Most diseases in the human body start to present symptoms before any real damage occurs. Not so with glaucoma. In its early stages glaucoma presents few, if any, symptoms. By the time the person notices any problems, irreversible vision loss has already occurred. That’s why glaucoma is the leading cause of blindness in Americans over age 60.
Our experienced ophthalmologists at Physicians Eye Clinic can spot the early signs of glaucoma and successfully help you get a handle on this dangerous disease before it causes permanent vision loss.
What is Glaucoma?
Glaucoma is a group of eye diseases involving fluid in the eye and an increase in pressure. In a normal eye, fluid exits the eye in a continuing stream. But when a person has glaucoma, the fluid is blocked from exiting and this causes pressure to build in the eye. Over time, this pressure damages the optic nerve. It is especially dangerous because most forms of glaucoma don’t exhibit any warning signs or symptoms until the patient already has permanent vision damage.
Risk Factors for Glaucoma
Anyone can develop glaucoma, but certain factors increase a person’s risk:
- Having high intraocular pressure
- Being over age 60
- Being African-American, Asian, or Hispanic
- Having a family history of glaucoma
- Having other medical conditions, such as diabetes, high blood pressure, heart disease, or sickle cell anemia
- Having corneas that are thin in the center
- Being extremely nearsighted or farsighted
- Having had an eye injury
- Having had certain types of eye surgery
- Long-time use of corticosteroid medications, particularly eye drops
Symptoms of Glaucoma
At Physicians Eye Clinic we are constantly on the lookout for signs of glaucoma. That’s one reason we perform the puff of air test during your routine eye exams. Primary open-angle glaucoma can develop in one or both eyes, but the person won’t notice anything during the early phases of the disease. The first real signs will be some loss of peripheral vision. This will progress.
These are the symptoms for the two most common forms of glaucoma:
Primary open-angle glaucoma symptoms:
- Patchy blind spots in your peripheral or central vision, frequently in both eyes
- Increasing inability to see objects out of the corner of the eyes
- Tunnel vision with advanced glaucoma
Acute angle-closure glaucoma symptoms:
- Severe headaches
- Eye pain
- Nausea and vomiting
- Blurred vision
- Halos around lights
- Eye redness
Causes of Glaucoma
The interior of our eyes is filled with fluid, known as aqueous humor. When your eye is normal, this fluid flows through the eye and exits through an area of tissue known as the trabecular meshwork. This is located where the iris and the cornea meet.
If a person has glaucoma, the trabecular meshwork develops a blockage or other damage, or the person’s eye produces too much aqueous humor. This causes pressure to build inside the eye. If it stays elevated, this pressure begins to damage the optic nerve. This deterioration will begin to show itself as the patient will notice blind spots in his or her visual field. This damage is permanent.
Diagnosis of Glaucoma
When you come see our three ophthalmologists at Physicians Eye Clinic, we test for glaucoma during every routine eye exam. That’s because early intervention is so important to successfully managing the condition before it causes permanent damage to the patient’s vision.
What do we do? We’re proud to offer the latest tests for glaucoma, including Cirrus HD-OCT and the Humphrey® Field Analyzer/HFA. This is the gold standard for perimetry testing. We test your visual acuity and visual field. We test the intraocular pressure inside your eye. We measure the thickness of your cornea. We inspect the drainage angle.
Types of Glaucoma
There are various types of glaucoma, but these two forms are the most common:
Primary open-angle glaucoma
This is the most common form of the disease. It happens gradually, as the eye simply doesn’t drain fluid efficiently. The term “angle” refers to the drainage angle inside the eye that controls the outflow of the fluid that is continually produced inside the eye. If the angle is “open” and still functioning, then the trabecular meshwork is partially blocked.
Primary open-angle glaucoma gradually reduces the person’s peripheral vision without other symptoms. By the time the person realizes there is a problem, the damage is permanent. If the pressure inside the eye remains high, destruction will eventually lead to tunnel vision, where the person can only see objects that are straight ahead. Ultimately, blindness will occur.
Acute angle-closure glaucoma
In this form, also called narrow-angle glaucoma, the iris bulges forward to narrow or block the drainage angle formed by the cornea and the iris. Fluids can’t exit the eye and pressure builds, damaging the optic nerve. Some people are born with a “narrow” drainage angle; they are at higher risk for developing acute angle-closure glaucoma.
Acute angle-closure glaucoma may occur suddenly with symptoms such as eye pain, headaches, halos around lights, and nausea and vomiting. This is an emergency situation. Each attack causes progressively more vision loss.
Is Glaucoma Hereditary?
Unfortunately, that is true with primary open-angle glaucoma. When we see a younger patient whose parents have had glaucoma, we really keep an eye out for any signs of increased intraocular pressure. Why? Studies have shown that a family history of glaucoma increases a person’s risk by four to nine times.
Unfortunately, there is no cure for glaucoma. Plus, once glaucoma has damaged a person’s vision, this is irreversible. Our treatment goals are to help slow or prevent vision loss. This can only be done through early intervention. The goal with treatment is to lower the intraocular pressure.
- Eyedrops — The first line of treatment is usually prescription eyedrops. Over the past decade a variety of new eyedrop options have been developed. This gives us options when looking for the drops that work best for your situation. These can reduce the internal eye pressure by either improving how the fluid drains from your eye or by decreasing the amount of fluid your eye is making. The problem with these treatments can be the patient. Because the person isn’t feeling or seeing any symptoms, he or she can be haphazard with their eyedrop regimen. This leads to inconsistent results, but it’s not really a lack on the part of the medications.
- Surgery — The goal here is to improve fluid drainage within the eye. There have some interesting additions to these procedures to return drainage out of the trabecular meshwork. We use these different surgical procedures for treating glaucoma:
- Laser therapy: Laser trabeculoplasty opens clogged channels in the trabecular meshwork.
- Filtering: In a trabeculectomy, part of the trabecular meshwork is removed to enhance drainage.
- Drainage tubes: Small tubes are inserted, usually through the trabecular meshwork, to open flow.
- Minimally invasive glaucoma surgery: These various techniques are used to lower eye pressure, generally with lower risk and easier recovery.
What Are The Risks of Not Treating Glaucoma?
At Physicians Eye Clinic, we can sound like we’re harping on patients to maintain their schedule of routine eye exams. Glaucoma is one of the reasons for this. If you opt to not have your eyes regularly checked, particularly after your 40th birthday, you’re risking vision loss. If we don’t see you, or if we’ve found glaucoma but you’re lackadaisical about your use of your eyedrops, the outcomes are predictable. You will first lose your peripheral vision. Eventually, this will progress to tunnel vision, where you can only see objects directly in front of you. Continued untreated glaucoma will then lead to blindness in one or both eyes.