National Glaucoma Awareness Month

To help spread awareness of this sight-stealing disease, January has been named National Glaucoma Awareness Month. Over three million people in the United States currently have glaucoma, although as many as 50% of the people affected may be unaware that they have it. Glaucoma has no early warning signs – allowing it to progress undetected until the damage is severe. According to the National Eye Institute, the number of glaucoma cases is increasing and is predicted to reach as high as 4.7 million people in the US by 2030.

What is Glaucoma?

Glaucoma is a degenerative eye disease that causes damage to the optic nerve over time. The damage to the nerve occurs most commonly when there is an increase in the intraocular pressure or the pressure inside of the eye. This is generally due to an abnormal fluid buildup in the eye’s interior. The eye is constantly producing a fluid called aqueous humor, which drains out of the eye at the same rate that it is being produced. If something goes wrong that causes the fluid not to drain properly, it will lead to an increase in pressure that will damage the fragile structures of the optic nerve at the back of the eye. The optic nerve is responsible for transmitting visual information from the eye to the brain for processing. Deterioration can cause permanent vision loss and, if left untreated, eventually blindness. No treatment can undo the damage to the nerve cells once it has been done.

Types of Glaucoma

Although there are many types of glaucoma, the two most common ones affecting people in the United States are Primary Open-Angle Glaucoma and Acute Angle-Closure Glaucoma.

Primary Open-Angle Glaucoma

This is the most prevalent type in the United States, accounting for almost 90% of the cases of glaucoma. This glaucoma progresses gradually when the drains in the eye are not working as well as they should. Imagine standing in a shower with a slow drain – you end up with an inch of water around your ankles because the water is coming out of the shower head faster than the drain can take it away. As the fluid’s pressure accumulates, it presses on the optic nerve, slowly damaging it. This type of glaucoma is painless and does not immediately change vision. Many patients don’t have symptoms in the early stages at all, and often by the time symptoms emerge, the damage to the ocular nerve is often severe. With consistent monitoring through regular eye exams, open-angle glaucoma can be found early, and treatments can be started in time to preserve vision.

Acute Angle-Closure Glaucoma

Acute angle-closure glaucoma sometimes also called narrow-angle glaucoma or closed-angle glaucoma presents the opposite of the slow advance seen in primary open-angle glaucoma. This type of glaucoma happens when the iris, which is the colored part of the eye is very close to the eye’s drainage angle and ends up blocking it completely. Thinking back to the analogy of the drain in the shower, acute angle-closure glaucoma would be like putting a stopper over the drain while the water is still running. When the drainage canals become entirely closed off, eye pressure can rise very quickly in what is commonly referred to as an acute attack. This is a medical emergency, and you should call your ophthalmologist immediately. If the pressure is not reduced within a few hours, it can cause irreversible damage to your vision.

Symptoms of Glaucoma

In the more common open-angle glaucoma, symptoms are not generally noticeable until vision loss occurs. Small blind spots may occur in peripheral or side vision, often affecting the inner vision closest to the nose first. The center of the vision is usually affected at the advanced stages of the disease. Unfortunately, most vision changes are noticed by patients when there is significant damage to the optic nerve. This subtle, often unnoticed progression has earned this type of glaucoma called “the silent thief of sight.” While glaucoma normally occurs in both eyes, it generally starts in just one.

Acute angle-closure glaucoma will sometimes have early signs that can be detected before an acute attack. Early symptoms could include blurred vision, mild headaches, eye pain, and halos around lights. People that experience these signs should get checked out by their ophthalmologist as soon as possible. An acute attack of angle closure glaucoma will include symptoms like severe pain in the eye or forehead, blurred or decreased vision, seeing rainbows or halos, redness of the eye, headache, nausea, and vomiting. This is a sign of a medical emergency, and help should be sought immediately.

