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Glaucoma

When excessive fluid pressure develops inside the eye the condition is called glaucoma. It is hereditary and usually becomes apparent in the second half of life. The optic nerve, which carries all our visual images to the brain, can be damaged by this increase in the pressure within the eye. Damage to the optic nerve causes a loss of vision that, without treatment, would eventually lead to complete and irreversible blindness.

The fluid in the eye, called the aqueous humor, normally undergoes slow replacement by freshly made fluid. Some of the existing fluid normally drains out of the eye slowly, but this drainage becomes blocked in glaucoma. More fluid gradually keeps coming in with none leaving, so the fluid pressure inside the eye goes up. Imagine over-filling a water balloon – but much more slowly.

Unfortunately, there are often no distinct early symptoms or pain from glaucoma, so the disease can gain a foothold for a few years without a person realizing they have it. This is the reason for eye exams on a regular basis – every year or two – especially in those over 40, to detect newly arising conditions. When it is noticed by a person, a common first loss of sight with glaucoma is in peripheral vision. In rare cases the swelling reaches a point where there is sudden headache or eye pain and blurring of vision. These symptoms at least prompt the person to seek medical help, but at this stage damage has been done to the optic nerves. Much better to have it caught ahead of time on an eye exam!

An eye care professional can diagnose glaucoma during a standard eye exam. Loss of peripheral vision may be noted, though this alone isn’t specific for glaucoma. For that, looking with a light into the interior of the eye is required. There is a characteristic, altered appearance of the optic nerve in glaucoma. If there is any doubt – if the change in the optic nerve is minor, for example - a simple test called tonometry directly assesses pressure within the eyes. Those who see an eye care professional on a regular (1-2 year) basis may have a “baseline” photo taken of the retina and optic nerve, which can aid in detecting small changes.

Glaucoma can run in families, so those with close relatives having the condition are at increased risk for developing it and should have yearly eye exams, especially after the age of 40. Others at elevated risk are those with diabetes, those taking certain steroid medications, and those in any number of racial and ethnic subpopulations. These include African-Americans in particular but also those of Russian, Japanese, Hispanic, Irish, or Scandinavian descent.

The two main types of glaucoma are open-angle (OAG), by far the most common form, and angle-closure glaucoma (ACG). This second, less common type can sometimes develop much more rapidly than open It can also be referred to as “closed-angle,” to make the comparison with open-angle glaucoma simpler, but doctors find “angle-closure” to be more accurate in technical detail. In any case, usually both eyes are affected by glaucoma, though commonly one may be worse than the other.

Treatment for open-angle glaucoma is with eye drops, laser treatment or with microsurgery – or some combination of these. Laser treatment or microsurgery are the usual approaches for angle-closure glaucoma. With laser treatment, an attempt is made to open up the drainage that should exist for the eyes. Patients with glaucoma should consult with one or more trusted vision professionals to learn more about their various options.

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