GLAUCOMA

What is Glaucoma?

Glaucoma, also known as the "Silent Thief of Sight", is a common eye disorder that affects over 2.25 million people over the age of 40, and only half know they have it. It is the leading cause of irreversible blindness in the United States. More than 1.6 million Americans have significant visual impairment from glaucoma.

Glaucoma is actually a group of disorders that cause what is known as an Optic Neuropathy. The Optic Neuropathy is caused by progressive damage to the optic nerve, which is that part of the eye that transmits visual signals from the retina to the brain. Once the optic nerve has been damaged by Glaucoma, it is irreversible. The big problem with Glaucoma is that it is essentially ASYMPTOMATIC, meaning that there are really know symptoms until well into the late stages of the disease.

Some common risk factors for Glaucoma are:

Increased Eye Pressure
Nearsightedness
Family History of Glaucoma
Old Eye Trauma
Diabetes
Past Ocular Surgery

The only risk factor that we can control in glaucoma is Intraocular Pressure. It has been shown that by decreasing Intraocular pressure to an acceptable level, the vision loss from can be prevented.

Symptoms

As noted earlier, there are no early symptoms in Glaucoma. Late stages of Glaucoma and some acute Glaucoma's can cause:

Blurred Vision
Halos Around Lights
Decreased Peripheral Vision
Extremely Bad Headache with Light Sensitivity
Difficulty Focusing

The hallmark of Glaucoma is loss of peripheral vision with gradual loss of central vision. If left untreated, Glaucoma can cause complete loss of vision, i.e. Lights Out!

Below is an example of normal vision with full peripheral fields:

Now this picture simulates what is seen in someone with advanced Glaucoma:

As the disease progresses, it slowly snuffs out vision until it's all gone. Once the vision is lost, it can't be regained.

DIAGNOSIS

If we suspect Glaucoma, the first thing we check is Intraocular pressure. If your Intraocular pressure is higher than normal then that raises a red flag. The next thing we look at is your optic nerve. If the optic nerve looks glaucomatous then the next step is to perform a Visual Field.

A Visual Field test is a non invasive, 15 minute test that allows us to take a look at your peripheral visual fields. It will detect even the slightest changes from Glaucoma which helps us direct management. The Visual Field also allows us to track progress of your treatment.

Below is a picture of a normal appearing optic nerve:

And here is a nerve that has some Glaucomatous damage. Note the enlarged central area:

Not everyone that has high Intraocular pressures has Glaucoma. If you are found to have high pressures but a normal nerve, then the thickness of your cornea is measured. If you have a thicker than normal cornea, your pressures will be falsely elevated. If this is the case, a visual field is still performed but many times we only observe these patients.

Treatment

Luckily there are many good treatment options for Glaucoma. The primary goal in treatment is to reduce the Intraocular pressure to a level that stops damaging the optic nerve.

Most times the pressure can be controlled with eye drops alone. Drops given once, twice or three times a day can successfully control Intraocular pressure for a life time.

Argon Laser Trabeculoplasty is a painless outpatient procedure that can be performed on patients who do not want to be on drops chronically or who have failed drop therapy. The laser is performed by placing a contact lens on the eye and applying laser to that portion of the eye that drains fluid. Optimum response is seen at 2 weeks after the procedure. The Laser is successful in controlling pressure in 75% of eyes over 3-5 years. Sometimes the laser treatment must be repeated and/or drops started again.

If medication and laser therapy fail to control pressure adequately then Filtering Surgery should be considered. Filtering surgery creates an alternate drain for the fluid inside the eye. By routing the fluid outside, Intraocular pressure can be controlled.

If you think you or a loved one has Glaucoma, please call us at 318-212-3937!