Glaucoma

What is glaucoma?

Glaucoma is a disease where fluid in the eye builds up and creates high pressure, leading to damage of the optic nerve. It is the leading cause of blindness in patients over 60 years old. Thankfully, with appropriate medical and sometimes surgical management, glaucoma can be prevented and treated successfully.

What causes glaucoma?

The eye constantly makes fluid called aqueous humor. As new fluid is created, old fluid leaves through a drainage angle. If this drainage process malfunctions, pressure within the eye builds and ultimately damages the optic nerve. As nerve fibers die, dark spots occur in the field of vision. Once all the fibers die, blindness ensues. This drainage problem can happen slowly over time (painless) or quickly all at once (very painful). Watch this helpful video.

What are typical symptoms of glaucoma? 

Since the drainage problem can sometimes happen slowly over time, glaucoma is often painless. Most people don’t notice any change in their vision until the damage to the optic nerve is significant. Regular eye exams increase the chance of early detection and prevention of vision loss. Painful glaucoma (acute angle closure glaucoma) can happen suddenly and cause severe pain, redness, decreased vision, nausea or vomiting. 

Who is at risk for glaucoma?

Risk factors include: 

• Age over 40
• Genetics
• Prior eye injury
• Steroid-containing medications
• Thin corneas or thin optic nerves
• Diabetes, high blood pressure and other chronic medical problems

How is glaucoma diagnosed?

An ophthalmologist can diagnose glaucoma on a comprehensive eye exam with the pupils widened (dilated). The doctor will check your eye pressure, examine the drainage angle, check the optic nerve, test your vision and measure the thickness of your cornea. 

Are there medications for glaucoma?

Usually, glaucoma can be effectively managed with medications that either reduce the production of fluid in the eye or improve the drainage of fluid from the eye. 

All medications have some potential side effects. Be sure to discuss all your medications with your ophthalmologist and your primary care doctor to minimize the risk of side effects. 

Can glaucoma be treated with surgery?

There are 2 types of surgery to help improve drainage of fluid from the eye: laser assisted procedures and more traditional operations. 

Laser-Assisted
The surgeon uses a laser to create tiny holes and improve drainage at the drainage angle (trabeculoplasty) or through the iris (iridotomy) 

Operating Room

Trabeculotomy is when the surgeon creates a small flap in the sclera and fluid can drain out of the flap and into the tissue surrounding the eye, thereby lowering eye pressure. 

Glaucoma drainage devices can be implanted in the eye to help drain fluid into a reservoir beneath the conjunctiva of the eye, where it can then be absorbed by nearby blood vessels.

Cataract surgery can also be helpful in reducing eye pressure since the old cloudy lens sometimes blocks the drainage angles.