence of glaucoma. Does the optic nerve look healthy? Does this optic nerve have an anatomy or appearance suggestive of the glaucoma process? Then we look at pressure readings that are taken inside the eye.
However, it’s not so simple to diagnose. It’s like high blood pressure. One reading doesn’t give you the full picture. We have more advanced testing to determine conclusively if the patient does have glaucoma or not.
Q: How do I know if I have glaucoma?
Dr. Young: It is called the sneaky thief of vision, because there is not real way for people to tell on their own if they have it. Besides “angle closure” glaucoma, other glaucomas cause have no signs or symptoms, so patients will not know that they have it, at least until the very end stage of glaucoma when the patient is nearly blind from it already. Glaucoma is a disease which must be checked for during an eye examination. We may find during a routine eye exam that the patient has risk factors for glaucoma which need to be investigated, or we may find that the disease process is already active and needs to be treated.