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Glaucoma

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Nearly 3 million people in the United States have glaucoma; in fact, glaucoma is one of the leading causes of blindness in this country. Glaucoma is a fairly common eye disease. When a person has glaucoma, inner-eye fluid pressure progressively rises, resulting in vision loss and sometimes blindness. The most common form of glaucoma is called open angle glaucoma.

The anterior chamber is a small space at the front of the eye. Normally, fluid flows through this chamber to nourish and to bathe nearby eye tissue. For people with glaucoma, their eyes do not drain this fluid quickly and properly. If eyes do not drain fluid properly, fluid will build up and the eye pressure rises. Uncontrolled, this rise in pressure can cause optic nerve damage. This ultimately results in vision loss.

There are three primary kinds of glaucoma, and several types of glaucoma that are much less common. Most can be successfully treated with eye drops, laser treatment, prescription medications or a combination of all of these.

 

  • Open Angle Glaucoma  (also called chronic glaucoma) is the most common kind of glaucoma in the United States. There are a number of risk factors for open angle glaucoma, which include hypertension, diabetes, family history, race and age. Treatment commonly include eye drops, but treatment may also include specialized glaucoma laser surgery. Usually patients with open angle glaucoma have no symptoms, and the condition is generally painless.

  • Narrow Angle Glaucoma (also called"narrow angle glaucoma" and"closure glaucoma") is fairly uncommon in the United States, but is prevalent in Asian countries. Patients with narrow angle glaucoma often have some symptoms including eye pain, halos around lights, nausea, and headache. Treatment for this kind of glaucoma usually includes lasers.
     
  • Angle Recession Glaucoma is usually brought on by major blunt trauma. Most patients will experience no symptoms.

Treatment/Surgery:

There are multiple ways we treat glaucoma. Treatment for glaucoma usually focuses on monitoring eye pressure and measuring changes in the patient's ability to see peripherally. Glaucoma is usually considered controlled if the affected eye's pressure is at an acceptable level and there is little or no loss of peripheral visual field.

The first line of defense in glaucoma treatment is usually topical eye drops. These glaucoma drops are usually taken on a daily basis and are effective in controlling eye pressure. Most people with glaucoma will be able to control the fluid pressure in their eyes through the regular use of medications that reduce pressure inside the eye. These glaucoma medications include eye drops or pills and they are designed to reduce pressure by slowing the flow of fluid into the eye. Some are also designed to help improve drainage from the eye.

Another glaucoma treatment option is laser surgery. During laser surgery, a laser is focused on the anterior chamber eye where the fluid leaves the eye. This results in changes which ultimately make it easier for fluid to drain from the eye. Although laser surgery can successfully treat glaucoma, the effects of laser surgery may wear off and patients may need to have additional surgery or may need to keep taking glaucoma drugs in order to control the glaucoma. Selective Laser Trabeculoplasty (SLT) has high success rates in decreasing pressure in the eye for open angle glaucoma. This treatment, if successful, can replace topical drops and can be repeated if necessary. Another laser surgery, Laser Iridotomy, is usually used to treat narrow angle glaucoma. Laser Iridotomy surgery creates a tiny hole in the iris to allow an alternate channel for fluid that is inside the eye ("intraocular fluid", or"aqueous humor") to drain from the eye.

Other types of surgery can also help to reduce pressure from the eye; however, surgery is considered a last option for glaucoma patients whose eye pressure cannot be controlled in other ways. Trabeculectomy surgery is one of the most commonly performed non-laser glaucoma surgeries. Trabeculectomy involves directing intraocular fluid to outside the eye, which increases the absorption of the fluid. Trabeculectomy surgery is often undertaken when glaucoma medications fail.

Seton or shunt placement for glaucoma also involves the creation of an alternate pathway for intraocular fluid be absorbed outside the eye. It, too, is not a first line of treatment and may be reserved for very difficult situations. iStent works like the stents used to prevent heart attacks and strokes. When blood vessels get clogged, a stent creates access to the vessel flow. While it's a highly innovative technology, how iStent works is elegantly simple:

  • If you have glaucoma, over time your eye's natural drainage system becomes clogged.
  • iStent created a permanent opening through the blockage to improve the eye's natural fluid outflow.
  • By improving the outflow of fluid in your eye, iStent is designed to lower and control the pressure within your eye.

iStent can be implanted during a cataract surgery procedure. Once implanted, iStent will begin working to safely and effectively manage eye pressure and because of iStent, there may be a reduction in glaucoma medications.

Frequently Asked Questions:

What are the symptoms of Glaucoma?

At first, people suffering from glaucoma will suffer no symptoms. There is no pain associated with this condition, and in the beginning stages the vision is not affected. However, as the disease progresses, he or she may notice the peripheral vision failing. This means that while the vision to the front will still be clear, objects that are on the side may be missed. As the disease progresses, the field of vision slowly narrows and eventually blindness results. Although glaucoma cannot be cured, it can be controlled with proper treatment.

Who develops Glaucoma?

Although anyone can get glaucoma, some people are at higher risk. They include: African-Americans, anyone over the age of 40, and people with a family history of glaucoma.