So you’ve got glaucoma – now what?
What does that mean and what are your treatment options?
Being told you have the disease can be scary, but it does not mean you are alone.
Glaucoma currently affects nearly 70 million people worldwide, making it one of the leading causes of blindness.
Despite how common it is, many individuals don’t know much about glaucoma or how it affects their vision.
In this article, we will take a closer look at this condition, from its causes and symptoms to the various treatment options available.
But before we dive into the specifics of glaucoma, let’s first take a look at what the disease actually is.
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What Is Glaucoma?
Glaucoma is a group of eye diseases that cause damage to the optic nerve, which is vital for good vision.
It typically occurs when the clear fluid inside the eye ( the aqueous humor) builds up and puts pressure on the optic nerve at the back of the eye.
The increased pressure in the optic nerve causes a progressive vision loss and can result in blindness–but this does NOT happen to everyone with glaucoma.
Many people who develop glaucoma will not experience symptoms in the early stages of this disease until they experience a rapid vision loss.
Fortunately, with early diagnosis and treatment, this disease can be controlled.
Still, no matter which type you have, once it develops, it cannot be reversed and may only worsen over time.
So, having regular visits to your eye doctor (ophthalmologist) for check ups will help detect any sign of eye damage or vision loss that may lead to glaucoma.
Symptoms of Glaucoma
Initially, glaucoma can have very subtle symptoms or no symptoms at all.
That’s why most people don’t realize that they have the disease until the early stages of glaucoma results in noticeable damage to their central or “straight-ahead” vision.
The first symptoms usually only affect your peripheral (side) vision, and you may not even notice them.
This type of vision loss can occur very slowly or quickly depending on whether glaucoma is open-angle or closed-angle.
Other glaucoma symptoms may include:
- glare or halos around lights
- tunnel vision, where straight-ahead vision is constricted and the peripheral field of view expands outwards in a circular fashion
- blurred vision
- “eye fatigue” or having to blink a lot–especially after reading or driving for an extended period of time
- streaks across your field of view (a greenish-blue haze)
- redness in the eye
- painful ache in the eye or behind the eyes
In general, these symptoms don’t appear suddenly and typically worsen steadily over time.
So, if you experience any of these symptoms for more than a few days, contact your ophthalmologist right away since glaucoma should be treated as early as possible to prevent permanent vision loss.
What Causes Glaucoma?
For reasons that are still unknown, the aqueous fluid produced by the ciliary body of your eye increases in volume and puts pressure on the front part of your eye.
This causes an increase in pressure inside the eyeball (intraocular pressure or IOP), which can damage both your optic nerve and retinal blood vessels.
So why does this occur?
It could be from an abnormality in the drain for this fluid ( trabecular meshwork), or because of an alteration in the pressure inside your eye.
Also, other medical conditions can increase the risk of glaucoma by increasing intraocular pressure. Conditions that increase the pressure in your body can raise the pressure inside your eyes.
Some of these conditions include:
- diabetic retinopathy
- high blood pressure
- heart disease
- blockage of blood vessels in your eye
Additionally, some medications such as corticosteroids, antihistamines, and NSAIDs may cause intraocular pressure.
What Are the Major Types of Glaucoma?
There are two major categories of glaucoma: open-angle and closed-angle glaucoma.
Open-Angle or Chronic Glaucoma
This is the most common form of glaucoma, accounting for about 19% of vision loss among African Americans and 6% of all blindness among Caucasians.
In this type of glaucoma, drainage openings in your eye become blocked slowly over time.
As a result, the aqueous humor cannot flow out of your eye as it should, so your intraocular pressure gradually increases.
This elevated pressure eventually damages the optic nerve at the back of your eye, leading to vision loss.
In this type of glaucoma, the angle of your eye never closes, so even if you don’t exhibit any other early symptoms of glaucoma, your doctor may still diagnose you with open-angle glaucoma.
Angle-Closure or Acute Glaucoma
In angle-closure glaucoma, your eye may have a sudden increase in pressure because the drainage system gets blocked.
Your pupil is typically very small or “miotic” during an attack of acute/angle-closure glaucoma, and this causes your iris to cover the drainage system.
Although less common than open-angle glaucoma, this type of glaucoma makes up for it by being more dangerous if not treated immediately.
Other Common Types of Glaucoma:
Congenital Glaucoma
Also called childhood glaucoma, an obstruction in the drainage system usually causes this type of glaucoma due to a defect in development.
It results from abnormal development of structures in your eye during birth or shortly after birth.
It is estimated that congenital glaucoma affects up to 1 in 10,000 infants in the US.
In other cases, congenital glaucoma can be caused by a family history of glaucoma.
The type of treatment prescribed will depend on what type of glaucoma your child has, but microsurgery is often recommended.
Secondary Glaucoma
This type of glaucoma can occur when another disease or condition damages your optic nerve, which drains the aqueous humor in your eye.
It may be difficult to distinguish between primary and secondary glaucoma in some cases.
For example, a person may have “simple” or open-angle glaucoma from birth that does not affect vision for many years.
Then, they may later develop secondary glaucoma due to an injury or other condition that affects the optic nerve.
Common factors contributing to secondary glaucoma are diabetes, high blood pressure, cardiovascular disease, inflammation of the iris or eyes, tumors that affect the optic nerve, and certain medications.
Normal-Tension Glaucoma
Normal-tension glaucoma is also called low-tension glaucoma.
It is relatively rare but occurs more often in older adults with normal intraocular pressure.
It is characterized by changes in peripheral vision, seeing halos around lights, or distortions in vision that are not caused by cataracts.
A dilated eye examination with optic nerve evaluation is used to identify this type of glaucoma.
The doctor may also recommend regular checkups to monitor intraocular pressure and evaluate other underlying factors causing the vision changes.
