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Glaucoma is a disease that may be associated with elevated intraocular pressure that causes progressive loss or damage to the optic nerve with eventual blindness. Light enters your eye and travels to the retina, the inner layer of the eye. The retina sends signals to the optic nerve, which then transmits the signals to your brain. In the normal eye, a fluid called aqueous humor is formed in the front of the eye, and then drains out through tiny drains called the trabecular meshwork. There is a pressure inside the eye that is required for health and falls within a certain range, 10-21 mmHg. With glaucoma, the aqueous humor does not drain properly, leading to increased pressure in the eye. The fluid build up can be gradual, with slow progression of the disease and no early symptoms. Glaucoma is a silent thief that steals your sight very slowly.
Patients who have open angle glaucoma may not experience symptoms in the early stages. As the glaucoma progresses with damage to the optic nerve, you may notice blind spots in your side (peripheral) vision. Patients who are risk for narrow angle glaucoma, because the drainage angle gets blocked, may not have any symptoms until they get an attack. Some early symptoms of early narrow (acute) glaucoma include halos, headaches, eye pain, redness, or blurred vision. During an attack of acute glaucoma, symptoms include eye redness, blurry vision, headache, nausea and vomiting, halos around lights, and intense eye or brow pain.
In some patients with normal tension glaucoma, the pressure in the eye is in the normal range, but they develop symptoms of glaucoma such as trouble seeing in there side (peripheral) vision. In other patients (almost 8%), their pressure can be higher than normal, but not experience any symptoms of glaucoma. These patients are called "glaucoma suspects".
There are several different types of glaucoma, which can cause increased intraocular pressure as a result of different factors, and may include:
This is the most common form of glaucoma (60-70%), which occurs in about 2-5% of the population over 40 years, increasing with age.
Open angle glaucoma occurs when the fluid inside your eye fails to drain normally from the eye, with a pressure build up. This pressure build up causes damage to the optic nerve. The pressure varies throughout the day, so that 50% of patients who have glaucoma have normal pressures on exam, but sometimes higher at a different time of day. Symptoms are usually not present initially, and slowly progress with damage to the periphery of vision.
This occurs when the optic nerve is damaged but intraocular pressure does not rise. This type of glaucoma is seen in patients with migraines, autoimmune disease, and poor blood flow to the optic nerve, such as from a heart attack or massive hemorrhage.
This occurs when there is a higher pressure than normal, but no signs of glaucoma, such as trouble seeing in the periphery. These patients are called glaucoma suspects and followed because of the risk of developing glaucoma.
Also known as angle closure glaucoma, this may develop suddenly, when a blockage in the eye prevents fluid from draining properly and leads to an increase in eye pressure.
In this type of glaucoma, the angle between the iris and the cornea is too narrow.
Patients with this condition may experience headaches, eye pain, nausea, and blurred vision, and can benefit from surgery to remove a small portion of the iris and create a new opening for the passage of the fluid in the front of the eye.
This form is a rare glaucoma present in infants and young children, and can be inherited.
This develops as a result of another disease, such as an eye injury, inflammation of the eye, diabetes, steroids and others.
Glaucoma typically occurs in patients over age 50 but can occur in a younger age group. The risk of developing glaucoma increases with each decade of life to about a 15% chance of developing glaucoma over age 80. Older individuals are also more likely to develop serious damage from glaucoma as well. Primary open angle glaucoma occurs more frequently in blacks than in whites. Fifteen percent of the blindness in the United States is due to glaucoma and it is the most common cause of blindness in Afro-Americans and the third most common cause of blindness in Caucasians.
There is a higher chance of developing glaucoma if there is a family history. Relatives of patients who have glaucoma have a six times higher chance of developing glaucoma then those in the general population
Associated conditions with high risk of developing glaucoma are patients who are highly nearsighted or myopic. Patients with diabetes mellitus also have a higher chance of developing open angle glaucoma as well as those patients who have cardiovascular problems perhaps due to poor circulation to the optic nerve. Other conditions include elevated eye pressure, far sightedness, past eye injury, migraine, and having a thin central cornea.
Glaucoma initially may not have any symptoms, causing many people not to know they have the disease. Regular eye exams, especially as you get older are important in early detection. The glaucoma exams includes:
TonometryThis exam measures the pressure in your eye. Normal pressure is 10-21mmHg, but patients with normal tension glaucoma their pressure can be in the normal range, and still have damage to their optic nerve with peripheral field loss.
GonioscopyThis exam looks at the drainage angle, and used to determine the type of glaucoma you have.
This exam allows an examination of the inside of the eye, with evaluation of the optic nerve. Glaucoma causes damage to the optic nerve, causing a change in the appearance, known as cupping. Increased cupping of the nerve is associated with visual field loss.
Click a photo below to view larger.
This exam looks for loss of side (peripheral vision) or blank spots in your vision. These tests are repeated looking for progression of disease.
This exam looks at the optic nerve, looking for early damage or progression of glaucoma
This exam measures the corneal thickness, which affects the pressure readings in your eye. Patients with thin corneas have a higher risk of getting glaucoma.
The goal of treatment is to reduce the intraocular pressure to an appropriate range. Generally this can be achieved by the use of eye drops. Some of these eye drops work by enhancing the drainage of fluid from the eye and others achieve their affect by reducing the production of aqueous in the eye. In some patients who do not respond to topical drops, treatment includes:
This laser causes tiny burns in the drainage area (trabecular meshwork) and this stimulates the drain to work better.
This is usually done with a laser, and is used to prevent or treat narrow angle glaucoma, by creating a small opening in the iris, giving the aqueous fluid access to the drainage angle.
This creates a drainage opening in the eye, allowing the aqueous fluid to exit the eye.
This is typically a small tube or valve that is implanted into the eye, allowing the aqueous fluid to drain from the eye. Click the image below to view larger.
