Glaucoma is a disease of the optic nerve that is usually but not always related to elevated intraocular pressure. The two most common types are primary open angle and angle closure, also known as narrow angle. Other subtypes include traumatic, pseudoexfoliation, pigmentary, neovascular and normal-pressure glaucoma where optic nerve damage develops despite low or normal intraocular pressures.
Glaucoma is often called the ‘silent thief of sight’ because the damage to vision is painless, gradual and most often without symptoms. It can slowly steal your eyesight without your even realizing that anything is wrong. It affects an estimated 3 million Americans, and is the second leading cause of blindness in the United States. Fortunately, if it is detected early and properly treated, most vision loss is preventable.
An estimated 3 million Americans have glaucoma, and at least half don’t realize they have it because often there are no visual symptoms in the beginning stage. 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 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 nerves. Depending on the results of that test, a visual field test may also be recommended.
It should be noted that acute angle-closure (also termed closed-angle or narrow-angle) glaucoma can produce severe symptoms with the rapid and painful rise in pressure. Patients may experience intense eye pain accompanied by nausea, redness, swelling of the eye, loss of peripheral vision as well as blurred vision and halos. It is important to reduce the pressure quickly because permanent vision loss can occur if the pressure is not reduced in a timely manner. It is considered a medical emergency, so immediate professional treatment is needed to preserve sight.
Other types of angle-closure glaucoma, however, can progress very slowly and cause eye damage without any obvious symptoms or pain in early stages.
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.
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 primary open angle, this drainage system does not function properly, causing a slow buildup of fluid pressure. When this happens, optic nerve damage may occur. As the optic nerve deteriorates, there is a loss of peripheral vision, most times without notice because of the gradual nature in which the deterioration progresses. Often it is only after irreparable vision loss has occurred that a person becomes aware they even have this disease.
Acute 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 generally occurs in people over 40 and may cause vision loss rapidly if no treatment is given. Patients may experience severe eye pain accompanied by nausea, redness, swelling of the eye, loss of peripheral vision as well as blurred vision and halos. Symptoms of glaucoma usually last until the eye pressure is lowered. It is important to reduce the pressure quickly because permanent vision loss can occur if the pressure is not reduced in a timely manner.
Acute narrow angle glaucoma occurs more frequently at night, during emotional stress, and sometimes with the use of some over-the-counter cold medicines such as Dristan, Contac, or Benadryl. It is considered a medical emergency, so you need to call us immediately at 1-866-865-2020 so that we can provide professional treatment to preserve your sight. Also, if you have had acute angle glaucoma in one eye, you are at risk for an attack in the second eye. Your doctor is likely to recommend preventive treatment.
A separate form of angle closure called chronic angle closure glaucoma can be slowly progressive, not producing the same sudden onset of symptoms as the acute form, but may also have the same devastating results of vision loss.
A simple test called gonioscopy can differentiate between the open angle and angle closure forms of glaucoma.
Treatment for both types of angle closure includes a simple in-office procedure called Laser Iridotomy, where a tiny opening in the iris is made to help open the closed angle. This procedure is also necessary for a condition called Narrow Angles, when the angle is narrow but there is no evidence of glaucoma
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 increasing the outflow of fluid from the eye. If you are experiencing glaucoma symptoms, we urge you to come in and speak to one of our professionals.
Some of the treatment options are:
Glaucoma drops are often the first treatment for lowering the pressure in the eyes because they have been found to be very effective as long as they are used as prescribed. Your doctor may even use a combination of drop types in order to get the best results. Usually they must be used several times a day so it’s important for patients to create a routine schedule that they can keep. We find that patients are using smart phone technology to set alarms to remind them when it is time for their drops. These drops work quite well at keeping the pressure in the eye low but they can be expensive.
For patients who can’t afford eye drops, have difficulty instilling them, have side effects from the drops, or prefer not to use them for various lifestyle reasons, Selective Laser Trabeculoplasty (SLT) may be another option. SLT is a fast, effective, and painless advancement in the treatment of primary 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 clogging the drainage chamber, thereby increasing fluid outflow 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 it 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. Many patients are eventually able to discontinue use of some or all of their medications if they were using them prior to the laser.
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. It has 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.
Diode laser is another laser technology used to reduce pressure by treating the ciliary body. It is often recommended in the late stages of glaucoma, but some patients are opting for this treatment earlier in the course of their disease.
Trabeculectomy also known as filtering surgery is an outpatient procedure performed under topical anesthesia to create a new drainage channel in the eye. Fluid from inside the eye travels to the tissue lining the outside of the eye forming a little bubble known as a filtering bleb. The body absorbs the fluid and the pressure is reduced. The procedure, which can also be performed at the same time as cataract surgery, is indicated in moderate to severe glaucoma with the goal of lowering the pressure sufficiently to prevent further optic nerve damage and vision loss. Many patients do not need to use glaucoma drops after this procedure.
Laser Iridotomy is necessary in certain types of narrow angles and angle closure glaucoma. It is an office based procedure using topical anesthesia where a laser is used to make a small opening in the iris to help open up the angle. Both eyes are generally done and success is nearly 100%.
The iStent is a tiny L shaped device, measuring only 1 millimeter long and 0.33 millimeters high, that is used to decrease eye pressure in patients with open-angle glaucoma. iStent surgery involves inserting the iStent device in the natural drainage channels of the eye during cataract surgery. This allows a permanent internal drain of the fluids to reduce the high pressures in the eye. This treatment is recommended in mild to moderate glaucoma.