If you couldn’t guess, January is National Glaucoma Awareness Month. With a nickname like the silent thief of sight, is it any wonder that it needs more awareness?
Did you know that glaucoma is one of the leading causes of blindness for people who are sixty and older? It is the number one cause of blindness in African Americans.
According to Dr. Sarwat Salim, Professor of Ophthalmology and Director of Glaucoma Service at the New England Eye Center of Tufts University, “Approximately 3 million people are afflicted with glaucoma in the United States and about 50% of these individuals may not even know that they have the disease because of its asymptomatic nature.”
Keep reading to learn more about this condition!
What is glaucoma?
Glaucoma is a group of diseases that affect the optic nerve, a part of the eye that is responsible for transmitting visual signals to the brain to form an image.
Unlike other eye conditions, most patients can’t tell if they have glaucoma because the early loss of vision starts at the far periphery. By the time they realize that something is wrong, central vision is usually affected and permanent vision loss has already occurred.
In glaucoma, the optic nerve becomes damaged when fluid builds up inside the eye.
Having extra fluid in the eye increases the amount of pressure in your eye. Increased intraocular pressure damages the optic nerve.
Once the optic nerve is damaged, vision cannot be regained. To prevent vision loss, glaucoma must be diagnosed as early as possible. From there, the condition can be properly treated, and further vision loss can be avoided.
What are the risk factors?
It is well established that increased intraocular pressure is a key risk factor for the development of glaucoma.
Dr. Salim highlighted several other risk factors including, “advancing age, family history of glaucoma, African or Latino descent, severe myopia or nearsightedness, and systemic diseases such as hypertension (high blood pressure) or diabetes. Physical injury to the eye can also cause glaucoma. Also, long-term use of steroids (either drops or pills) can increase intraocular pressure.”
How is glaucoma diagnosed?
Since there are no symptoms regular eye exams are important! An eye exam with your eye doctor is the only way to diagnose glaucoma.
The American Academy of Ophthalmology recommends a complete eye exam by the age of 40. Those at increased risk should have a complete eye exam before the age of 40.
Dr. Salim notes that the “important elements of the examination include visual acuity test, tonometry to measure intraocular pressure, gonioscopy to assess the drainage canal in the eye, slit lamp examination to assess the anterior segment of the eye, use of special lenses to examine the optic nerve and posterior segment of the eye, and visual field test to assess the loss of peripheral or central vision.”
There are some patients who are known as “glaucoma suspects”. This is because they have higher than normal eye pressure, but no signs of damage to the optic nerve.
Glaucoma suspects have a higher risk of developing glaucoma and should be monitored regularly. It is possible to have higher intraocular pressure and not have glaucoma, but it’s rare.
Glaucoma treatment options
Although there is no cure for glaucoma, there are treatment options. When caught early, the treatment starts with eye drops.
According to Dr. Salim, “The eye drops either decrease the production of fluid in the eye or increase the outflow of fluid from the eye, thereby reducing intraocular pressure.”
Many glaucoma patients find success using eye drops to control their eye pressure. If eye drops don’t work, some patients may require special pills.
These pills work by limiting the amount of fluid that is being produced in your eye. Some patients may be prescribed pills if they can’t handle taking eye drops due to discomfort or adverse side effects.
Usually, the pills are used on a short term basis while surgical options are being explored and are not used long-term due to their systemic side effects.
Treating advanced glaucoma
For glaucoma that’s more advanced or not adequately controlled with medical therapy, Dr. Salim notes that these patients may require laser or incisional surgery.
One procedure is a laser trabeculoplasty. With a laser trabeculoplasty, a special lens is held up to the eye.
A beam of light is then aimed through that lens and laser energy is applied to the drainage canal of the eye. This laser treatment allows the fluid in the eye to properly drain.
If laser trabeculoplasty doesn’t help, surgical treatment may become necessary. Depending on the severity of your glaucoma different surgical procedures may be recommended.
For early to moderate glaucoma, Dr. Salim mentioned that new, less invasive procedures are being offered at the New England Eye Center. These procedures are collectively referred to as MIGS or Microinvasive Glaucoma Surgery.
For advanced glaucoma and for those cases which do not respond to MIGS, Dr. Salim mentioned that there are two traditional glaucoma surgeries which create a new path for fluid drainage.
The first is a trabeculectomy. With a trabeculectomy, your surgeon creates a new drain in the eye.
When creating a new drain, a small flap is created to cover the new opening. Once the procedure is completed, a filtration bleb forms under your upper eyelid.
This system helps control the flow of fluid into the eye and drains out through the flap into the bleb.
The second method is implantation of a glaucoma drainage device. A drainage tube is placed into the eye and connected to a reservoir under the eyelid. The eye’s fluid drains through the tube into the reservoir.
If you have any of the risk factors described above and would like a glaucoma consultation, schedule an appointment at the New England Eye Center in Boston today!