Pigmentary Glaucoma
This type of glaucoma occurs in people with pigmentary defects in the iris.
As a result, the angle that drains fluid from your eye becomes inflamed and narrows, which causes sudden attacks of high pressure that can lead to vision loss.
It is essential to know the early symptoms because pigmentary glaucoma is difficult to detect with regular eye exams.
Risks Factors for Developing Glaucoma
Anyone can be affected by glaucoma, but some factors can increase your likelihood of developing it. These risk factors include:
Age of 40
The risks of developing glaucoma increase with age.
People over the age of 40, particularly African Americans and Hispanics, should talk to their doctor about getting screened at least once every two years, or more often if they have other risk factors which can cause eye pressure to rise suddenly.
African American, Asian, or Hispanic
According to the National Eye Institute (NEI), African Americans are more than twice as likely to develop glaucoma compared with white individuals in the US.
This is believed to be due to a combination of factors, including genetics and environmental factors such as the higher risk of diabetes, high blood pressure, and increased exposure to pollutants.
Also, people of Asian or Hispanic descent are also believed to have an increased likelihood of developing angle-closure glaucoma.
Poor Eyesight
Some studies suggest that individuals with a degree of nearsightedness, or myopia, have a greater risk of developing glaucoma.
In addition, people diagnosed with hyperopia (farsighted) may have an increased likelihood of glaucoma at a later age.
Abnormalities in the optic nerve pathway could cause changes in your eyes that lead to poor vision, contributing to glaucoma.
Eye Injury or Eye Surgery
A penetrating injury to your eye can cause scarring and damage to the optic nerve, which may lead to glaucoma.
Also, if you have had cataract surgery involving a shunt implant, you could develop glaucoma later due to the procedure’s effect on your intraocular pressure (IOP).
Health Conditions
Certain health conditions such as elevated blood pressure, diabetes, and eye inflammation can contribute to glaucoma.
Other conditions such as eye injury and cataracts can also play a role.
Usage of Corticosteroid Medications
Corticosteroid medications are commonly used to treat autoimmune conditions, asthma, and allergies.
The drugs come in several forms, including creams or pills. Allergy symptoms can also be reduced using steroid nasal sprays.
Though not common, prolonged use of corticosteroids may increase IOP, leading to glaucoma.
Generally, it is important to limit your exposure to these medications if you are at risk of glaucoma.
Talk with your doctor about the benefits and risks of using corticosteroids before taking them for an extended period.
Thin Cornea
Sometimes, glaucoma can occur as a result of thin corneas. Corneal thickness is critical because it allows the cornea to bend light from your eye onto the retina.
If you have thin corneas, this may lead to glaucoma later in life due to increased eye pressure and damage to the eye.
Genes
Glaucoma may also run in families because of a gene mutation. If your parents or siblings have open-angle glaucoma, you may be at an increased risk of the disease.
However, you should note that genetics is not always a factor, and many people who have glaucoma do not know anyone else with it.
How Is Glaucoma Treated?
If you have been diagnosed with glaucoma, it is vital to begin treatment as soon as possible.
While there is no cure for this condition and cannot restore your eyesight if vision has already been lost, it can prevent further damage by lowering your eye pressure.
Some common treatments for glaucoma include:
Eye drops: Eye drops work by decreasing the amount of fluid in your eye, lowering your intraocular pressure, and protecting your eyes from further damage.
In addition to prescription eye drops, you should also use artificial tears to help alleviate dryness or discomfort in your eyes related to glaucoma.
Oral medications: Not everyone with glaucoma will need prescription eye drop medications.
However, several types of medications can help lower IOP by reducing fluid production in the eye, increasing the outflow of fluid through the trabecular meshwork and ciliary body, or decreasing the optic nerve sensitivity to pressure.
These drugs include beta-blockers and calcium channel blockers.
Depending on the severity of your condition, you may use these types of drugs as a first or second-line treatment for this disease.
Eye surgery: If your glaucoma is advanced and you have already lost much of your vision, surgery may be needed to help improve your remaining eyesight.
In some cases, high-risk patients with advanced glaucoma may benefit from a procedure called trabeculectomy.
This surgery involves creating a new drainage channel within your eye to help reduce your pressure.
However, you should always speak with an experienced glaucoma specialist about treatment options before having any type of eye surgery.
Assessing eye pressure: An ophthalmologist uses a device called a tonometer to check the pressure in your eyes without the need for eye drops.
While these tools are not meant to replace actual doctor care, they can help you keep track of any recent changes in your pressure levels.
Bottomline
Glaucoma is a severe and debilitating eye disease as the second leading cause of blindness worldwide. Fortunately, there are a number of treatments and procedures available to slow down the progression of glaucoma. Therefore, it is extremely important to be aware of the risk factors and symptoms in order to detect them early enough before your eyesight is compromised or you lose your vision permanently. As always, consult your ophthalmologist before starting any new medication or treatment for this disease.
Sources
What is glaucoma? (2015, January) Retrieved from
aao.org/eye-health/diseases/what-is-glaucoma
8 Risk Factors for Glaucoma ( 2019, February 19). Retrieved from,
https://www.communitymedical.org/about-us/news/8-risk-factors-for-glaucoma
Facts about glaucoma. Retrieved from,
nei.nih.gov/health/glaucoma/glaucoma_facts
Glaucoma Can Strike At All Ages, Even Newborn Babies. Retrieved from, https://www.glaucoma.org/gleams/glaucoma-can-strike-at-all-ages-even-newborn-babies.php
Glaucoma Data and Statistics
The Genetics of Glaucoma
https://www.glaucoma.org/glaucoma/the-genetics-of-glaucoma-what-is-new.php
