Glaucoma is irreversible damage to the
optic nerve, usually due to increased pressure within the eye (intraocular
pressure or IOP) from malfunction of the eye's drainage system. Untreated,
glaucoma causes progressive loss of vision and blindness, but early diagnosis
and treatment can slow or even hault the progression of the disease.
High intraocular pressure and low corneal thickness increase
the risk for development and progression of glaucoma. Glaucoma
is more common in older adults, in those with family history of glaucoma,
and African-Americans.
Glaucoma can occur at any level of intraocular
pressure-it is the ability of each person's optic nerve to withstand pressure
within the eye that determines if that person will develop glaucoma. Glaucoma
damage can occur with a "normal" intraocular pressure (IOP).
Some important facts:
-In the USA, glaucoma is the second leading cause of blindness.
-Glaucoma is the leading cause of blindness in African-Americans.
-2.25 million Americans have glaucoma.....and half are unaware
they are affected.
-80,000 Americans are blind from glaucoma.
-5-10 million have high intraocular pressure.
-African Americans are four times more likely to have glaucoma.
How does glaucoma happen?
Within the eye, the ciliary body produces a fluid called
aqueous humor. The aqueous fluid normally leaves the eye through the drainage
angle between the cornea (the transparent front of the eye) and the iris
(the colored part of the eye). Obstruction to this outflow causes aqueous
fluid to build up, causing the pressure inside the eye to rise.
It is important for your doctors to know what other medications
you are taking to prevent drug interactions and significant side effects.
The first line of treatment for glaucoma includes eye drops and laser
trabeculoplasty. In many cases, several medications are necessary
to reduce the pressure adequately, which can be expensive. Laser treatments
can often lower the IOP, without the risk of side effects from glaucoma
medicines.
Surgery is necessary when medical treatment fails to sufficiently lower
the pressure. The aim of glaucoma surgery is to allow fluid to drain from
the eye more efficiently, lowering the intraocular pressure. However, glaucoma
surgery cannot restore the vision that has already been lost – the
goal of surgery is to prevent further deterioration.
There is no cure for glaucoma, only treatment. Therapy is life long and
takes commitment, but in the end you will be preserving your precious
eyesight.
Primary open angle glaucoma is the most
common type of glaucoma. Obstruction to outflow of aqueous from the eye
causes aqueous fluid build-up, resulting in higher IOP. This high pressure
damages the optic nerve, resulting in loss of peripheral vision. But the
vision loss is gradual and painless, so that patients are unaware until
the problem becomes severe. Treatment includes eye drops, laser trabeculoplasty
and finally glaucoma surgery if other treatments are not effective.
Angle closure glaucoma
is much less common, affecting only 10% of Glaucoma patients. Here, the drainage angle of the eye is very narrow, resulting in poor outflow of aqueous and elevated IOP. Complete blockage – acute angle closure – can occur suddenly, with very high IOP. Symptoms of angle closure include blurred vision, halos around lights, severe eye pain, headache, nausea and vomiting. Acute angle closure is an emergency, as it can lead to permanent blindness if not treated quickly. The most common treatment is a laser iridotomy, which creates a new passage for the aqueous fluid to reach the drain of the eye.
Secondary glaucoma occurs as a result of
another disease or problem in the eye, such as trauma, pseudoexfoliation,
pigment dispersion or inflammation. Treatment depends on the severity
of the disease.
Congenital glaucoma is relatively rare,
seen in infants at birth or within the first 3 years thereafter. Common
signs of congenital glaucoma are cloudy cornea, persistent tearing, and
enlargement of the eye. Most cases of congenital glaucoma require surgery.
2) Low corneal thickness – such thinner eyes are more easily damaged
by high pressure.
3) Age: People over 40 are at increased risk of open angle glaucoma.
Glaucoma is 3-8 times more common among people in their seventies compared
to people in their forties.
4) Race: African- Americans have a higher incidence of primary open angle
glaucoma than Caucasians, and the disease occurs earlier and is more severe.
Pigmentary glaucoma occurs more commonly in Caucasians. Angle closure
is more common in Asians. Exfoliation type glaucoma is most common in
people of European descent.
5) Family history: The prevalence of glaucoma is 10% among siblings,
and the lifetime risk of developing glaucoma by the age of 89 is 10 times
higher for relatives of glaucoma patients.
6) Others: Steroid responsiveness (rise in IOP in patients on steroid
treatment) increases the risk of developing glaucoma. Ocular trauma increases
the incidence of glaucoma.
Diabetes and high blood pressure are linked to glaucoma. Migraine and
sleep apnea are associated with low tension glaucoma.
Because glaucoma does not present symptoms in most cases,
everyone over 40 should have an annual eye examination, including a measurement
of intraocular pressure. If glaucoma is suspected, additional testing
is required to evaluate the optic nerve inside the eye, and the peripheral
vision (with a visual field test). A special lens called a gonioscope
is also used to examine the front of the eye. Other tests such as the
HRT and OCT can analyze the optic nerve and nerve fiber layer to assist
treatment.
Regular examinations are needed to measure the effectiveness of treatment.
Visual field tests need to be periodically repeated to verify that the
glaucoma is not progressing.
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