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Glaucoma is a group of eye diseases and conditions involving high eye pressure, which damages the optic nerve.
As of 2010, nearly 3 million Americans struggled with glaucoma. That number is expected to rise to over 6 million by 2050, per the National Eye Institute (NEI).
Without swift treatment, glaucoma can lead to blindness. Vision damage related to glaucoma is not reversible, but there are treatments that can help to stop the progression of the disease.
Regular eye exams can detect glaucoma. The sooner you are diagnosed and start treatment protocols, the better. While there is no cure, you can greatly slow the progression of the disease.
What Is Glaucoma?
Glaucoma is a group of eye diseases that cause damage to the optic nerve due to high eye pressure.
Most common in older adults, glaucoma is one of the top causes of blindness for those over age 60. The eye damage and vision loss caused by glaucoma are not reversible, but as soon as it is diagnosed, you can take steps to prevent further damage and at least slow vision loss.
Your optic nerve is what sends information from your eyes to your brain to process what you are seeing. Typically, glaucoma is caused by a buildup of pressure in the eye that causes damage to the optic nerve, which can lead to vision loss.
A fluid, called aqueous humor, sits between your cornea and lens inside your eye. If this fluid level gets too high and can't drain properly, it results in high IOP (intraocular pressure). High pressure levels in the eyes can damage the optic nerve or restrict blood flow.
Risk Factors for Glaucoma
The disease can impact anyone, but there are certain things that can increase the odds for glaucoma. Risk factors include:
- Family history of glaucoma.
- Being over age 60.
- Being Hispanic or African American and over age 40.
- Chronic eye inflammation.
- Thinner corneas.
- Medication that increases eye pressure.
- Medical conditions, such as heart disease or diabetes.
- Prolonged use of corticosteroids.
- Injury to the eye.
- Eye tumors.
- Optic nerve sensitivity.
Types of Glaucoma
There are two main types of glaucoma: primary open-angle glaucoma (which is the most common) and angle-closure glaucoma.
- Primary open-angle glaucoma: With this form of glaucoma, there are often no early symptoms. It is caused by the aqueous humor draining too slowly, which is commonly related to a blockage in your drainage angle.
You may lose side and peripheral vision before you even realize that you are suffering from the condition. It can lead to vision loss and blindness without treatment.
- Angle-closure glaucoma: If your iris is too close to your drainage angle in your eye, it can lead to a buildup of fluid and this form of glaucoma. If you have chronic angle-closure glaucoma, you may not notice any symptoms unless there is an acute attack.
This is considered an eye emergency, requiring immediate medical care. Signs are:
- Severe headache.
- Intense eye pain.
- Blurry vision.
- Nausea and vomiting.
- Halos or rainbow "rings" around lights.
There are additional forms of glaucoma.
- Normal tension glaucoma: Low blood pressure or limited blood flow can be a risk factor for this type of glaucoma. Normal tension glaucoma is indicated by optic nerve damage without high IOP.
- Pigmentary glaucoma: This type of glaucoma occurs when pigment granules build up in the drainage channels of your eyes, which can slow or block drainage of fluid.
- Congenital glaucoma: An underlying medical condition, defect in the drainage angle, or drainage blockage can damage the optic nerve in children or infants, leading to this form of glaucoma. Typically watery eyes, cloudy corneas, and light sensitivity are indicators of congenital glaucoma.
- Secondary glaucoma: This form of glaucoma is caused by something else, such as an injury to the eye, medical condition, medications, or other eye conditions that can lead to high IOP and damage to the optic nerve.
Glaucoma occurs when your optic nerve is damaged. Millions of nerve fibers make up your optic nerve, and high IOP can cause them to die off. This can create blind spots in your vision. If the pressure continues unchecked, the result can be blindness.
The aqueous humor in your eye is constantly being produced. It flows into the eye and should drain out at equal rates. If the drainage angle becomes blocked, it can lead to fluid buildup, which raises your IOP and damages your optic nerve.
Glaucoma can run in families, so there is a potential genetic link. It can also be caused by medical conditions, trauma to the eye, or medications.
There are often no early warning signs or symptoms of glaucoma. The best thing you can do to manage it is to catch it as early as possible, so regular eye exams are essential. A specialized instrument will be used to run a test called a tonometry to measure your IOP, typically after using eye drops to dilate your pupils.
If your pressure is high (above 21 mmHg (millimeters of mercury), it can be a sign of glaucoma. Imaging technology and peripheral vision field tests can also be used to diagnose glaucoma.
About half of the people living with glaucoma do not even realize it since there are often no early symptoms. If you start to notice your field of vision getting smaller and it being harder to see things off to the side, get checked. Loss of peripheral vision can be a sign of glaucoma.
What to Do Immediately After Diagnosis
Even though you can't undo damage that may have already occurred because of glaucoma, and you can’t reverse vision loss related to the condition, you can slow its progression or stop it altogether.
Treatments for glaucoma work best when started as early as possible. It is important to get regular eye exams to keep track of your eye pressure and ensure that glaucoma is diagnosed as soon as possible.
Be sure to follow all of your doctor's instructions and explore your options for treatment. To prevent or slow the progression of vision loss, you will need to start taking measures to manage your glaucoma immediately. Swift treatment can help you to keep your vision intact.
Blindness only impacts about 5 percent of people suffering from glaucoma. Vision loss can be halted or slowed through proper treatment.
