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There are different theories for the cause of glaucoma. It is important to understand that the end result for all the theories is progressive damage to the optic nerve (optic neuropathy).One such theory is based on elevated intraocular pressure. It is important to note that high intraocular pressure is not synonymous with glaucoma. There are certain types of glaucoma that have normal intraocular pressure.A clear liquid called aqueous humor circulates the front portion of the eye. To maintain a healthy level of pressure within the eye, a small amount of this fluid is produced constantly while an equal amount flows out of the eye through a microscopic drainage system. Because the eye is a closed structure, if the drainage area for the aqueous humor – called angle - is blocked, the excess fluid cannot flow out of the eye. Fluid pressure within the eye increases, pushing against the optic nerve and causing damage.
Another theory is based on compromise of the blood supply to the optic nerve resulting in progressive damage to the nerve. There may be many factors that come in to play to cause vascular compromise.
There are different types of glaucoma, but they can be broadly divided into these two groups.
This is the most common form of glaucoma in the United States. The risk of developing chronic open angle glaucoma increases with age. The drainage angle of the eye becomes less efficient over time and pressure within the eye gradually increases possibly resulting in damage to the optic nerve. In some patients, the optic nerve becomes sensitive even to normal eye pressure and is at risk for damage.Treatment is necessary to prevent further vision loss.Typically open-angle glaucoma has no symptoms in its early stages and vision remains normal. As the optic nerve becomes more damaged blank spots begin to develop in the field of vision. You typically won’t notice these blank spots in your day-to-day activity until the optic nerve is significantly damaged and the spots become large.
In certain eyes, the iris could be very close to the drainage angle. These eyes are often small and farsighted and the iris could be sucked into the drain and could block it completely. Since the fluid cannot exit the eye, pressure could build up rapidly inside the eye, resulting in acute closed-angle attack. Symptoms may include:
This is a true eye emergency and if you have any of these symptoms constantly or intermittently call your ophthalmologist immediately. If not treated quickly, this type of glaucoma can result in blindness. The majority of patients with closed-angle glaucoma develop it slowly without any symptoms prior to attack.
Your ophthalmologist considers different kinds of information to determine your risk for developing the disease. The most important risk factors include:
Your ophthalmologist will weigh all this factors before deciding whether you need treatment or be followed as a glaucoma suspect. This means your risk of developing glaucoma is higher than normal and you need to be followed closely to detect early signs of glaucoma.
Regular eye examinations by your eye doctor are the best ways to detect glaucoma. A glaucoma screening that only checks pressure is insufficient to determine if you have glaucoma. The only way to detect this is with a complete eye exam.During your glaucoma evaluation, your ophthalmologist will measure your intraocular pressure (tonometry); inspect the drainage of your eye (gonioscopy); evaluate for the presence of optic nerve damage (ophthalmoscopy); and test the field of vision of each eye (visual field testing of perimetry).Photography of the optic nerve or computerized imaging may be recommended. These tests may need to be repeated on a regular basis to monitor any changes in your condition.
As a rule, damage caused by glaucoma cannot be reversed. Eye drops, laser surgery and surgery are used to help prevent further damage. In some cases, oral medications may also be prescribed. With any type of glaucoma, periodic examinations are important to prevent vision loss. Glaucoma can progress without your knowledge; hence, the need for routine follow-up to watch for disease progression and adjustment of therapy as needed from time to time.
Glaucoma is usually controlled with eye drops taken daily. These medications lower eye pressure by reducing aqueous production or increasing outflow through the drainage angle or other tissue.Never change or stop taking your medication without consulting your ophthalmologist. If you are about to run out of your medication, call your ophthalmologist to have you medication refilled.
Glaucoma medications can preserve your vision, but may also produce side-effects. You must notify your ophthalmologist if you think you may be experiencing side-effects.Some eye drops may cause:
All medications can have side-effects or can interact with other medications. Therefore, it is important that you make a list of the medication you regularly take and share this list with each doctor you see.
Surgery in the operating room
Treatment for glaucoma requires teamwork between you and your doctor. Your ophthalmologist can prescribe treatment, but only you can make sure you follow your doctor’s instructions and take your eye drops.Once you are taking medication for glaucoma your ophthalmologist will want to see you more frequently. Typically you will need to follow up every three to four months, but this will vary depending on your treatment needs.
Regular medical eye exams may help prevent unnecessary vision loss. People with risk factors (listed above) have a higher risk for developing glaucoma and require more frequent screening examinations.Recommended intervals for eye exams are:
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