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Glaucoma

What is Glaucoma?

Glaucoma is an eye disease caused by damage to the optic nerve occurring from eye pressure (not blood pressure). Optic nerve damage from this disease causes permanent loss of side vision that can lead to blindness. Glaucoma is the second leading cause of blindness worldwide and millions of people in the world go blind from this problem every year. This disease is especially dangerous since many people do not know that they are affected and it is often called the “sneak thief” of sight. Unfortunately, there is no cure for glaucoma yet but it can be controlled with lifelong eye care.

Who is at risk for Glaucoma?

Scientific studies have shown that there are risk factors that increase a person’s risk for developing glaucoma. These risk factors include:

  • Older than 60 years old
  • Eye pressure
  • Family History of glaucoma
  • African or Hispanic/Latino ancestry
  • Type 2 diabetes mellitus
  • Near sightedness

What are the types of glaucoma?

Glaucoma is an eye disease that comes in more than 30 different types. These types have different characteristics, are more common in certain ethnic backgrounds, and can have different recommended treatments. Many of the forms of glaucoma are based on the access to the part of the eye called the “Angle”. The angle is where the internal drainage system of the eye is located. This internal drainage system is different from the external drainage system where our tears drain. The only way to determine if you have glaucoma and what type is to undergo a complete ocular examination. Some of these types of glaucoma include:

  • Primary Open Angle Glaucoma: This type of glaucoma is more common in African-Americans and Hispanics. It is characterized by open access to the eye’s internal drainage system (the angle) but the drainage system does not work well. Most of the time, this type of disease can cause vision loss without the patient feeling any changes.
  • Acute Angle Closure Glaucoma: This type of glaucoma is caused by a sudden rise in eye pressure from a blockage of the eye’s internal drainage system called the “angle”. This sudden high eye pressure usually causes eye pain and redness, blurred vision, and sometimes nausea and vomiting. If the eye pressure is not lowered quickly, it can cause permanent vision loss. Certain medications can increase the risk of developing this condition. A complete eye exam can identify if you are at risk for angle closure glaucoma and a laser procedure can be performed to prevent vision loss from this type of glaucoma.
  • Chronic Angle Closure Glaucoma: This type of glaucoma is more common in the Asian population. It is characterized by a slow progressive blockage of the eye’s internal drainage system.
  • Pseudoexfoliation Glaucoma: This is a type of glaucoma in which a protein is deposited all over within the eye. This protein can affect the internal drainage system and create high eye pressures. It also deposits on the lens of the eye and it’s support structure. This can make cataract surgery more challenging.
  • Pigmentary Glaucoma: This type of glaucoma is characterized by pigment being released from the colored part of the eye – the iris. It is more common in near-sighted men in their 20-30’s. This pigment can settle in and block the drainage system causing high eye pressures.
  • Neovascular Glaucoma: This type of glaucoma has abnormal blood vessels growing over the eye’s internal drainage system and causing glaucoma. There are multiple causes for these blood vessels to start growing including poorly controlled diabetes and hypertension.

How do you diagnose Glaucoma?

There is no single test that can diagnose glaucoma as there may be with other conditions (for example, pregnancy testing). It takes a complete eye examination and a variety of testing to determine if a patient has glaucoma. Some parts of the examination include measuring the eye pressure, examining the angle with a technique called gonioscopy, testing for side vision loss, and checking for any optic nerve damage. The purpose of these exams is to establish the diagnosis of glaucoma and to develop a treatment plan designed for each individual patient. Early detection of this disease is so important to prevent any loss of vision. Repeated eye exams are needed to check for the development of glaucoma, especially if a patient has multiple risk factors. Unfortunately, far too many people are diagnosed after they have already lost some vision from glaucoma.

Adults without any risk factors, family history, or symptoms, should undergo a compete eye exam by the age of 40. Your eye physician will recommend the timing for your next follow up exam. Adults who are 65 or older, should undergo complete eye exams every 1-2 years to examine for disease, or as recommended by your eye physician.

How do you monitor and treat Glaucoma?

The purpose of glaucoma monitoring and treatment is to maintain the health of the optic nerve and to prevent vision loss. Since glaucoma is a progressive disease, it requires constant monitoring to maintain control of the disease. With control, it is possible to prevent vision loss from glaucoma. There are multiple treatment types for glaucoma including medications and surgery. Currently, the main purpose of treatment is to lower eye pressure to control the disease. Medications such as eye drops are very effective and are commonly used as the initial treatment, unless contraindicated. There are also laser procedures that are designed to lower the eye pressure and may also be used as the initial treatment. If medications and laser procedures are unable to control glaucoma, glaucoma surgeries to create new drainage systems for the eye may be needed. The patient and the physician work together to develop a treatment plan for each individual patient. It takes a lifetime of work to keep glaucoma under control but it is a worthwhile effort to preserve vision and quality of life.

iStent®

The iStent® Trabecular Micro-Bypass is an exciting new procedure designed to help cataract surgery patients who are also affected by mild to moderate open-angle glaucoma. Implanted inside the eye to reduce pressure and slow the progression of glaucoma, iStent® is the smallest device ever approved by the U.S. Food and Drug Administration. After an intraocular lens (IOL) has been placed during cataract surgery, the iStent® is inserted to allow better drainage of excess liquid from the eye. The small titanium implant is designed to treat glaucoma without causing eye irritation or harming surrounding tissue.

The iStent® implant can make it possible to reduce, and even eliminate, the need for expensive medications to control glaucoma. Dr. Michael Manning at Gulfcoast Eye Care will evaluate your condition and help you determine if you are a candidate for the iStent® procedure.

If you have risk factors for glaucoma, please contact Gulfcoast Eye Care to be evaluated.

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