GLAUCOMA

A clear fluid called aqueous humor circulates inside 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 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.

Chronic Open-Angle Glaucoma: 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 porous over time, and pressure within the eye gradually increases, which can damage the optic nerve.  In some patients, the optic nerve becomes sensitive even to normal eye pressure and may become damaged.  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 appear in the field of vision. You typically won’t notice these blank spots in your day-to-day activities until the optic nerve is significantly damaged and these spots become large.

Closed-Angle Glaucoma: Some eyes are formed with the iris (the colored part of the eye) too close to the drainage angle. In these eyes, the iris can be sucked into the drainage angle and block it completely. Since the fluid cannot escape the eye, pressure inside the eye quickly rises causing acute angle closure glaucoma. This is an emergency situation in which the high intraocular pressure can cause permanent loss of vision in a matter of hours. Patients with acute angle closure glaucoma can have severe headaches, eye pain, nausea and vomiting.  Patients at risk for narrow angle glaucoma are usually far-sighted and have eyes that are shorter than normal. Early signs of intermittent angle closure include episodes of blurred vision, an ache over the brow region, headaches, and rainbow-colored halos around lights.  Unfortunately, two-thirds of those with closed-angle glaucoma develop it slowly without any symptoms prior to an attack.

Your ophthalmologist considers many kinds of information to determine your risk for developing the disease.

The most important risk factors include:

• Age
• Elevated eye pressure
• Family history of glaucoma
• African or Spanish-American ancestry
• Far-sightedness or near-sightedness
• Past eye injuries
• Thinner central corneal thickness
• Systemic health problems, including diabetes, migraine headaches, and poor circulation.

Your ophthalmologist will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a glaucoma suspect. This means your risk of developing glaucoma is higher than normal, and you need to have regular examinations to detect the early signs of damage to the optic nerve.

Unfortunately you can’t!  Most people have no symptoms when glaucoma is in its early stages. The only way to find out if you have glaucoma is to have a regular eye examination.

If you wait until your vision is impaired, glaucoma may already be quite advanced. As the optic nerve becomes more damaged, blank spots begin to appear in your field of vision. You typically won’t notice these blank spots in your day-to-day activities until the optic nerve is significantly damaged and these spots become large. Blindness results if the blank spots become large enough. With early detection and appropriate treatment, your vision can be preserved.

Regular eye examinations are the best way to detect glaucoma. A glaucoma screening that checks only the pressure of the eye may miss certain types of glaucoma. The only sure way to detect glaucoma is to have a complete eye examination.

During your evaluation, your doctor will:

• Measure your intraocular pressure (tonometry);
• Measure the thickness of your cornea (corneal pachymetry);
• Inspect the drainage angle of your eye (gonioscopy);
• Evaluate whether or not there is any optic nerve damage (ophthalmoscopy);
• Test the peripheral vision of each eye (visual field testing, or perimetry).
• Photography of the optic nerve or other computerized imaging may be recommended. 

Some of these tests may not be necessary for everyone. These tests may need to be repeated on a regular basis to monitor any changes in your condition.

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Vision loss from glaucoma is permanent but can usually be prevented with early detection and treatment.  Early detection is vital to stopping the progress of the disease. Once glaucoma has been identified, treatment will need to be instituted. Glaucoma management is usually a lifelong process that requires frequent monitoring and constant treatment. The appropriate treatment depends upon the type and stage of glaucoma. Although there is generally no cure per se for open-angle glaucoma, medication or surgery can slow or prevent further vision loss. Treatment for glaucoma generally involves various methods of lowering the eye pressure. This can be achieved through either medications, lasers, or surgery, depending upon how much pressure lowering is needed. Typically, medications are tried first. If there are side effects from the medications or sufficient pressure lowering is not achieved then laser treatment can be added. Surgery is generally reserved for cases in which the combination of medications and laser treatment do not sufficiently lower the pressure to a safe level, or are not well tolerated.

Glaucoma is usually controlled with the daily use of eye drops. These medications lower eye pressure, either by decreasing the amount of aqueous fluid produced within the eye or by improving its outflow through the drainage angle.

Never change or stop taking your medications without consulting your doctor.  Always use your drops when you are coming in for an appointment with your doctor.  If you are about to run out of your medication, ask your doctor if you should have your prescription refilled.  Glaucoma medications can preserve your vision, but they also may produce side effects. You should notify your doctor if you think you might be experiencing side effects.

SIDE-EFFECTS OF EYE DROPS MAY INCLUDE:

• A stinging or itching sensation
• Red eyes or redness of the skin surrounding the eyes
• Changes in pulse and heartbeat
• Changes in energy level
• Changes in breathing (especially with asthma or emphysema)
• Dry mouth
• Changes in sense of taste
• Headaches
• Blurred vision
• Change in eye color

Helm Vision Group is one of the few practices to offer Selective Laser Trabeculoplasty (SLT). SLT is one of the most significant advancements in the treatment of glaucoma. SLT is an extremely safe and effective laser treatment which can help a patient control their glaucoma without the use of eye drops, in many cases. In fact, 80% of patients experience meaningful pressure reduction in only a single treatment. Eye pressure may drop as quickly as a day after the procedure, or may take several weeks to show an effect.

Clinical studies have shown that SLT is very safe, and reduces or eliminates redness and irritation that often occurs with drops. Selective

A virtually painless procedure, SLT stimulates the body’s natural mechanisms to enhance outflow of the fluid in your eye. SLT selectively targets only specific cells leaving surrounding tissue intact. Macrophage cells are activated by the laser and stimulated to remove debris which can clog the meshwork through which fluid escape the eye.

80% of patients experience meaningful pressure reduction with only a single treatment.

When planning for a surgery it is important that you have a thorough understanding of the risks, benefits, and alternatives of the procedure. Dr. Helm may determine that a trabeculectomy is required for treatment of your glaucoma. The benefit of the surgery is to lower the eye pressure, and reduce the risk of glaucoma damage occurring to the optic nerve. The main alternative to trabeculectomy is continued eye drops, accepting the possibility that with a higher pressure there is a risk for continuing glaucoma damage. A trabeculectomy is a safe and effective surgery, with a low risk of severe complications.

Laser Peripheral Iridotomy is used for the treatment of narrow-angle glaucoma or mixed mechanism glaucoma in which a patient has elements of both open and narrow-angle glaucoma. The laser is used to place a small hole in the iris (colored part of eye), which prevents future acute angle closure glaucoma (sudden onset of high pressure in the eye), or decreases risk of further blockage of the drainage area of the eye.

This procedure includes a surgery to implant a small tube to allow fluid to drain from the inside of the eye to a small plastic plate behind the eye. A Baerveldt glaucoma implant or Ahmed glaucoma implant are the most common types. A drainage device is created to lower eye pressure to prevent vision loss from glaucoma, however, this surgery will not improve vision. Results are overall positive with patients who receive a glaucoma drainage device. In fact, 90% have good pressure control after one year and only 10% may require further surgeries in the first year.

Since there is no way to determine if glaucoma is under control based on how a person feels, it is critical that you continue to use your eye drops daily and that your ophthalmologist perform regular examinations.

Most types of glaucoma cannot be prevented.