Leader Heights Eye Center, 309 Leader Heights Road, York, PA 17402 • Phone: (717) 747-5430

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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 can be thought of as 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 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 permanently impaired, which is why it is so important to get regular eye exams with dilation of the pupils.

Ocular hypertension is a risk factor for actual open-angle glaucoma. When the eye’s 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, certain medical conditions, race 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 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 is more often “chronic”, that is, slow in onset. An eye exam will reveal this type of glaucoma. Angle-closure glaucoma is usually treated by putting 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 descent 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 with dilation of the pupils.

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 you 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 usually need to be repeated on a regular basis to monitor any changes in your vision caused by glaucoma.

How is glaucoma treated?

The idea behind treating glaucoma is to lower the eye’s pressure, so that no more damage to the optic nerve occurs, preventing further vision loss. The only way we know to decrease the risk of further damage is to lower the eye’s intraocular pressure, the fluid pressure inside the eye.  We can lower the pressure with laser, drops or surgery in the operating room.

Initial Treatment of Glaucoma: Laser or Drops?

As the first, and hopefully only, treatment for your glaucoma, you may choose to lower the eye’s pressure with laser or drops. The idea of having a laser makes many people nervous, and drops is certainly a legitimate way to go. Most ophthalmologists still have patients try multiple drops before going with a laser, rather than using it as first-line treatment. However, consider…

Glaucoma drops are for life. You will need to use them once or twice per day, every day, which is one more thing you have to remember. Many studies have shown that most patients are not able or willing to use the drops consistently, as directed, over the long haul. Imperfect drop-taking is a risk for your getting more glaucoma damage to your optic nerves.

Glaucoma drops can be expensive. The ones that work the best for most people are the most expensive.

Glaucoma drops have side-effects, even if you are not aware of them. They cause changes to the eye’s surface, increasing dryness. If you need surgery or laser later on because the drops don’t work adequately, being on drops for years makes it less likely the procedure will work.

The laser is an office procedure, done at a slit lamp, similar to the instrument we use to do your exam. It doesn’t hurt. You don’t need to change clothes or mind your activity afterward. There is a little redness and discomfort for a few days after. The laser works about 75% of the time — in about 25% it has no effect, in which case we would start drops. If the laser lowers your pressure but not quite all the way, it may have at least allowed us to have you use a less expensive drop or fewer drops than we would have done without the laser.

The downside to laser? Very rarely, it can make the eye’s pressure go up, rather than down. Dr. Lander has done laser trabeculoplasties since 1981 and seen this happen once.

If you would like to learn more about the laser procedure, look on the internet under “selective laser trabeculoplasty.” Certainly, feel free to ask us any questions about it.

What is the risk of going blind?

That depends on how advanced your glaucoma is at the time it is discovered and how conscientious you are about taking care of it. If you are on drops, it is very important that you take them consistently. If you haven’t been taking the drops as you should, tell the doctor – we will work out a treatment plan that you can do, and we promise not to scold! Also, be sure to come in for regular checks, so that we can see if the treatment is working, and we can see if the damage to the optic nerves is getting worse. If you follow the treatment, we can prevent the glaucoma damage from getting worse the great majority of the time.  

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