What is Glaucoma?
Glaucoma is a leading cause of vision loss and blindness in the US. The term Glaucoma refers to a group of diseases that cause damage to the optic nerve as a result of increased pressure in the eye. It is generally caused by aging and genetics, 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.
What Are The Different Forms of Glaucoma?
Open Angle Glaucoma
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.
Angle Closure Glaucoma
A 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.
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.
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 medicated eye drops. These drops reduce the pressure inside the eye. Different drops work in different ways: they may decrease fluid production inside the eye, or increase the outflow of fluid from 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.
Minimally Invasive Glaucoma Surgery (MIGS Procedures) is a newer and exciting development in glaucoma treatment. MIGS refers to a group of procedures that are much less invasive than traditional glaucoma surgery. While they require a trip to the operating room, they are generally short procedures with little down time. The risks of these procedures are also less than traditional glaucoma surgery. These procedures can work well for mild to moderate glaucoma. More severe or poorly controlled glaucoma usually requires the traditional glaucoma procedures such as a trabeculectomy or a glaucoma valve procedure. While more invasive, these traditional approaches generally are more successful in lowering pressure especially in more advanced or uncontrolled glaucoma. Click here to read more about MIGS procedures.
For more advanced glaucoma, or glaucoma that is difficult to control with drops, laser or MIGS procedures, traditional glaucoma surgery (trabeculectomy or tube shunt surgery)may be recommended.
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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