Glaucoma is a silent killer of eyesight, so to speak. Although it is the leading cause of blindness in Americans over age 60, in its early stages glaucoma presents few if any symptoms. By the time the person notices issues, irreversible vision loss has already occurred.
At Shenandoah LASIK & Cataract Center, we can spot the early signs of glaucoma and successfully treat the condition before it causes permanent damage.
What is Glaucoma?
Glaucoma is a group of eye disorders that damage the eye’s optic nerve. This usually happens when fluid builds up in the front part of the eye. This fluid, which normally exits the eye in a continuing stream, builds pressure increases within the eye. Eventually this damages the optic nerve.
Glaucoma is the second leading cause of blindness in the U.S. for all ages, following only macular degeneration. Glaucoma can occur at any age, but it is much more prevalent in older adults.
If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye within 20 years.
What Causes Glaucoma?
The elevated eye pressure that is glaucoma is caused by a buildup of the aqueous humor, the fluid that flows through the inside of the eye. This internal fluid normally drains out of the eye through a tissue called the trabecular meshwork. This is found where the iris and cornea meet. If the trabecular meshwork is damaged or blocked, or when the eye overproduces aqueous humor, pressure increases in the eye. As the pressure increases, it begins to damage the optic nerve.
What Are the Most Common Types of Glaucoma?
Primary Open-Angle Glaucoma
This is the most common form of the disease. It happens gradually, where 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.
Signs and Symptoms of Glaucoma
There are different forms of glaucoma, but the most common forms are known as open-angle glaucoma and acute angle-closure glaucoma. These are the symptoms for these forms:
Primary open-angle glaucoma symptoms:
- Patchy blind spots in your peripheral or central vision, frequently in both 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
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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 black, 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 eyedrops
At our practice, during every routine eye exam we test for glaucoma because early diagnosis and treatment is key to success against the disease. We test your visual acuity and visual field. The intraocular pressure inside your eye is tested. We also measure the thickness of your cornea, and we inspect the drainage angle. 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.
Once glaucoma has damaged a person’s vision, this is irreversible. Treatment can help slow or prevent vision loss, if the disease is caught early. The goal with treatment is to lower the intraocular pressure.
Eyedrops — The first line of treatment is usually prescription eyedrops. 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. There are now a variety of different eyedrop options, depending on how your eyes respond. Many people don’t comply with their dosages and the need for consistent application of their eyedrops, however, and this is a leading cause of continued damage because the patient isn’t experiencing any pain or symptoms.
Surgery — The goal here is to improve fluid drainage within the eye.
- 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 Happens If Glaucoma Goes Untreated?
The risks with not having your eyes regularly checked, or not using your glaucoma pressure-reducing eyedrops once diagnosed, are pretty straightforward. You will first lose your peripheral vision. Eventually, this will leave you with only 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.
Glaucoma develops unbeknownst to the patient in almost all cases. That’s why maintaining a regular schedule of eye exams is important, particularly after your 40th birthday.