Your eye may look like one smooth orb, but deep inside, it's full of angles. Specifically, your eye needs to maintain an angle of opening between the cornea and iris. People with neovascular glaucoma have a closed angle due to unusual blood vessels in the eye. (Learn more)

Neovascular glaucoma usually develops in tandem with another condition, like diabetes or heart disease. Unusual blood vessels grow in the eye, and they starve vital structures of oxygen. Those dying tissues call out for more blood, and that sparks more blood vessels to grow. (Learn more)

The symptoms of neovascular glaucoma tend to develop in stages. At first, you may only notice redness or mild pain. As the disease progresses, you may experience severe pain combined with nausea. (Learn more)

Your doctor might use surgery to help your eyes drain. Medications can also help to reduce pressure in your eye.

But tapping into the underlying disease that caused the condition is critical. Without that help, your glaucoma symptoms could grow more severe. (Learn more)

Understand Your Eye's Angles

brown eye

The center of your eye is filled with fluid called aqueous humor. In a healthy eye, that liquid is replaced seamlessly. Some comes in while the excess drains through a channel between the iris and the cornea. That channel is called an angle, and it's key to understanding glaucoma.

The most common type of glaucoma, according to the American Academy of Ophthalmology, is open-angle glaucoma. For people with this form of the disease, the channel between the iris and the cornea becomes clogged and sluggish. The space is structurally open, but liquid can't move efficiently.

Angle-closure glaucoma involves an iris that is too close to (or invading) the channel. It can completely block drainage, and when that happens, pressure builds up within the eye.

Neovascular glaucoma is an angle-closure form of the disease. It's serious, and it develops due to a complex set of steps within the body.

Neovascular Glaucoma Overview

Your eyes are nourished with blood vessels, and typically, they're found in just a few spots within the eye. For people with neovascular glaucoma, the body produces far too many blood vessels. And as the body attempts to fix the problem, it worsens.

Researchers have known about neovascular glaucoma since 1906, says the American Academy of Ophthalmology, but the condition has been called many things.

  • Congestive glaucoma
  • Hemorrhagic glaucoma
  • Rubeotic glaucoma
  • Thrombotic glaucoma

Your body doesn't make a conscious choice to add blood vessels to your eye. Instead, those tissues grow because of another condition. Review of Ophthalmology says people with these conditions can develop neovascular glaucoma:

  • Branch retinal vein occlusion
  • Central retinal vein occlusion
  • Chronic inflammatory diseases
  • Chronic retinal detachment
  • Diabetes
  • Diabetic retinopathy
  • Ocular ischemic syndrome
  • Radiation exposure
  • Tumors

If you have these conditions, you may experience difficulties with blood vessels in your eye or elsewhere in your body. But you may not even know that the problems exist.

You may not see these blood vessels growing, and you may not have pain because of the problem. But the conditions can prompt unusual changes within your eyes, and that can steal your vision.

If you develop diabetic disease or retinal vein blockage, says the BrightFocus Foundation, your eye health can worsen. It happens in steps.

  • Your retina needs more oxygen. Retinal blockages and diabetes-related illnesses can slow blood flow to your retina. Those tissues rely on oxygen, and without it, they can die. You may not feel this issue happening.
  • Your retina sounds the alarm. Retinal tissues release chemicals to boost blood flow. One of those chemicals is vascular endothelial growth factor (VEGF). Your retina releases a great deal of this chemical.
  • Your body builds more blood vessels. These tissues should bring more blood to the retina, but they tend to be abnormal and leaky.
  • Excess chemicals migrate. The VEGF your body can't use moves to the front of the eye, and more blood vessels grow there.

As your body builds more and more blood vessels, they tangle together. They can connect to the iris and pull it toward the cornea. Or they can grow within the angle itself. In either case, liquid removal is reduced. Pressure begins to build.

Symptoms of Neovascular Glaucoma

itchy eyes

Rising pressure within the eyes is serious. Your optic nerve in the back of the eye relies on nourishment and space to survive. If the pressure grows too significant, the optic nerve is damaged. The damage can't be reversed, and it can happen so slowly that you don't notice it.

Experts say neovascular glaucoma progresses in three reliable stages, and each has symptoms you can watch for.

  • Stage 1: Your eyes might be red, and you might be sensitive to bright lights. Your pupils react to light, but not effectively.
  • Stage 2: Your eyes are red and painful. Your light sensitivity continues, and you might have a mild headache. Your pupils still react to light and dark, but the reflex seems slow or sluggish.
  • Stage 3: Your pain is intense, and it might cause you to vomit. Your pupils are unusual. They may stay in a fixed position, or they may be an unusual shape.

There is no set timeline to move through these stages. Some people walk through all the steps quickly, and others don't develop significant problems for years.

Therapies Your Doctor Might Use

You can't afford to ignore neovascular glaucoma. The sooner you can get treatment, the more likely it is that you'll preserve a healthy amount of your vision. Your doctor will tailor your plan per your eye health and disease progression.

The American Academy of Ophthalmology says many cases of neovascular glaucoma are treated with surgery. If the blood vessels are prolific and tangled, they can pull your eye into an unusual shape that medications and drops can't amend. Surgery can help your doctor to remove all of that unwanted tissue, and that can help your eye to drain as it should.

If your neovascular glaucoma is caught in early stages, medication management may work well, experts say. Your doctor can use drugs to lower the pressure within the eye and reduce inflammation. That can help your eyes to drain so you can preserve your sight.

These steps can help to ease discomfort and improve vision, but they can't be considered a cure for neovascular glaucoma. The condition develops as a result of another health issue in your body, and unless that is treated, you may still deal with worsening symptoms. Your blood vessel growth may continue unchecked.

Your eye doctor will partner with your medical specialist to develop a plan that can address your underlying health condition. You'll need to follow the treatment plan carefully, so your overall health and your eye health can improve at the same time.

 

References

What Is Glaucoma? (August 2019). American Academy of Ophthalmology.

Neovascular Glaucoma. (November 2019). American Academy of Ophthalmology.

Preserving Vision in Neovascular Glaucoma. (January 2015). Review of Ophthalmology.

What Is Neovascular Glaucoma? (November 2017). BrightFocus Foundation.

Neovascular Glaucoma Stages. (October 2015). Review of Optometry.

Diagnosis and Treatment of Neovascular Glaucoma. (July 2006). American Academy of Ophthalmology.

Neovascular Glaucoma. (March 2011). Ocular Surgery News.