Glaucoma Eye Exams
Glaucoma is a leading cause of preventable vision loss and blindness in older individuals in the United States and Canada and the second leading cause of blindness in the World, even more than macular degeneration.
What is Glaucoma?
Glaucoma is not a single disease. It is actually a group of eye diseases that cause damage to the optic nerve due to an increase in pressure inside the eye, which is called intraocular pressure (IOP). When detected in the early stages, glaucoma can often be controlled, preventing severe vision loss and blindness. However, symptoms of noticeable vision loss often only occur once the disease has progressed. This is why glaucoma is called “the sneak thief of sight”. Unfortunately, once vision is lost from the disease, it usually can’t be restored.
Treatments include medication or surgery that can regulate the IOP and slow down the progression of the disease to prevent further vision loss. The type of treatment depends on the type and the cause of glaucoma.
Glaucoma is a disease that causes a gradual degeneration of cells that make up the optic nerve which carries visual information from the eye to the brain. As the nerve cells die, vision is slowly lost, usually beginning in the periphery. Often, the loss of vision is unnoticeable until a significant amount of nerve damage has occurred. Therefore, it is believed that as many as half of all people with glaucoma may be unaware of their disease.
What Causes Glaucoma?
At the front of the eye, there is a small space called the anterior chamber. Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues. In glaucoma the fluid drains too slowly out of the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and loss of vision.
Who Is Most Likely To Get Glaucoma?
Nearly 3 million people have glaucoma, a leading cause of blindness in the U.S. Although anyone can get glaucoma, some people are at higher risk, for example, African Americans over age 40, anyone over age 60, or people with a family history of glaucoma.
Prevention is possible only with early detection and treatment. Since symptoms are often absent, regular eye exams which include a glaucoma screening are essential, particularly for individuals at risk of the disease. While anyone can get glaucoma, the following traits put you at a higher risk:
- Age over 60
- Hispanic or Latino descent, Asian descent
- African Americans over the age of 40 (glaucoma is the leading cause of blindness in African Americans, 6-8 times more common than in Caucasians.)
- Family history of glaucoma
- People with severe nearsightedness
- Certain medications (e.g. steroids)
- Significant eye injury (even if it occurred in childhood)
Signs and Symptoms of Glaucoma: Due to a buildup of pressure in the eye, glaucoma causes damage to the optic nerve which is responsible for transmitting visual information from the eye to the brain. How does glaucoma affect your vision?
Types of Glaucoma: There are a number of types of glaucoma, some more acute than others. Learn about the common types of glaucoma and the differences between them.
Diagnosis and Treatment of Glaucoma: Early detection and treatment of glaucoma are essential to stopping or slowing the disease progression and saving vision. Treatment can include medicated eye drops, pills, laser procedures and minor surgical procedures depending on the type and stage of glaucoma.
Signs and Symptoms of Glaucoma
The intraocular pressure caused by glaucoma can slowly damage the optic nerve, causing a gradual loss of vision. Vision loss begins with peripheral (side) vision, resulting in limited tunnel vision. Over time if left untreated, central vision will also be affected which will increase until it eventually causes total blindness. Unfortunately, any vision that is lost from the optic nerve damage cannot be restored.
What are the Symptoms?
Typically, glaucoma sets in without any symptoms. At the early onset of the most common type of glaucoma “open angle” glaucoma, vision remains normal and there is no pain or discomfort. This is why the disease is nicknamed the “sneak thief of sight”.
Vision stays normal, and there is no pain. However, as the disease progresses, a person with glaucoma may notice his or her side vision gradually failing. That is, objects in front may still be seen clearly, but objects to the side may be missed. As the disease progresses, the field of vision narrows and blindness results.
An acute type of glaucoma, called angle-closure glaucoma, can present sudden symptoms such as foggy, blurred vision, halos around lights, eye pain, headache and even nausea. This is a medical emergency and should be assessed immediately as the intraocular pressure can become extremely high and cause permanent damage within hours.
How Is Glaucoma Diagnosed?
We use advanced retinal imaging (OCT) that allows the doctor to see beneath the surface to the nerve fiber layer where the damage can be seen. Visual field loss, optic nerve swelling, increased eye pressure, and a family history of glaucoma are also signs of glaucoma.
How Can Glaucoma Be Treated?
