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Glaucoma Care

Glaucoma is a complex condition. The diagnosis and treatment is not always straightforward. With careful evaluation, regular follow-up visits, and diligent treatment in coordination with your ophthalmologist and primary care physician, vision can be preserved.

What is Glaucoma?

Glaucoma is a condition that leads to progressive optic nerve damage (optic neuropathy) and eventual blindness if it is left untreated. We don’t know the exact cause, but there are many factors that increase the risk for development and progression of glaucoma. Some of these risk factors include: age, genetics (family history), elevated eye pressure, thin corneas, previous eye injury, vascular disease (poor circulation), and other systemic conditions such as hypertension (high blood pressure) and diabetes.

What are the different types of glaucoma?

  • Chronic open-angle glaucoma: This is the most common form of glaucoma in the United States.The risk of developing chronic open-angle glaucoma increases with age. The drainage angle of the eye becomes less efficient over time, and pressure within the eye gradually increases, which can damage the optic nerve. In some patients, the optic nerve becomes sensitive even to normal eye pressure and is at risk for damage. Treatment is necessary to prevent further vision loss.Typically, open-angle glaucoma has no symptoms in its early stages and vision remains normal. As the optic nerve becomes more damaged, blank spots begin to appear in the field of vision. You typically won’t notice these blank spots in your day-to-day activities until the optic nerve is significantly damaged and these spots become large. If all the optic nerve fibers die, blindness results.
  • Closed-angle glaucoma: Some eyes are formed with the iris (the colored part of the eye) too close to the drainage angle. In these eyes, which are often small and farsighted, the iris can be sucked into the drainage angle and block it completely. Since the fluid cannot exit the eye, pressure inside the eye builds rapidly and causes an acute closed-angle attack.Many people with closed-angle glaucoma have no symptoms at all and completely normal vision. In severe cases, where the eye pressure becomes extremely high, the following symptoms may occur:
    • blurred vision
    • severe eye pain
    • headache
    • rainbow-colored halos around lights
    • nausea and vomiting

The symptoms above indicate a true eye emergency. If you have any of these symptoms, call your ophthalmologist immediately. Unless this type of glaucoma is treated quickly, severe optic nerve damage, and possibly blindness can result.

Glaucoma: Structure of eye, normal eye In a normal eye, clear fluid is produced in the ciliary body, behind the iris. This fluid slowly moves to the front of the lens and through the pupil. Eventually it exits the eye through the trabecular meshwork.
Glaucoma: Structure of eye, closure glaucoma In angle closure glaucoma, fluid can not exit the eye because the trabecular meshwork is blocked by iris tissue. Pressure in the eye can become very elevated, causing damage to the optic nerve.
Glaucoma: Structure of eye, laser opening A laser opening in the iris can provide a bypass route, so fluid can gain access to the trabecular meshwork.

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How is Glaucoma treated?

Unfortunately, there is no cure for glaucoma. However, the good news is that glaucoma is one of the most studied diseases of the eye, and many treatment options are available to prevent the progression of glaucoma and preserve the eyesight of patients with the disease. The mainstay of treatment is to optimize the eye pressure for each individual as well as to optimize the patient’s health, especially in regards to cardiovascular disease and diabetes. Your ophthalmologist is the most qualified physician to make recommendations regarding eye pressure control. Some patients may require lower pressures than others. Treatment may include: topical medications (eye drops), oral medications, laser, surgery, or a combination of any or all of these modalities.

Your primary care or family physician will be instrumental in optimizing your overall health, which is also an integral part in the management of glaucoma.

Who is at risk for glaucoma?

Your ophthalmologist considers many kinds of information to determine your risk for developing the disease.

The most important risk factors include:

  • age
  • elevated eye pressure
  • Hispanics, East Asian, or African ancestry
  • farsightedness or nearsightedness
  • past eye injuries
  • thinner central corneal thickness
  • systemic health problems, including diabetes, migraine headaches, and poor circulation

Our doctors will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a glaucoma suspect. This means your risk of developing glaucoma is higher than normal, and you need to have regular examinations to detect the early signs of damage to the optic nerve.

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How Do I know I have glaucoma?

There are very few symptoms of glaucoma in the early stages of the disease. Since there is no cure for glaucoma, it is critical to detect and treat glaucoma at its earliest stage in order to preserve the eyesight. By the time a person notices symptoms at home, such as: blind spots, difficulty functioning in low-lighting conditions, tunnel vision, or visual loss, it may be too late. These symptoms usually develop slowly over time, and may takes years to develop, making it even more difficult to notice. Occasionally, a person may experience an acute “attack” of glaucoma, consisting of severe pain, halos, redness, unilateral headache, nausea, and blurry vision. If you experience any of these symptoms, it is an emergency, and you should contact your ophthalmologist urgently.

Otherwise, a screening exam by your ophthalmologist is the most effective defense against glaucoma. If you have a strong family history of glaucoma or blindness, you should be examined in your 20’s. If you have had a serious eye or head injury, you should be examined at the time of your accident and yearly thereafter. All others should have a screening exam before the age of 50. Your ophthalmologist will then make recommendations for future appointments after the initial visit.

What types of testing is needed for detecting glaucoma?

At the time of your examination, your doctor may elect to have you return for additional glaucoma testing if it is warranted. These tests include: Visual field testing (peripheral vision test), optic nerve imaging, and cornea thickness measurement. It is important to return for these additional tests if your doctor has clinical suspicion, and it should be repeated periodically, at least on an annual basis. Sometimes, a diagnosis may not be possible after the initial visit, and may require vigilant monitoring, sometimes over years, before a definitive diagnosis of glaucoma can be made.

A significant benefit of having your glaucoma care and follow up performed at Beach Eye Medical Group is that we have invested in the most advanced technology to monitor glaucoma progression. We use the Cirrus HD OCT (Optical Coherence Tomography) from Carl Zeiss Meditec. With this instrument, we are able to detect subtle and small changes in the health of your optic nerve better than ever before. Wherever you choose to go, make sure your eye care provider has invested in the best technology for you. Remember, vision loss in glaucoma is not reversible so early detection and treatment is the best therapy.

If your doctor institutes treatment, it is important to comply with all medical therapy and follow-up visits. Again, since there is no cure, prevention is critical.

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Will I go blind from glaucoma?

Glaucoma is a slow-progressing disease. Though it is unlikely that you would go completely blind from glaucoma, uncontrolled glaucoma can certainly lead to progressive vision loss. A certain form of glaucoma known as Narrow-Angle glaucoma may lead to quick vision loss because of the acute nature in which it can present. Your doctor can help decrease the risk of acute vision loss with regular examinations and a laser procedure known as a peripheral iridectomy.

Where can I get more information?

The information contained above is not intended to be a comprehensive discussion of glaucoma, but rather an overview.

Please visit the website of the American Academy of Ophthalmology and The Glaucoma Research Foundation for additional information:

www.AAO.org

www.glaucoma.org

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