Glaucoma is a serious eye condition that can cause blindness if untreated. It affects about 2% of whites and 8% of African Americans over the age of 40. Glaucoma causes no symptoms until it is very advanced; this is why it’s often called “the sneak thief of sight.” The disease is easily treatable and blindness can be prevented if the disease is detected early, so a routine eye examination is imperative if you feel you may be at risk for developing the disease.
Glaucoma arises when the eye pressure is too high, causing damage to the optic nerve. The optic nerve acts like a wire, sending vision information from the eye to the brain for processing. Damage to the nerve therefore causes gradual loss of vision. Because the peripheral (side) vision is affected first, patients may not even realize they are losing vision from glaucoma unless they are told by their eye doctor.
The eye pressure is determined by a delicate balance between fluid being formed in the eye and fluid being drained from the eye. Problems with fluid drainage cause an increase in eye pressure. After checking your vision, one of the first things your doctor will do during your office visit is to check the eye pressure. We place a numbing drop in the eye and touch the eye very lightly with a special instrument that records the pressure.
We may use another technique called gonioscopy to examine the area where fluid drainage occurs. If the drainage mechanism is open, your doctor may diagnose a condition called “open angle glaucoma”. This is the most common form of glaucoma. If the drainage mechanism is blocked, a condition called “narrow angle glaucoma” is diagnosed.
Your doctor will also evaluate the optic nerve for signs of glaucoma damage. The optic nerve in glaucoma has a “cupped” appearance easily seen on examination.
If your doctor suspects glaucoma, a visual field test is performed to look for signs of peripheral vision loss. Visual fields taken over time can detect worsening vision loss.
The doctors at Ophthalmology Associates of Bay Ridge use the latest equipment to diagnose glaucoma, including the HRT optic nerve analyzer, OCT nerve fiber layer analyzer and Humphrey visual field testing.
Glaucoma Risk Factors
Certain people are more likely to develop glaucoma. These patients should undergo regular yearly screening for glaucoma. The major risk factors are:
- Family history of glaucoma, especially history of glaucoma surgery in the family
- Race: People of African origin are at increased risk
- Age: Older patients are at increased risk
- Elevated eye pressure
- Abnormal optic nerve appearance
- Blocked drainage mechanism
People with multiple risk factors are called glaucoma suspects and are followed closely for the development of glaucoma.
Glaucoma Treatment And Surgery For Glaucoma
If your doctor determines you have glaucoma, he will recommend a glaucoma treatment aimed at lowering the eye pressure to prevent further vision damage. Many treatments for glaucoma are available, and your doctor can help decide which glaucoma treatment is best for you.
- Eye drops. One of the most common ways to treat glaucoma is with eye drops. These drops, taken once or twice daily, are very effective in lowering eye pressure. Sometimes, more than one glaucoma drop is necessary. Your doctor will help choose the combination of drops that is right for you. If you are using eye drops for glaucoma, it is extremely important to take your medicine every day in order for the eye pressure to be adequately controlled.
- Laser therapy (SLT). Ophthalmology Associates of Bay Ridge is proud to offer SLT (selective laser trabeculoplasty), a safe, powerful long-term treatment for glaucoma. This treatment uses a cold laser to open up the drainage area in the eye so more fluid flows out of the eye and eye pressure is lowered. It is performed in the office, lasts about 10 minutes, and is very safe. Patients who have the procedure are able to return to work either the same day or the following day. In recent studies, patients who had SLT as a first line glaucoma treatment did as well as patients who use glaucoma drops. Compared to drops, SLT has numerous advantages that make it an excellent first-line treatment for glaucoma. SLT is a one-time treatment, eliminating the hassle of remembering to place glaucoma drops daily. Furthermore, the procedure is covered by your insurance, saving the considerable monthly expense of eye drops. Many of our patients choose to have the laser treatment for these reasons. Sometimes, the laser treatment is performed if eye drops are not lowering the eye pressure enough and additional therapy is necessary.
- Laser Therapy for Narrow Angles. Patients who are diagnosed with narrow angle glaucoma undergo a different laser treatment called peripheral iridotomy. This procedure is also performed in the office and lasts only a few minutes. Iridotomy prevents a painful, potentially blinding condition known as “angle closure glaucoma,” and your doctor will recommend this treatment if you are at risk for developing angle closure.
- Glaucoma Surgery. Patients who have very advanced glaucoma require glaucoma surgery to lower the eye pressure. There are many different surgical procedures performed, and your doctor will discuss whether surgery is appropriate and which procedure is best for you. Glaucoma surgery is typically reserved for patients who fail laser or medical therapy. The most common surgery for glaucoma is called trabeculectomy. This surgery creates a new path for fluid to exit the eye, resulting in lower eye pressure. Sometimes, in cases of poorly controlled glaucoma and cataract, a combined surgery for glaucoma and cataract is performed. If you have these two conditions, your eye doctor will let you know if a combined surgery is indicated.
Glaucoma causes progressive, IRREVERSIBLE vision damage. You won’t know if you’re at risk for glaucoma unless you are told by your eye doctor. It is imperative to have an eye examination as early as possible because blindness can be prevented if glaucoma is detected early and the appropriate glaucoma treatment course is initiated.
People with known risk factors for glaucoma should be screened every 6-12 months. Patients with glaucoma are usually seen every 3-4 months, depending on how well-controlled the eye pressure is.
If you have glaucoma, it is extremely important to continue regular followup as directed by your physician. Only your eye doctor can tell if your treatment regimen is still effective, and whether additional therapy is needed.