The Importance of Regular Eye Exams

Regular eye exams are a crucial part of preventative health care – just like visiting your primary care provider for a yearly check-up, you should also schedule annual appointments with your eye care provider to help maintain healthy vision. As with glaucoma, many degenerative eye conditions progress slowly and remain undetected until the optic nerve damage is irreversible. While glaucoma is one of the most prevalent causes of blindness worldwide, it can be avoided with early treatment.

Glaucoma Risk Factors

Anyone can develop glaucoma, but several factors might cause someone to be at a higher risk of developing the condition. According to the American Academy of Ophthalmology, these risk factors include:

• Race – People of African, Asian, or Hispanic descent are at a higher risk
• Age – People over the age of 60 years old
• Family History – Having family members who have had glaucoma increases risk, especially if it is a sibling
• High Eye Pressure – Small increases in intraocular pressure can have greater effects if the starting pressure in the eye is already elevated
• Farsighted (Hyperopic) or Nearsighted (Myopic) – Other vision issues or abnormalities in eye shape can increase glaucoma risk
• Previous Eye Injury – Prior trauma to the eye can have many long-term effects
• Thin Corneas – People with thinner center corneas or other corneal abnormalities have higher chances of developing glaucoma
• Long Term Steroid Medication Usage – It has been documented in patients that long term steroid medications may induce increased intraocular pressure
• Other Total Health Issues – Diabetes, migraines, high blood pressure, poor blood circulation, and other health issues affecting the total body

Protecting Your Vision

It is important to practice good eye health by maintaining regular eye exams, particularly if you find yourself in one of the high-risk categories. Medicare will cover one glaucoma test yearly for recipients in the high-risk groups. The American Academy of Ophthalmology recommends a comprehensive eye exam for everyone at 40, as that is when many eye conditions start to present. Open-angle glaucoma is hereditary, so researching family health history is also a smart idea.

Overall health and instituting healthy behaviors can play an important part in the prevention and management of degenerative eye conditions. Keeping a healthy body weight will lower the chances of developing type 2 diabetes or high blood pressure, which will then decrease the likelihood of developing glaucoma or glaucoma-like diabetic retinopathy. Monitoring and controlling high blood pressures are significant in preserving normal levels of intraocular pressure. Additional preventative measures include being physically active and avoiding smoking.

Diagnosis

Glaucoma can only be diagnosed with a comprehensive dilated eye exam – a screening that only checks intraocular pressure is not enough to make a diagnosis. In a glaucoma exam, the eye doctor will check intraocular pressure and inspect the drainage in the eye, examine the retina and optic nerve for signs of damage, test peripheral vision, and measure the thickness of the cornea.

Treatment

Many treatment options exist for glaucoma, and you and your eye care provider can team up to decide the best course of action for your case following diagnosis.

Eye Drops

The most common management for glaucoma is daily medicated eye drops. This type of treatment can lower pressure in the eye in two main ways: by reducing the amount of fluid produced by the eye or by helping the fluid to drain better out of the eye.

Laser Surgery

Glaucoma patients can also benefit from laser surgery, which can be performed to help the fluid drain from the eye. In patients with open-angle glaucoma, Selective Laser Trabeculoplasty (SLT) can be performed as a replacement for, or in addition to, medical management. In this procedure, the surgeon will use a laser to help the drainage angle perform better and reduce fluid. Successful SLT treatment lasts 1 to 5 years and can be repeated as needed. For patients experiencing angle-closure glaucoma, the surgeon can perform a Laser Peripheral Iridotomy (LPI) to give alternative routes for fluid flow within the eye.

Surgery

Sometimes, lasers can’t be used, or laser surgeries would be ineffective. Other procedures can be done in an operating room for instances such as these. The surgeon can create drainage in the eye by removing tissue or installing a tiny shunt smaller than a grain of rice to direct fluid to surrounding tissue, where it can be better absorbed.

Contact ICON Eyecare

Approximately 120,000 people have blindness caused by glaucoma in the US, accounting for 9-12% of all cases of blindness. Vision loss from glaucoma is preventable, and the experts at ICON Eye Care are ready to help you on your journey to maintain your eye health. Call us to schedule a consultation and take the first step towards healthier vision today!