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Glaucoma

Glaucoma is the leading preventable cause of blindness in the U.S. today. In fact, it is estimated that over two million Americans have some type of glaucoma and half of them do not know it. Although it cannot be cured, it can usually be controlled. Vision loss may be minimized with early treatment.

Glaucoma causes damage to the optic nerve, which is the “cable” that carries messages from our eye to the brain, allowing us to see. In general, elevated eye pressure (either by overproduction of fluid within the eye or a decreased ability of the eye to drain out of the eye) causes damage to the optic nerve. This damage is gradual, and there are usually no warning signs. Unlike other eye problems, there is no pain, redness or change in vision until late in the disease. Because of this, many patients are not aware that they have glaucoma until the disease becomes very advanced and vision is permanently lost.

The good news is that your eye doctors at the Kleiman Evangelista Eye Center can help diagnose and detect glaucoma at an early stage, before any vision is lost. Regular checkups in adults over the age of 35 can pick up the earliest signs of glaucoma, and with proper treatment, can keep the disease from progressing. Certain people (patients with a family history of glaucoma, older individuals, African-Americans, patients with diabetes and people taking steroid medications) are more at risk than others, so regular examinations with an eye doctor are even more important.

Keep in mind that everyone should be checked for glaucoma at around age 35 and again at age 40. Those considered to be at a higher risk, including those over the age of 60 should have their eye pressure checked every year or two.

Symptoms of Glaucoma

• In the early stages, there are no symptoms. There is no pain or outward sign of trouble.
• Mild aching in the eyes
• Gradual loss of peripheral vision (the top, sides and bottom areas of vision)
• Seeing halos around lights
• Reduced visual acuity (especially at night, that is not correctable with glasses)

Are You at Risk?
Glaucoma can occur in people of all races at any age. However, the likelihood of developing glaucoma increases if you are African American, a diabetic, have a relative that has been diagnosed with glaucoma, very nearsighted, or over 35 years of age.

Diagnosing Glaucoma
To diagnose glaucoma, the doctors at the Kleiman Evangelista Eye Center will use tonometry to check your eye pressure. After applying numbing drops, the tonometer is gently pressed against the eye and its resistance is measured and recorded.

An ophthalmoscope can be used to examine the shape and color of your optic nerve. The ophthalmoscope magnifies and lights up the inside of the eye. If the optic nerve appears to be cupped or is not a healthy pink color, additional tests will be run.

Perimetry is a test that maps the field of vision. Looking straight ahead into a white, bowl-shaped area, you’ll indicate when you’re able to detect lights as they are brought into your field of vision. This map allows your doctor to see any pattern of visual changes caused by the early stages of glaucoma.

Gonioscopy is used to check whether the angle where the iris meets the cornea is open or closed. This helps your doctor determine if they are dealing with open-angle glaucoma or narrow-angle glaucoma.

Nerve fiber layer analysis is a new tool to help evaluate the nerve fiber layer, which can become damaged from glaucoma. It can allow your doctor to provide early detection of glaucoma and close monitoring of the condition during follow-up visits.

Treating Glaucoma
In the past, there were few treatments for glaucoma, and often the side effects were even worse than the disease. Fortunately, at the Kleiman Evangelista Eye Center we now have many new treatment options. There are several new medications (drops and pills) that can be used or taken several times a day with minimal side effects. And, new studies have shown that laser treatment of glaucoma may be as good or better than initial treatment with medications.

Medicines for glaucoma slow the production of fluid within the eye by improving the flow through the drainage meshwork. Keep in mind, these medicines should never be stopped without consulting your doctor, and you should notify all of your other doctors about the medications you are taking.

Surgeries that treat the drainage canal include both Argon Laser Trabeculoplasty and Selective Laser Trabeculoplasty surgery. Both procedures require only a few numbing drops before applying a laser beam to the trabecular meshwork. This results in an improved rate of drainage. When laser surgery is successful, it may reduce the need for daily medications.

Another laser procedure, Endoscopic CycloPhotocoagulation (ECP) is used to treat the ciliary body, reducing the amount of fluid production and intraocular pressure. ECP is most often performed along with cataract surgery, but can also be performed on an outpatient basis. The majority of patients having ECP reduce or eliminate their need to take glaucoma medications.