How to Manage Glaucoma
The first thing you need to do when diagnosed with glaucoma is to take treatment seriously and act immediately. The longer you put off treatment, the worse things can get, resulting in more vision problems. Encourage your family members to get checked as well since glaucoma can run in families.
In addition to following your doctor’s instructions, implement the following to manage glaucoma:
- Eat a healthy and balanced diet to promote overall health and wellness.
- Exercise regularly to improve blood flow and keep your eye pressure down.
- Take any prescribed glaucoma medication exactly as prescribed.
- Discuss potential side effects or vision changes with your doctor.
- Keep up with regular eye exams.
- Do not smoke. Smoking can irritate and inflame the eyes and cause high blood pressure. If you currently smoke, talk to your doctor about how to quit.
- Minimize your caffeine intake. This can help to keep your eye pressure regulated.
- Sleep with your head elevated to lower eye pressure at night. Try to keep your head above your heart as much as possible.
- Drink fluids slowly to keep your eyes from getting strained.
- Keep your eyes protected. They may be sensitive to light. Further trauma to the eye can increase IOP and exacerbate glaucoma.
There are three main treatments for glaucoma: medications, laser treatment, and surgery. Your doctor will discuss your options with you and help you decide on the best course of action.
Prescription eye drops and medications are often the first courses of action, especially for glaucoma in its early stages. Eye drops for glaucoma are designed to either lower the amount of fluid in your eye or help it to drain better. You may be prescribed more than one type of eye drop or medication.
Prescription eye drops for glaucoma include:
- Beta blockers. Medications like Betimol, Timoptic, Istalol (timolol), and Betoptic (betaxolol) reduce production of aqueous humor. They are used once or twice a day.
- Carbonic anhydrase inhibitors. Azopt (brinzolamide) and Trusopt (dorzolamide) lower fluid production in the eye. They are normally given in a twice-daily dosage, but they can sometimes be prescribed for use three times a day.
- Alpha-adrenergic agonists. Lopidine (apraclonidine), Qoliana, and Alphagan P (brimonidine) lower aqueous humor production while also raising fluid outflow. These are used in a twice-daily dosage, but they can sometimes be prescribed for use three times a day.
- Zioptan (tafluprost), Xalatan (latanoprost), Vyzulta (latanoprostene bunod), Travatan Z (travoprost), and Lumigan (bimatoprost) increase outflow of aqueous humor in a once-daily dosage.
- Cholinergic or miotic agents. Isopto Carpine (pilocarpine) increases aqueous humor outflow from your eye. It can be dosed up to four times per day.
- Rho kinase inhibitor. Rhopressa (netarsudil) lowers rho kinase enzymes to reduce eye pressure in a once-daily dosage.
Carbonic anhydrase inhibitors may also be prescribed orally if eye drops alone are not enough to control the pressure in your eyes.
Laser and surgical treatments can help to lower pressure in the eyes. These are often considered after medications are not ineffective or in the case of more advanced glaucoma.
- Laser trabeculoplasty: This laser eye surgery procedure for treating open-angle glaucoma creates an opening to allow fluid to drain better out of the eye. This procedure can be done quickly in an office setting and may need to be repeated down the line.
You can usually return to your normal activities the next day, but you will need someone to drive you home from the procedure. Your vision will be blurry, and eye irritation and minor discomfort are common immediately following laser trabeculoplasty.
It will take up to four to six weeks to know if the procedure is effective. You will likely need to continue medications during this time. In some cases, you may need to continue using medications indefinitely.
- Laser iridotomy: This is a form of laser eye surgery for treating angle-closure glaucoma that creates a small hole in the iris to let the fluid flow properly to the drainage angle. The procedure is quick, and you will likely be able to return to normal activities the next day. You may experience some pain, eye irritation, and blurry vision the day of laser iridotomy.
About a quarter of the time, the drainage angle may not open, and additional measures may need to be taken. You will likely need to continue your glaucoma medications after the procedure as well.
- Surgical trabeculectomy: This surgery creates an opening in the sclera (white part of your eye), and part of the trabecular meshwork where the blockage is occurring is removed to allow for proper drainage. Surgical trabeculectomy is performed in a hospital. You will need to limit your activities for up to a month to allow your eyes time to heal.
- Minimally invasive glaucoma surgery (MIGS): There are several forms of MIGS that are performed to minimize risk by being less invasive than traditional surgery. With MIGS, tiny incisions are made with microscopic instruments. MIGS procedures reduce the risk of complications and shorten recovery times. There are several different types, including:
- Shunt placement.
- Laser surgeries.
- Trabecular bypass.
These procedures can be performed for less advanced glaucoma. They usually require less postoperative care.
- Surgical placement of drainage tubes: A small shunt is surgically placed in your eye to allow the aqueous humor to drain properly, thereby lowering eye pressure. The surgery typically takes an hour or two, and it is performed in a hospital. It will take two to four weeks before you can fully return to regular activities.
Discuss treatment options with your eye care provider, and start managing the condition as soon as possible. Treatment will depend on the type of glaucoma you are suffering from, its severity, any other medical conditions you have, and any medications you are taking.
Talk to your health care providers about all possible risk factors and side effects, and be sure they are aware of your full medical history. Generally, your eye care provider will monitor your glaucoma and prescribe a treatment regime to slow its progression. If the condition worsens, they will discuss more invasive treatment measures, like surgery.
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What Is MIGS? (September 2019). Glaucoma Research Foundation.