Glaucoma

Overview

Glaucoma is a group of diseases that can cause damage to the optic nerve, loss of visual field (peripheral vision) and blindness. Between 1.5 and 2 million people in the United States have glaucoma. Many but not all patients with glaucoma have high intraocular or eye pressure (also called the glaucoma test). Early glaucoma may have no visual symptoms noticed by a patient, but detectable with an eye examination. Once the optic nerve is damaged, it cannot be repaired. If untreated, glaucoma may lead to loss of vision and blindness. When detected at an early stage, vision loss may be prevented or minimized.

The intraocular pressure is controlled by the flow of fluid in the eye. In glaucoma, the fluid may drain out of the eye too slowly, causing the pressure to increase. This increased pressure usually does not cause pain but may push and damage the optic nerve. The optic nerve sends the information about what we see to the brain. When the optic nerve is damaged from glaucoma, the peripheral (side) vision is usually affected first. This loss is slow and most patients do not notice the loss of vision until it is severe. Some patients may have reduced blood supply to the optic nerve or increased susceptibility of the optic nerve to damage. In these patients, even an eye pressure in the normal range may be too high and lead to optic nerve damage and loss of peripheral vision.

The most common cause of glaucoma is called “primary open angle glaucoma” or “chronic open angle glaucoma”. It is more common in people over 40 years old with increasing risk with age. A family history increases the chance of having glaucoma. African-Americans have an increased risk of glaucoma and it may progress more rapidly and develop at an earlier age in African-Americans. Other risks may include nearsightedness, high blood pressure, and diabetes. A prior history of being hit the eye may also increase your risk of glaucoma. Whether the eye pressure is high or normal, treatment is usually initially with eye drops. The eye drops lower the eye pressure and help prevent progression of the glaucoma. Some patients with glaucoma are also treated with laser or surgery to help lower the eye pressure. It is important to have a glaucoma test yearly after the age of 45 and every two years before then especially if you have any risk factors.

Another rarer form of glaucoma, called “angle closure glaucoma” may cause sudden pain, redness, and blurred vision. This progresses rapidly and needs prompt attention by an ophthalmologist. It is usually treated with a laser or surgery, and possibly drops. This condition is somewhat rare and most patients are not at risk for it. Only an eye exam can determine if a patient is at risk for “angle closure glaucoma”, allowing preventive treatment to be performed.