Glaucoma is a leading cause of blindness and visual impairment, affecting over 3 million people in the United States. It can affect patients of all ages, many of whom do not experience any symptoms. In fact, over half of the people afflicted do not even realize they have it. Glaucoma refers to a group of diseases that have the final common pathway of causing damage to the optic nerve. The optic nerve functions much like a cable, connecting our eyes to our brains, relaying what we see. Damage from glaucoma, most frequently caused by elevated eye pressure, can lead to the development of blind spots in our visual field. Without routine eye exams to check the health of one’s eyes, these blind spots can go undetected and in the worst-case scenario can lead to total permanent blindness.
In the early stages, glaucoma does not have any noticeable symptoms and is commonly referred to as the "silent thief." Though a cure has yet to be developed, it’s progression can be slowed via early detection and appropriate treatments.
Glaucoma often causes no pain or other noticeable symptoms until the disease has progressed significantly. Later stages of the disease may cause a gradual loss of peripheral vision, as well as eye pain, blurred vision, nausea, vomiting, halos around lights and other troubling symptoms. The type and severity of symptoms depend on the type of glaucoma and the patient's eye and overall health.
Glaucoma can affect both newborns and the elderly and anyone in between. Those who are at an increased risk for developing glaucoma are those who:
Are 45 years of age
Do not attain regular eye exams
Have a family history of the condition
Experience abnormally high eye pressure
Are of African heritage
Have preexisting health conditions, such as Diabetes
Have experienced some form of eye trauma
Have taken corticosteroids for extended periods of time
Glaucomatous optic nerve damage occurs, in most cases, from elevated eye pressure. The eye itself, much like a ball, is a closed system. In the eye, a fluid called the aqueous humor is produced by a gland called the ciliary body. This fluid flows throughout the eye, delivering nutrients to its different parts. The fluid then drains out of the eye through a complex tissue called the trabecular meshwork. Elevated ocular pressure can come about if there is an imbalance between how much fluid is produced or how much fluid is being drained. This elevated pressure can then damage the optic nerve leading to glaucomatous damage. Many different ocular disorders can lead to elevated pressure. Nearly any eye disorder associated with aging, inflammation, bleeding, injury, tumors, or even birth defects can raise eye pressure.
Types of Glaucoma
Primary Open-Angle Glaucoma (POAG) – This condition is one of the most common and preventable causes of blindness in the world, affecting 1.5% to 2% of the population in the United States. In POAG, there are no obvious, specific ocular abnormalities or systemic diseases causing the condition. It usually affects both eyes to the same degree with most patients diagnosed after age 40 with no gender predilection.
Low Tension Glaucoma – Is a sub-condition of POAG. Also, known as "normal-tension" glaucoma, this persistent optic neuropathy happens even though the pressure in the eye remains low. It has very similar characteristics as POAG and is classicly defined with a pressure of less than 21mmHg. Treatment is the same as for POAG and studies have demonstrated that even though the pressure is low, further reduction can decrease the risk of optic nerve damage and visual field loss.
Secondary Open-Angle Glaucoma – This condition refers to glaucoma that is caused by other types of eye conditions or diseases. There is an increased resistance to outflow which leads to elevated pressure.
Pseudoexfoliative Glaucoma – Is a genetic disorder that causes a protein called Fibrillin to collect near the edges of the pupil, lens, or within the drainage system of the eye. This blockage can then increase the pressure and lead to optic nerve damage. It can occur in one or both eyes. Risk factors include age, female gender, and Scandinavian descent. Treatment is similar to the other types of glaucoma in lowering the intraocular pressure with medication, laser or surgery.
Pigment Dispersion Glaucoma – This condition happens when the pigment or color from one's iris starts to chafe off and deposit in various structures in the eye. If enough pigment deposits within the drainage system, a blockage can lead to elevated pressure. Risk factors include Caucasian race, male gender, myopia, usually between 20-50 years old. Treatment is similar to other types of glaucoma. Of note, these patients have been found to respond very well to Selective Laser Trabeculoplasty.
Steroid-induced Glaucoma – Most commonly caused by topical steroid eye drops or intraocular steroids, any form of steroid medication can lead to elevated pressure. This includes oral steroids, topical creams, nasal sprays, and injections. It is believed that 30% of all people are susceptible to the elevation.
Acute-Angle Closure – Also known as narrow-angle glaucoma, this condition affects only about one out of every ten glaucoma patients and involves a blockage in the trabecular meshwork that can lead to symptoms such as redness, discomfort, blurred vision, or headaches. This blockage may develop as a result of structural abnormalities, hyperopia or tumors within the eye. Acute-angle closure can develop suddenly or gradually, depending on the cause. Most patients who develop angle-closure glaucoma are born with narrow drainage angles that put them at a higher risk for developing this condition.
Secondary Angle Closure – Patients with secondary angle-closure glaucoma have a blockage within the drainage system of the eye that is usually associated with an ocular or systemic cause.
Neovascular Glaucoma – This severe condition arises when the drainage system is blocked by the development of abnormal blood vessels. This is usually associated with bleeding and scar tissue formation. The most common causes of neovascular glaucoma are diabetes mellitus, central retinal vein occlusions, and ocular ischemic syndrome. Patients often present with acute vision loss, pain, red eyes, and elevated intraocular pressure. Treatment involves controlling the pressure as well as the underlying disease.
Inflammatory Glaucoma – This type of glaucoma is caused by an underlying disease, which creates inflammation and increases the pressure within the eye. Treatment is focused on both treating the underlying cause as well as controlling the pressure.
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Our expert ophthalmologists use various required tests to learn whether someone has glaucoma. Each of these tests are very comfortable, quite simple, and quick. First, we will expand the pupils and maybe anesthetize the eyes with eye drops. When the eye drops start to work, we will start performing the tests, which will include evaluating the intraocular pressure (tonometry) and the corneal thickness (pachymetry), measuring the size of the angle between the cornea and iris (gonioscopy), observing and taking images of the appearance of the optic nerve, establishing the patient’s field of peripheral vision, and testing for any spots of blindness.
Once a diagnosis of glaucoma is made, there are numerous approaches available to successfully manage the condition. All of these methods focus on reducing internal eye pressure to stop more injury to the optical nerve. A great number of people who are in the first stages of the disease are often able to delay or stop their vision loss by managing glaucoma with prescription eye drops.
For patients whose condition is more severe, we use various treatments, including MIGS (minimally invasive glaucoma surgery), laser therapies, and trabeculectomies, that may ease the condition significantly. The Ophthalmology Associates of the Valley team of highly skilled ophthalmologists are devoted to establishing the best treatments for our patients' individualized eye healthcare.
Take Control of Glaucoma
At Ophthalmology Associates of the Valley, we frequently meet with individuals dealing with glaucoma to assist them in managing the disease. It’s critical to know that getting a diagnosis and treatment in the early stages can help you keep your symptoms under control. We urge everyone who has these symptoms, who has a genetic predisposition or who has a current diagnosis to plan a consultation at one of our San Fernando Valley of Los Angeles, CA offices.