Glaucoma

What is glaucoma?

Glaucoma is an eye condition that damages the optic nerve, which may lead to blindness for some patients.

There are two major types of glaucoma.

Primary open-angle glaucoma

This is the most common type of glaucoma. It happens gradually, where the eye does not drain fluid as well as it should (like a clogged drain). As a result, eye pressure builds and starts to damage the optic nerve. This type of glaucoma is painless and causes no vision changes at first.

Some people can have optic nerves that are sensitive to normal eye pressure. This means their risk of getting glaucoma is higher than normal. Regular eye exams are important to find early signs of damage to their optic nerve.

Angle-closure glaucoma (also called “closed-angle glaucoma” or “narrow-angle glaucoma”)

This type happens when someone’s iris is very close to the drainage angle in their eye. The iris can end up blocking the drainage angle. You can think of it like a piece of paper sliding over a sink drain. When the drainage angle gets completely blocked, eye pressure rises very quickly. This is called an acute attack. It is a true eye emergency, and you should call your ophthalmologist right away or you might go blind.

Here are the signs of an acute angle-closure glaucoma attack:

• Your vision is suddenly blurry
• You have severe eye pain
• You have a headache
• You feel sick to your stomach (nausea)
• You throw up (vomit)
• You see rainbow-colored rings or halos around lights

Many people with angle-closure glaucoma develop it slowly. This is called chronic angle-closure glaucoma. There are no symptoms at first, so they don’t know they have it until the damage is severe or they have an attack.

Angle-closure glaucoma can cause blindness if not treated right away.

What causes glaucoma?

Your eye constantly makes aqueous humor. As new aqueous flows into your eye, the same amount should drain out. The fluid drains out through an area called the drainage angle. This process keeps pressure in the eye (called intraocular pressure or IOP) stable. But if the drainage angle is not working properly, fluid builds up. Pressure inside the eye rises, damaging the optic nerve.

The optic nerve is made of more than a million tiny nerve fibers. It is like an electric cable made up of many small wires. As these nerve fibers die, you will develop blind spots in your vision. You may not notice these blind spots until most of your optic nerve fibers have died. If all of the fibers die, you will become blind.

What are the symptoms of glaucoma?

Glaucoma is a silent thief of sight

Glaucoma has no symptoms in its early stages. In fact, half the people with glaucoma do not know they have it! Having regular eye exams can help your ophthalmologist find this disease before you lose vision. Your ophthalmologist can tell you how often you should be examined.

Two types of glaucoma exist: acute angle-closure glaucoma and open-angle glaucoma. The symptoms of acute angle-closure glaucoma include redness of the eye, seeing halos around lights, blurred vision, pain in the eye, nausea, and severe headache. Open-angle glaucoma, on the other hand, has no obvious early symptoms until the patient experiences patchy blind spots in the central or peripheral vision when advanced. Over time, this may progress to tunnel vision and ultimately blindness if not prevented.

Patients who have been diagnosed with acute angle-closure glaucoma will need emergency treatment to reduce the pressure in the eye.

How is glaucoma diagnosed?

The doctors at Friedberg Eye Associates diagnose glaucoma with several in-office tests. These tests include:

• Gonioscopy - Gonioscopy inspects the fluid drainage angle.
• Pachymetry - This test measures the thickness of the cornea.
• Visual field test - A visual field test looks for areas of vision loss.
• Tonometry - This test measures pressure in the eye.
• OCT measures retinal thickness
• Fundus photos are pictures of the optic nerve

What treatments are available?

The damage glaucoma causes before diagnosis is irreversible. However, if the doctor determines that a patient has glaucoma, they will recommend treatments to reduce the pressure in the eye and prevent additional damage. In many cases, the first line of treatment will include eye drops and possibly oral medications to reduce pressure. Some patients may also need a laser procedure performed in the office or a surgical procedure to lower the pressure in the eye. Friedberg Eye Associates offers several surgical procedures for patients with glaucoma, including laser surgery and iStent.

Although surgery can effectively lower eye pressure, it also poses risks. Some of the risks of glaucoma surgery include loss of vision, abnormally high or low pressure in the eye, bleeding, inflammation, infection, and pain. The doctors at Friedberg Eye Associates can help each patient decide on the most appropriate course of treatment for glaucoma.

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