Glaucoma

Glaucoma has few or no initial symptoms experienced by the patient. It is referred to as the “silent sight killer” because it can cause permanent blindness if not caught early. The disease involved harm to the optic nerve that carries information from the eye to the brain.

In most cases, glaucoma is associated with higher-than-normal pressure inside the eye, or ocular hypertension. If untreated or uncontrolled, glaucoma first causes peripheral vision loss and eventually can lead to blindness.

According to the American Academy of Ophthalmology (AAO), the most common type of glaucoma — called primary open angle glaucoma (POAG) — affects an estimated 2.2 million people in the United States, and that number is expected to increase to 3.3 million by 2020 as the U.S. population ages.

Globally, glaucoma is the second leading cause of blindness (behind cataracts), according to the World Health Organization.

Glaucoma Symptoms

Glaucoma is called the ” silent sight killer,” because most types typically cause no pain and produce no symptoms until noticeable vision loss occurs.

For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.

But with acute angle closure glaucoma, symptoms that occur suddenly can include halos around lights, blurry vision, intense eye pain, nausea and vomiting. If you have these symptoms, make sure you see one of our eye physicians immediately, or visit the emergency room immediately so steps can be taken to prevent permanent vision loss, and also relieve pain.

Diagnosis, Screening and Tests for Glaucoma

During routine comprehensive eye exams, a tonometer is used to measure your intraocular pressure, or IOP. Your eye typically is numbed with eye drops, and a small probe gently rests against your eye’s surface. Other tonometers send a puff of air onto your eye’s surface.

An abnormally high IOP reading indicates a problem with the amount of fluid in the eye. Either the eye is producing too much fluid, or it’s not draining properly.

Normally, IOP should be between 10 and 20 mmHg (millimeters of mercury) — a unit of measurement based on how much force is exerted within a certain defined area.

If your IOP is higher than 30 mmHg, your risk of vision loss from glaucoma is 40 times greater than someone with intraocular pressure of 15 mmHg or lower. This is why medications such as eye drops are designed to keep IOP low.

Other methods of monitoring glaucoma involve the use of sophisticated imaging technology — such as scanning laser polarimetry (SLP), optical coherence tomography(OCT) and confocal scanning laser ophthalmoscopy — to create baseline images and measurements of the eye’s optic nerve and internal structures.  (FOCUS Eye Center is privileged to have this advanced diagnostic instrument in our office.)

Then, at specified intervals, additional images and measurements are taken to make sure no changes have occurred over time that might indicate progressive glaucoma damage.

Visual field testing is a way for your eye physician to determine if you are experiencing vision loss from glaucoma. Visual field test involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals to make sure you are not developing blind spots from damage to the optic nerve or to determine the extent or progression of vision loss from glaucoma.  It is probably the most boring test you will perform, but it is extremely valuable in tracking the progression of glaucoma.

Types of Glaucoma

The two major types of glaucoma are chronic or primary open-angle glaucoma (POAG) and acute angle-closure glaucoma. The “angle” in both cases refers to the drainage angle inside the eye that controls aqueous outflow. Other variations include normal-tension glaucoma, pigmentary glaucoma, secondary glaucoma and congenital glaucoma.

(1) Primary open-angle glaucoma. About half of Americans with chronic glaucoma don’t know they have it. This common type of glaucoma gradually reduces your peripheral vision without other symptoms. By the time you notice it, permanent damage already has occurred.

If your IOP remains high, the destruction caused by POAG can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead.

(2) Angle-closure glaucoma. Angle-closure or narrow-angle glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting.

These signs may last for a few hours, then return again for another round. Each attack can cause progressively more vision loss.

(3) Normal-tension glaucoma. Like POAG, normal-tension glaucoma (also called normal-pressure glaucoma, low-tension glaucoma or low-pressure glaucoma) is a type of open-angle glaucoma that can cause visual field loss due to optic nerve damage. But in normal-tension glaucoma, the eye’s IOP remains in the normal range.

Latest Glaucoma

Also, pain is unlikely and permanent damage to the eye’s optic nerve may not be noticed until symptoms such as tunnel vision occur.

The cause of normal-tension glaucoma is not known. But many doctors believe it is related to poor blood flow to the optic nerve. Normal-tension glaucoma is more common in those who are Japanese, are female and/or have a history of vascular disease.

(4) Pigmentary glaucoma. This rare form of glaucoma is caused by clogging of the drainage angle of the eye by pigment that has broken loose from the iris, reducing the rate of aqueous outflow from the eye. Over time, an inflammatory response to the blocked angle damages the drainage system.

You are unlikely to notice any symptoms with pigmentary glaucoma, though some pain and blurry vision may occur after exercise. Pigmentary glaucoma most frequently affects white males in their mid-30s to mid-40s.

(5) Secondary glaucoma. Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma, which also may develop with presence of inflammation, a tumor or enlargement of the lens due to a cataract.

(6) Congenital glaucoma. This inherited form of glaucoma is present at birth, with 80 percent of cases diagnosed by age one. These children are born with narrow angles or some other defect in the drainage system of the eye.

It’s difficult to spot signs of congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.

Glaucoma Treatments

Eye drops with medication aimed at lowering IOP usually are tried first to control glaucoma.

Because glaucoma often is painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting Dr. Lofgran or Dr. Hammons about a possible alternative therapy.