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Glaucoma



What is Glaucoma?

Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable with its numerous wires). Glaucoma damages nerve fibers, which can cause blind areas and vision loss.

Glaucoma is pressure damage to the optic nerve. Usually, in glaucoma the pressure within the eye (“intra-ocular pressure,” or IOP) is higher than average, but glaucoma can occur at any IOP. The eye produces a clear fluid called “aqueous humor” and a tiny drain at the base of the cornea drains that fluid out of the eye. The usual reason for a pressure build-up is a partial blockage of the drain. Why a given IOP causes glaucoma damage in one person’s eye but not another’s remains a bit of a mystery.

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What are the types of Glaucoma?

The most common form of glaucoma is primary open-angle glaucoma. In medicalese “primary” means “we don’t know what causes it.” Probably, there is something wrong with the eye’s drain. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired, which is why it is so important to get regular eye exams.

Ocular hypertension is often a forerunner to actual open-angle glaucoma. When ocular pressure is above normal, the risk of developing glaucoma increases. Several risk factors will affect whether you will develop glaucoma, including the level of IOP, family history of glaucoma, and corneal thickness (people with thin corneas are more glaucoma-prone). If your risk is high, your ophthalmologist (Eye M.D.) or optometrist may recommend treatment to lower your IOP to prevent future damage.

GlaucomaIn angle-closure glaucoma, the iris (the colored part of the eye) may come forward and completely close off the drain, blocking the flow of aqueous fluid and leading to increased IOP and optic nerve damage. In “acute” angle-closure glaucoma there is a sudden increase in IOP to a very high level, due to rapid buildup of aqueous fluid. This condition is considered an emergency, because optic nerve damage and vision loss can occur within hours of the problem. An acute attack is characterized by dull eye pain with nausea, redness and blurred, misty vision with rainbows or haloes. Angle-closure glaucoma can be “chronic” too, that is, slow in onset. An eye exam will reveal this type of glaucoma. Angle closure glaucoma is usually treated by cutting a hole in the iris with a laser. This is a simple office procedure.

Even some people with “normal” IOP can experience vision loss from glaucoma. This condition is called normal-tension glaucoma. In this type of glaucoma, the optic nerve sustains pressure damage, even though the IOP is considered statistically normal. Normal-tension glaucoma is not well understood, but lowering IOP has been shown to slow progression of this form of glaucoma.

Your doctor may tell you that you are at risk for glaucoma, if you have one or more risk factors, including having an elevated IOP, a family history of glaucoma, certain optic nerve conditions, or are of a particular ethnic background. People of African decent are prone to open-angle glaucoma; east Asians are prone to the angle-closure variety. Regular examinations with your eye doctor are important so that glaucoma doesn’t go undetected.

The goal of glaucoma treatment is to lower your eye pressure to prevent or slow further vision loss. Your doctor will recommend treatment, if the risk of vision loss is high. Treatment usually consists of laser treatment to make the eye’s drain work better and/or eye drops. Sometimes, surgery in the operating room is required to create a new drain in the eye. Glaucoma is a chronic disease that can be controlled but not cured. Ongoing monitoring (every three to six months) is needed to watch for changes and to be sure the IOP remains adequately low. Ask your ophthalmologist or optometrist, if you have any questions about glaucoma or your treatment.

Glaucoma Evaluation

Because it has no noticeable symptoms, glaucoma is a difficult disease to detect without regular, complete eye exams.

During a glaucoma evaluation, your ophthalmologist (Eye M.D.) or optometrist will perform the following tests:

Each of these evaluation tools is an important way to monitor your vision to help ensure that glaucoma does not rob you of your sight. Some of these tests will not be necessary for everyone. Your ophthalmologist or optometrist will discuss which tests are best for you. Some tests may need to be repeated on a regular basis to monitor any changes in your vision caused by glaucoma.

What are the risk factors for glaucoma?

If you are of African or Hispanic ancestry and especially if you have a known family member with glaucoma, you are at a higher risk for vision loss from this eye disease.

Primary open-angle glaucoma is the leading cause of blindness among people of African ancestry, occurring at a rate of four times higher than among Caucasian patients. It also occurs about 10 years earlier among people of African ancestry than among Caucasians and develops more rapidly. Studies show that in the United States, African Americans between the ages of 45 and 64 are approximately 15 times more likely to go blind from glaucoma than Caucasians with glaucoma in the same age group. Primary open-angle glaucoma is also the leading cause of blindness among people of Hispanic (and especially Mexican) ancestry, occurring at a rate approaching that of people of African ancestry.

It is not clear why people of African ancestry have higher rates of open-angle glaucoma and subsequent blindness. One factor may be that they are more susceptible to developing elevated IOP earlier in life, which is thought to contribute to optic nerve damage and eventual vision loss. There also may be anatomical factors in the eye that are in play.

Glaucoma causes no symptoms early in its course--you will not experience pain or vision changes while it is developing. The best way to protect yourself and your family members against vision loss from glaucoma is by being aware of your higher risk of developing this disease and by having regular eye examinations for glaucoma at appropriate intervals.

Recommended intervals for a comprehensive eye evaluation in people of African ancestry are as follows:

It is also recommended that people of Hispanic ancestry have regular, comprehensive eye evaluations. This is especially important after age 60.

If you are diagnosed with glaucoma, please make sure to tell your family members and urge them to have an eye exam for glaucoma.

Here are some resources for more information on glaucoma:

The Glaucoma Foundation
80 Maiden Lane, Suite 1206
New York, NY 10038
Phone: 1-800-GLAUCOMA (452-8266)
www.glaucoma-foundation.org

The National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
Phone: 1-301-496-5248
www.nei.nih.gov

Prevent Blindness America
Phone: 1-800-331-2020
www.preventblindness.org

The American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
www.aao.org

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