Although open-angle glaucoma cannot be cured, it can usually be controlled. The most common treatments include:
- Medications – These may be either in the form of eye drops or pills. Some drugs are designed to reduce pressure by slowing the flow of fluid into the eye. Others help to improve fluid drainage. For most people with glaucoma, regular use of medications will control the increased fluid pressure. But, these drugs may stop working.
- Laser Surgery – During laser surgery, a strong beam of light is focused on the part of the anterior chamber where the fluid leaves the eye. Small changes result, making it easier for fluid to exit the eye. Over time, the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking glaucoma drops.
However, surgery is usually reserved for patients whose pressure cannot be controlled with eye drops, pills, or laser surgery.
Types of Glaucoma
The primary forms of glaucoma are open-angle and narrow-angle, with open-angle being the most common type.
Primary open-angle glaucoma (POAG)
POAG gradually progresses without pain or noticeable vision loss initially affecting peripheral vision. By the time visual symptoms appear, irreparable damage has usually occurred, however, the sooner treatment starts the more vision loss can be prevented. When untreated, vision loss will eventually result in total loss of side vision (or tunnel vision) and eventually total vision loss.
Normal-tension glaucoma or low-tension glaucoma
This is another form of open-angle glaucoma in which the intraocular pressure remains within the normal level. The cause of this form of glaucoma is not known, but it is believed to have something to do with insufficient blood flow to the optic nerve, causing damage. Individuals of Japanese descent, women and those with a history of vascular disease or low blood pressure are at higher risk.
Acute angle-closure glaucoma is marked by a sudden increase in eye pressure, which can cause severe pain, blurred vision, halos, nausea, and headaches. The pressure is caused by a blockage in the fluid at the front of the eye which is a medical emergency and should be treated immediately. Without prompt treatment to clear the blockage vision can be permanently lost.
The inherited form of the disease that is present at birth. In these cases, babies are born with a defect that slows the normal drainage of fluid out of the eye; they are usually diagnosed by the time they turn one. There are typically some noticeable symptoms such as excessive tearing, cloudiness or haziness of the eyes, large or protruding eyes or light sensitivity. Surgery is usually performed, with a very high success rate, to restore full vision.
Glaucoma can develop as a complication of eye surgeries, injuries or other medical conditions such as cataracts, tumors, or a condition called uveitis which causes inflammation. Uncontrolled high blood pressure or diabetes can result in another serious form called neovascular glaucoma.
A rare form of glaucoma, this occurs when pigment from the iris sheds and clogs the drainage of fluid from the eye resulting in inflammation and damage to the eye and drainage system.
Treatment of glaucoma is dependant upon the severity and type of glaucoma present.
Glaucoma Diagnosis and Treatment
During a routine comprehensive eye exam to check for glaucoma, your eye doctor will dilate your eye to examine the optic nerve for signs of glaucoma and will also measure the intraocular pressure (IOP) with an instrument called a tonometer.
Tonometry involves numbing the eye with drops and then gently pressing on the surface of the eye to measure the pressure. Since your IOP can fluctuate throughout the day and glaucoma can exist without elevated IOP this is not enough to rule out the disease. If there are signs of the disease, further testing will be performed.
Visual Field Test
A visual field test is designed to detect any blind spots in your peripheral or side field of vision. You will be asked to place your head in front of a machine while looking ahead and indicate when you see a signal in your peripheral field of view.
Your doctor may also measure the thickness of the cornea with an ultrasonic wave instrument in a test called pachymetry or use imaging techniques such as digital retina scanning or optical coherence tomography (OCT) to create an image of your optic nerve to look for glaucoma damage.
Treatment for glaucoma depends on the type and severity of the disease and can include medication such as eye drops or pills or laser or traditional surgery.
Medication and drops to lower IOP are often the first resort for controlling pressure-related glaucoma. These drops may have some uncomfortable side effects, but compliance with the treatment plan is essential for preserving vision and halting the progression of the disease.
Surgical procedures are designed to control the flow of fluids through the eye by either decreasing the amount of fluid produced or improving the drainage. Your doctor may decide that a combination of surgery and medication will be the most effective in many cases.
It cannot be stressed enough that the most effective treatment for glaucoma happens when the disease is detected and treated early before significant vision loss occurs. Any vision that is lost cannot be restored. This is why the best prevention is awareness by knowing your risks and taking responsibility by having your eyes examined on a regular basis.
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