Glaucoma is a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve.
The symptoms can start so slowly that you may not notice them. The only way to find out if you have glaucoma is to get a comprehensive dilated eye exam.
There’s no cure for glaucoma, but early treatment can often stop the damage and protect your vision.
At each annual eye exam, we re-evaluate each patient's risk factors for glaucoma. These include elevated intraocular pressure (IOP), a suspicious optic nerve appearance commonly referred to as "cupping," a repeatable visual field abnormality consistent with optic nerve damage, or a strong family history of glaucomatous disease. Systemic associations that are also considered are vascular dysregulation and sleep apnea.
Based off of these risk factors and additional exam findings. We may determine that a full glaucoma workup is warranted for further evaluation and as a baseline for future exams.
At your initial glaucoma workup, we will be performing the following tests as a baseline:
Tonometry- Inner eye pressure
Perimetry (visual field test)- The complete field of vision
Gonioscopy- The angle in the eye where the iris meets the cornea
Pachymetry- Thickness of the cornea
Opthalmoscopy- The shape and color of the optic nerve
Glaucoma is a slow, progressive condition that typically requires several repeatable data points before initiation of treatment.
Types of Glaucoma-PRIMARY GLAUCOMA
Glaucoma is a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve. This nerve is the pathway by which images are sent to your brain. Often early stages of glaucoma have no symptoms, but in late stage side vision is irreversibly lost. Comprehensive eye exams are essential for early diagnosis.
The most common form of glaucoma is Open Angle Glaucoma which results from an increase of pressure in the eye, intraocular pressure. With increase in pressure, the essential nerve fiber layer is damaged. In a healthy eye, the fluid flows from the front of the eye to back through channels maintaining a normal pressure range from 11-21mm Hg. Treatment focuses around lowering the pressure via medication, laser, or surgery.
A subset of this type of glaucoma is normal-tension glaucoma where your pressure falls within “normal ranges,” but we see evidence of changes in your optic nerve. Approximately 1 in 3 people with open-angle glaucoma have the normal-tension type. We rely on documented studies to assist in calculating each patient’s specific percentage of risk for glaucoma progression. Some factors that we consider before diagnosing are age, corneal thickness, family history, intraocular pressure, optic nerve cup size, and the results from your visual field subjectively testing your side vision.
Angle closure glaucoma, also called narrow-angle glaucoma, is a medical emergency. In this type of glaucoma, the outer edge of the iris (the colored part of your eye) blocks fluid from draining out of the front of the eye. The fluid builds up quickly, causing a sudden increase in eye pressure. If it’s not treated, angle-closure glaucoma can cause blindness in just a few days. Sudden symptoms may include intense pain in your eye, nausea, red eyes, and blurred vision. Standard treatment is typically a laser procedure, LPI, where a small opening is created in the iris that creates an alternative path for fluid to flow and decreasing intraocular pressure. This can be an acute or slow chronic closure that might not have any symptoms. We monitor and grade the opening of this angle at each comprehensive eye exam.
Types of Glaucoma-SECONDARY GLAUCOMA
Glaucoma can be caused by another medical condition and is classified as secondary glaucoma.
Neovascular glaucoma occurs when the eye makes extra blood vessels that cover the part of your eye where the fluid normally drains. It’s often associated with medical conditions such as diabetes and high blood pressure. Treatment involves lowering pressure and maintaining control of underlying condition.
People that have uveitis, inflammation of the eye, have a 2 in 10 chance of developing uveitis glaucoma. This inflammation is believed to cause scar tissue and damage the part of the eye where the fluid drains out. In some cases, the medicines that treat uveitis may also cause uveitic glaucoma, or make it worse. This is because corticosteroid medicines may cause increased eye pressure as a side effect.
Exfoliation glaucoma happens in people with exfoliation syndrome. In this condition extra material detaches from parts of the eye and blocks fluid from draining. This results in often higher pressures than other conditions which makes it especially important to timely lower pressure.
Pigmentary glaucoma occurs when pigment (color) from your iris flakes off. The loose pigment may block fluid from easily flowing through the channels which increases the intraocular pressure. This condition is most common in young, white men who are near-sighted. Treatment involves lowering eye pressure, but currently there isn’t a way to prevent the detaching of iris pigment.
What are the treatment options for glaucoma?
If you have glaucoma, it’s important to start treatment right away. While it won’t undo any damage to your vision, treatment can stop it from getting worse.
Medications. Prescription eye drops are the most common treatment. They lower the pressure in your eye and prevent damage to your optic nerve.
Laser treatment. To lower pressure in your eye, doctors can use lasers to help the fluid drain out of your eye. It’s a simple procedure that your doctor can do in the office.
Surgery. If medicines and laser treatment don’t work, your doctor might suggest surgery. There are several different types of surgery that can help the fluid drain out of your eye.