Glaucoma is called the “silent thief” because damage is painless, gradual and most often without symptoms. It can slowly steal your eyesight without your even realizing that anything is wrong. Glaucoma affects an estimated 3 million Americans, and is the second leading cause of blindness in the United States. Fortunately, if glaucoma is detected early and properly treated, most vision loss is preventable.
What Is Glaucoma?
The two most common types of glaucoma are chronic open angle glaucoma and acute narrow angle glaucoma.
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Chronic Open Angle Glaucoma
Our eyes have a constant flow of fluid that fills the front chamber of the eye and then drains into the bloodstream. It drains through the “angle” of the eye which is located between the cornea and iris. In chronic open angle glaucoma, this drainage system becomes clogged, causing a slow buildup of fluid pressure. When this happens, it reduces the blood supply to the optic nerve. As the optic nerve deteriorates, there’s a loss of peripheral vision, most times without notice because of the gradual nature. Often it is only after irreparable damage has occurred that a person becomes aware they even have this disease.
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Acute Narrow Angle Glaucoma
Acute narrow angle glaucoma results from a sudden, complete blockage of fluid drainage from the angle of the eye, causing a rapid and painful rise in pressure. It can occur at any age, causing blindness in a day or two, if no treatment is given. Patients may experience severe eye pain accompanied by nausea, redness and swelling of the eye, as well as blurred vision and halos. Acute narrow angle glaucoma occurs more frequently at night, during emotional stress and with the use of some over-the-counter cold medicines such as Dristan, Contac, or Benadryl. It is considered an emergency, so immediate professional eyecare is needed to preserve sight.
If you have had acute narrow angle glaucoma in one eye, you are certainly at risk for an attack in the second eye. Your doctor is likely to recommend preventive treatment.
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Could I Have Glaucoma and Not Know It?
An estimated 3 million Americans have glaucoma, and at least half don’t realize it because often there are no visual symptoms. A recent survey indicated that 7 out of 10 adults have not undergone an eye examination or glaucoma screening within the past three years. This is not good, as the only way to accurately diagnose glaucoma, especially in its early stages, is with a comprehensive medical eye examination. During such an exam, an instrument called a tonometer is capable of checking the pressure in the eye, painlessly and quickly. Also, your doctor will dilate your pupils to allow direct examination of the optic nerve. Depending on the results of the above tests, a visual field test may also be recommended.
Since glaucoma tends to run in families, it is important for the entire family to have regular eye examinations, especially if there is a family history of glaucoma.
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Early detection is the key to stopping the progress of the disease.
There is no cure for glaucoma, however, today’s medications or surgery can control and prevent further vision loss. The appropriate treatment depends upon the type of glaucoma, and usually is aimed at lowering the intraocular pressure in the eye. This can be done either by lowering the production of fluid or by opening the drainage system of the eye. Some of the treatment options are:
- Topical medication (eye drops)
- Systemic medication (pills)
- Laser surgery
- iStent® surgery
- Invasive surgery is normally reserved as the last treatment, if all else fails.
Most of our glaucoma patients are treated with drops to lower the pressure in their eyes. The drops must be used several times a day so it’s important for patients to create a routine schedule that they can keep.
Selective Laser Trabeculoplasty
Since drops can be very expensive, Selective Laser Trabeculoplasty (SLT) may be another option. SLT is a fast, effective, and painless advancement in the treatment of chronic open angle glaucoma. It can reduce the need and expense of eye drop medication that glaucoma patients usually need. The Eye Associates is proud to have been the first practice in Manatee County to offer this advanced treatment to our glaucoma patients.
Dr. Robert Friedman, The Eye Associates’ Fellowship Trained Glaucoma Specialist explains, “SLT is a ‘cold’ laser that works by using a specific wavelength to selectively target pigmented cells in the drainage chamber, thereby increasing fluid output and lowering the pressure in the eye. Because the short pulse of the laser does not allow time for heat to spread to other cells, SLT does not cause adverse scarring and damage to other tissues the way older laser treatments did.”
SLT is usually performed in a specially equipped laser room at our office and only takes about three to five minutes. Prior to the procedure, only drops are needed to numb your eye; no injections or needles are used. The laser applications are made through a slit lamp microscope, similar to the one used for eye examinations. Your doctor will hold up a special lens to your eye as a high-energy beam of light is aimed at the lens and reflected onto the meshwork drainage system in the angle of the eye. You will not feel any pain during the procedure.
In order to monitor the eye pressure, you will need to plan on coming in for a few follow-up visits. It may take several weeks to see the full pressure-lowering effect of this procedure and during this time, you will need to continue taking glaucoma medication. Many patients are eventually able to discontinue use of some or all of their medications.
ECP (Endoscopic CylcoPhotocoagulation)
ECP, sometimes called EndoLaser, is a glaucoma laser procedure that can be done on its own as an outpatient procedure, or in combination with cataract surgery. Instead of focusing on the eye's drainage system, ECP works by reducing the amount of fluid the eye makes. Using a laser to treat the ciliary body, the pressure in the eye is lowered.
ECP is a non-invasive, low risk procedure, that is relatively easy to perform, and proven to be effective in treating patients with glaucoma. The earlier pressure is lowered, the more likely patients can avoid possible optic disc damage. Also, another benefit of this laser procedure is that it may allow patients to reduce or eliminate their reliance on expensive eye drops.
iStent® surgery involves inserting a device usually during cataract surgery allowing a permanent drain of the fluids which can reduce the high pressures in the eye.
iStent® is a tiny L shaped device which is only 1 millimeter long and 0.33 millimeters high. The iStent® is used to decrease eye pressure in patients with open-angle glaucoma.
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Know Your Risk Factors For Glaucoma
- Does a family member have glaucoma? Glaucoma occurs twice as frequently among people who have a blood relative with glaucoma.
- Are you African-American and of Afro-Caribbean descent? If so, you are more likely to develop glaucoma and at a younger age.
- Are you over 50?
- Have you had an eye injury or eye surgery?
- Are you nearsighted?
- Have you taken steroids over an extended period of time?
- Do you have diabetes, anemia, and hardening of the arteries?
Answering YES to any of the above questions could mean that you are at risk for glaucoma.
The only way to know for sure that you do not have glaucoma is to have a comprehensive medical eye examination. If you are over 39 years of age, you should have an examination at least every two years. If you have any of the indicators listed above that put you at a higher risk for glaucoma, you should be tested once a year. Glaucoma is more prevalent with age, so anyone 60 years old or older should have a complete medical eye examination every year.
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If you have glaucoma, or have any of the above indicators that make you at higher risk for glaucoma, and would like to be evaluated by
our Fellowship Trained Glaucoma Specialist, Robert Friedman, M.D., please call us at (941) 792-2020 or toll free 1-866-865-2020 or contact The Eye Associates.