Glaucoma

Glaucoma is the leading cause of blindness and visual impairment in the United States. A simple, painless eye exam can detect the disease. With early detection and treatment, glaucoma can usually be controlled and blindness prevented.

Glaucoma can affect anyone from newborn infants to the elderly. It has been estimated that up to 3 million Americans have glaucoma. At least half of those people do not know they have it because glaucoma usually has no symptoms. People who are at a greater risk for glaucoma usually have the following conditions:

  • At least 45 years old without regular eye exams
  • A family history of glaucoma
  • Abnormally high eye pressure
  • African descent
  • Nearsightedness
  • Diabetes
  • Previous eye injury
  • Regular, long-term use of cortisone/steroid products

To detect glaucoma, your physician will test your visual acuity and visual field and test the pressure in your eye. Regular and complete eye exams help to monitor the changes in your eyesight and to determine whether you may develop glaucoma.

Treatment to control glaucoma include medications in the form of either eyedrops or pills, laser surgery and conventional surgery.

Angle Closure Glaucoma

Our eyes are filled with a fluid (the aqueous) that is produced in the ciliary body and drains through the trabecular meshwork. In a healthy eye, the rates of fluid production and drainage are equal, and pressure within the eye (intraocular pressure, or IOP) remains stable. In people with glaucoma, however, fluid is produced faster than it drains, and pressure in the eye rises. This can cause vision loss and eventually blindness.

About 1 in 10 glaucoma patients has primary angle closure glaucoma. This type of glaucoma occurs when the trabecular meshwork becomes blocked. Most patients experience redness, discomfort, blurred vision or headache. Treatment involves making an incision in the iris to restore the proper flow of aqueous fluid (an iridectomy or iridotomy) or creating a new, clear channel in the sclera (the white part of the eye) for the fluid to travel through (a trabeculectomy). Patients are often given medications in addition to these procedures to ensure that the glaucoma is kept under control.

A few patients experience acute angle closure glaucoma, a sudden rise in intraocular pressure that frequently causes blurred vision, severe pain, colored halos, reddened eyes, and nausea or vomiting. Immediate treatment is critical. A combination of eye drops or oral medications is usually prescribed to lower pressure and swelling and allow the physician to examine the eye. When the eye has been stabilized, an iridectomy or iridotomy may be performed.

Glaucoma Treatment

Glaucoma is an eye disease in which pressure inside the eye (intraocular pressure) rises dangerously high, damaging the optic nerve and causing vision loss. In a healthy eye, fluid is produced in the ciliary body, enters the eye, and then drains through tiny passages called the trabecular meshwork. In people with glaucoma, these passages become blocked and intraocular pressure rises.

Some cases of glaucoma can be treated with medications. For others, laser or traditional surgery is required to lower eye pressure. Common surgeries include:

Laser Peripheral Iridotomy (LPI) – For patients with narrow-angle glaucoma. A small hole is made in the iris to increase the angle between the iris and cornea and encourage fluid drainage.

Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT) – For patients with primary open angle glaucoma (POAG). The trabecular passages are opened to increase fluid drainage. ALT is effective in about 75% of patients, and SLT may be repeated.

Nd: YAG Laser Cyclophotocoagulation (YAG CP) – For patients with severe glaucoma damage who have not been helped with other surgeries. The ciliary body that produces intraocular fluid is destroyed.

Filtering Microsurgery (Trabeculectomy) – For patients who have not been helped with laser surgery or medications. A new drainage passage is created by cutting a small hole in the sclera (the white part of the eye) and creating a collection pouch between the sclera and conjunctiva (the outer covering of the eye).

Tube Shunt Surgery – May be recommended for patients with neovascular glaucoma, failed trabeculectomy, or susceptibility to developing scar tissue. A thin, flexible tube (a shunt) with a silicone pouch is inserted in the eye to facilitate drainage.

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