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Glaucoma

Glaucoma

Glaucoma is a group of eye diseases that damages the optic nerve. The optic nerve carries images from the retina, which is the specialized light sensing tissue, to the brain so we can see. When a significant number of nerve fibers are damaged, blind spots develop in the field of vision causing permanent visual loss. Most people don't notice these blind areas until much of the optic nerve damage has already occurred. Glaucoma is a leading cause of blindness in the world, especially in older people. Early detection and immediate treatment is the only way to prevent optic nerve damage and vision loss from glaucoma.

The exact cause of optic nerve damage from glaucoma is not fully understood, but it involves mechanical compression and/or decreased blood flow of the optic nerve. Although high eye pressure sometimes leads to glaucoma, many people can also develop glaucoma with normal eye pressure.

The Different Types of Glaucoma

Open-angle glaucoma

Chronic open-angle glaucoma is the most common form of glaucoma. The ‘open’ drainage angle of the eye gets blocked leading to gradual increase in eye pressure. If this increased pressure results in optic nerve damage, it is known as chronic open-angle glaucoma. The optic nerve damage and vision loss usually occurs so gradually and painlessly that you are not aware of trouble until the optic nerve is already badly damaged.

Angle-closure glaucoma

Angle-closure glaucoma results when the drainage angle of the eye narrows until completely blocked. In the eye, the iris may close off the drainage angle and cause a dangerously high eye pressure. When the drainage angle of the eye suddenly becomes completely blocked, pressure builds up rapidly, and this is called acute angle-closure glaucoma. The symptoms include severe eye pain, blurred vision, headache, rainbow haloes around lights, nausea and vomiting. This form of glaucoma occurs more frequently in people of African and Asian ancestry, and in certain eye conditions.

FAQ's

Unfortunately, most cases of glaucoma do not occur with readily noticeable symptoms that warn of the irreversible optic nerve damage being done. Following are the warning signs:
  • Unusual trouble adjusting to dark rooms
  • Difficulty focusing on near or distant objects
  • Squinting or blinking due to unusual sensitivity to light or glare
  • Change in color of iris
  • Red-rimmed, encrusted or swollen lids
  • Recurrent pain in or around eyes
  • Double vision
  • Dark spot at the center of viewing
  • Lines and edges appear distorted or wavy
  • Excess tearing or ‘watery eyes’
  • Dry eyes with itching or burning; and
  • Seeing spots, ghost-like images
The following may be indications of potentially serious problems that might require emergency medical attention:

  • Sudden loss of vision in one eye
  • Sudden hazy or blurred vision
  • Flashes of light or black spots
  • Halos or rainbows around light
The symptoms listed above may not necessarily mean that you have glaucoma. However, if you experience one or more of these symptoms, contact your eye doctor for a complete exam.
Regular eye-checkups are the best way to detect glaucoma. Your ophthalmologist will measure your eye pressure (tonometry); inspect the drainage angle of your eye (gonioscopy); evaluate your optic nerve (ophthalmoscopy); and test the visual field of each eye (perimetry). Optic nerve evaluation and visual field testing are performed at regular intervals to monitor the effects of glaucoma.
High eye pressure alone does not necessarily mean you have glaucoma, but it is an important risk factor your ophthalmologist will use to determine your risk for developing the disease.
  • Family history of glaucoma
  • Age 40 years or above
  • Short-sightedness
  • Diabetes
  • Serious eye injury
  • Undergone steroid treatment over an extended period
  • Hypertension
All of these factors will be considered before deciding if you need treatment for glaucoma; or whether you should be monitored regularly as a glaucoma suspect to detect the early signs.

The treatment for glaucoma depends upon the nature and severity of each case. In general, glaucoma cannot be cured, but it can be controlled overtime with the use of eye drops, pills, laser procedures, and surgical operations. These methods are used to prevent or slow further damage from occurring. Regular eye examinations are very important to detect progression and to prevent vision loss. Glaucoma can quickly worsen, thus, your treatment will likely be changed over time to achieve a lower ‘target eye pressure’.

Laser Surgery

Laser surgery may be effective for different types of glaucoma. In open-angle glaucoma, the drain itself is treated. The laser is used to enlarge the drain (trabeculoplasty) to help control eye pressure. In angle-closure glaucoma, the laser creates a hole in the iris (iridotomy) to improve the flow of aqueous fluid to the drain.

Operative Surgery

When operative surgery is needed to control glaucoma, miniature instruments are used to create a new drainage channel for the aqueous fluid to leave the eye. The new channel helps to lower the pressure. Though serious complications are rare with the usage of modern methods, they can occur, as with any surgery. This kind of extensive surgery is recommended only if your ophthalmologist feels that it is safe.
Your ophthalmologist can prescribe treatment for glaucoma, but only you can make sure you take your eye drops or pills regularly and on time. Do not stop taking or change your medications without consulting your ophthalmologist. Frequent eye examinations and tests are critical to monitor your eyes for any changes. Remember, it is your vision, and you must do your part to maintain it.
It can be usually controlled with eye drops taken several times a day or sometimes with pills. These medications decrease eye pressure, either by slowing the production of aqueous fluid within the eye or by improving the flow leaving the drainage angle. You must take them regularly for positive results. It is important to tell your doctor about any other medications you are using. Glaucoma medications can have side effects. You should notify your ophthalmologist immediately if you think you may be experiencing side effects.

Drops can sometimes cause:

  • Stinging sensation,
  • Red eyes,
  • Blurred vision,
  • Headaches,
  • Changes in pulse, heartbeat or breathing

Pills sometimes cause:

  • Tingling of fingers and toes,
  • Drowsiness,
  • Loss of appetite,
  • Bowel irregularities,
  • Kidney stones,
  • Anemia or easy bleeding

Regular medical eye exams may help prevent unnecessary vision loss.
You should have an examination:

  • Every 3 to 5 years, If you are age 39 and over,
  • Every 1 to 2 years, If a family member has glaucoma,
  • If you are of African ancestry,
  • If you have had a serious eye injury in the past,
  • If you are taking steroid medications

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