Dr. Wyse is a fellowship-trained glaucoma specialist. She spent an additional year of training studying glaucoma treatment (medical, laser and surgical) at Northwestern University Medical Center after her residency in ophthalmology, and this remains a strong focus of her medical practice.
What is Glaucoma?
Glaucoma is a leading cause of vision loss and blindness in the US. The term Glaucoma actually refers to a group of diseases that cause damage to the optic nerve as a result of increased pressure in the eye, but it can also be caused by eye injury, blocked blood vessels, inflammation, or severe infection in the eye. Often glaucoma is asymptomatic until fairly advanced with irreversible optic nerve damage, so early diagnosis and treatment are essential. While glaucoma is generally not curable, it can be treated and controlled to prevent vision loss, especially when diagnosed early.
Open angle glaucoma is the more common form of this condition and involves failure of the fluid inside the eye to drain properly. This leads to a pressure buildup in the eye, which damages the optic nerve. Open angle glaucoma causes a very slow deterioration of peripheral (side) vision, which is usually asymptomatic until more severe. The vast majority of patients with glaucoma have no symptoms unless the disease is moderate to severe.
The less common form of glaucoma is angle closure, which is caused by the drainage of the eye becoming more suddenly blocked off, resulting in a sudden buildup of pressure in the eye. Angle closure is often symptomatic with eye pain, redness and blurred vision with halos around lights.
How is Glaucoma Diagnosed?
Diagnosis of glaucoma requires a full eye exam. While many patients with glaucoma have high eye pressure, the eye pressure alone is usually not enough to diagnose or rule out glaucoma. About one third of glaucoma patients in the US will have normal pressures, and many patients with high pressure never develop glaucoma. For this reason, an eye pressure check alone is not adequate to screen a patient for glaucoma. An exam of the optic nerve, computerized nerve analysis, automated visual field testing, corneal thickness measurement (because corneal thickness affects eye pressure readings), and gonioscopy (a special lens is used to look at the drain of the eye) are all used to diagnose glaucoma. Click here for more information about the exam and testing for glaucoma.
How is Glaucoma Treated?
If glaucoma is diagnosed, treatment should begin promptly to minimize the risk of permanent vision loss. Though angle closure glaucoma must be treated with laser or microsurgery, most patients with open angle glaucoma can be treated with eye drops alone. These drops decrease fluid production inside the eye or increase the outflow of fluid out of the eye.
Laser trabeculoplasty is another option for glaucoma treatment—especially when drops have not lowered pressure enough, or the cost of drops or difficulty instilling them is an issue for the patient. Our practice offers Micropulse Laser Trabeculoplasty (MLT), the most advanced laser for this procedure. The micropulse laser has several advantages and is becoming a more common choice for patients because of its safety and the fact that it can be repeated.
For glaucoma patients who also have cataracts, the iStent Minimally Invasive Glaucoma Surgery is an option. This procedure helps lower eye pressure. Placement of the iStent is done at the same time as cataract surgery and can be performed in just a few minutes.
For more advanced glaucoma, or glaucoma that is difficult to control with drops or laser, surgery (trabeculectomy or tube shunt surgery) is used.
The goal of all of these treatments is to decrease pressure in the eye and preserve vision. Glaucoma treatment has a high success rate and can often prevent vision loss, but early detection is key since vision loss from glaucoma is irreversible.
Risk Factors for glaucoma
Risk factors for glaucoma include age, family history, nearsightedness, history of elevated eye pressure, history of an eye injury, African descent, and steroid use.
Regular eye exams for early diagnosis and treatment are the best prevention available for glaucoma-related vision loss.
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