Glaucoma

With over 65 million affected, glaucoma is one of the most common causes of blindness in the world. At Advanced Valley Eye Associates, we stress the importance of preventative eye care, for early diagnosis of eye diseases like glaucoma, and before they cause irreversible damage.

Knowledge is power, so let’s define glaucoma and discuss how you can avoid glaucoma-related vision loss. What is Glaucoma? Glaucoma refers to a group of eye diseases that cause optic nerve damage. It is often referred to as the “sneak thief of sight” because it can cause vision loss with no other symptoms. Many people who have glaucoma are completely unaware that they have it. The exact cause of glaucoma is not well known, although elevated eye pressure is known to be a factor.

Inside of your eye, fluid is constantly circulating in and out to keep the eye healthy and nourished. When this fluid is not able to drain properly, pressure builds inside of the eye. As pressure builds, damage is caused to the optic nerve. This damage is irreversible, and over time, glaucoma can cause blindness.

Types of Glaucoma

Primary open-angle glaucoma: This is the most common type.
Open-angle glaucoma occurs when the fluid that circulates in the front of the eye through drainage channels is unable to drain properly. This is usually caused by a slow clogging on the drainage canals, which are located at the top and bottom of the cornea. This type of glaucoma is the most common, accounting for about 90% of all glaucoma cases. This type progresses slowly over time.

Acute angle-closure glaucoma: Much more rare.
Angle closure attack is much more urgent than primary open-angle, but is less common. This condition is caused by a sudden blockage of the drainage canals. This causes a quick rise in intraocular pressure and demands immediate medical attention. Unlike primary open-angle, angle-closure glaucoma has noticeable and painful symptoms. Damage can occur very quickly with angle-closure glaucoma.

Mixed and unusual forms of glaucoma: A potpourri of individual types.
There are many other examples of a large group of “The Glaucoma Syndromes” associated with extra pigmentation in the eye, certain materials being produced in the eye and blocking the drainage canals, chronic steroid use, other medications, previous eye trauma. /scarring, and genetic malformations. Still, by being named “glaucoma” they still lead to damage to the optic nerve due to high pressure in the eye.

Glaucoma Symptoms & Risk Factors

As mentioned above, most cases of glaucoma do not present any symptoms. Many people do not realize that something is wrong until they start experiencing vision loss. At that point, it is too late to restore any lost vision. This can be avoided with regular eye examinations, early diagnosis and prompt treatment.

In the case of angle-closure glaucoma, symptoms occur rapidly. These symptoms include:

• Headaches and eye pain
• Halos around lights
• Dilated pupils
• Vision loss
• Red eyes
• Nausea
• Vomiting

Anyone can get glaucoma. However, your chances of developing it increase if you:

• Are of African-American or Hispanic descent
• Have diabetes
• Have high blood pressure
• Have heart disease
• Have had physical injuries to the eye, such as being hit in the eye
• Are over the age of 60
• Have a family history of glaucoma
• Use corticosteroid medication

Glaucoma Treatments

Almost all glaucoma treatments are aimed at lowering and controlling intraocular pressure. Glaucoma is treated if your doctor and you decide that the risks of treatment are outweighed by the benefit of preventing permanent visual loss! Your doctor at Advanced Valley Eye Associates with work with you to decide when, and how, to treat glaucoma by lowering the pressure in your eyes. Treatment to lower the eye pressure can be done with medications, laser, or actual surgery.

Often, lowering high pressure may be as simple as a laser procedure performed in the office (SLT, or Selective Laser Trabeculoplasty), or involve using eyedrops at home a number of times daily. Your treatment will depend on the type and severity of your glaucoma, as well as how eyes respond.

Selective Laser Trabeculoplasty (SLT)

In this treatment for open angle glaucoma, laser energy is delivered to the drainage system of the eye, the trabecular meshwork. This treatment is extremely safe and is well-tolerated by patients. The SLT technique is very gentle, and studies show that it does not damage the tissue of the drainage system. The SLT procedure takes only minutes to apply, and there is usually no discomfort felt by the patient. Following the laser treatment, one usually continues any existing glaucoma eye drops. After several weeks one returns to measure the intraocular pressure and to assess the success of the procedure.

Microincisional Glaucoma Surgery (MIGS)

If you require more definitive pressure lowering, various surgical techniques exist. Some of these are performed during cataract surgery, if this is already scheduled. These are known as the Micro-incisional techniques (MIGS, or Micro Incisional Glaucoma Surgery), and often add no more than an extra 4-5 minutes during your cataract surgery!

Minimally invasive or microincisional glaucoma surgery (MIGS) is a treatment option for patients who have a glaucoma diagnosis and are undergoing cataract surgery. This is a procedure performed in the operating room, on the same session as cataract surgery. After the cataract has been removed and the intraocular lens implant of your choice has been placed, the surgeon can insert an addition microscopic device into the eye to help with lowering eye pressure. Several devices are presently FDA-approved in the US, including the iStent and CyPASS.

More advanced and technically challenging glaucoma surgeries can be performed, with some utilizing long term bypass shunts. Usually, these are performed by a fellowship-trained glaucoma specialist.

If you have been diagnosed with glaucoma or you are due for your next eye examination, please contact Advanced Valley Eye Associates at our Davis office!