Glaucoma

Glaucoma is damage to the optic nerve as a result of the eye’s internal pressure being too high. It is called the “sneak thief of sight” because in almost all cases the person cannot feel this higher pressure and therefore does not know the damage is occurring. First the peripheral or side vision is affected, and if not detected early enough the central vision can also be lost. It is important to realize that whenever damage results from glaucoma, is permanent. This it is critical to catch any signs of glaucoma at the earliest stages, and that is why regular eye exams are so important.

How does Glaucoma occur?

There are different types of glaucoma, as discussed below. In general, glaucoma occurs when the internal eye fluid cannot drain out as fast as it is being produced. The internal eye pressure (called the intraocular pressure) builds up, and this pressure damages the optic nerve in the back of the eye. Some types of glaucoma may also be partly due to inadequate circulation of blood to the optic nerve, which can make it more prone to pressure damage.

Types of Glaucoma

• Open Angle – the most common type. It occurs when the drainage canals inside the eye become clogged with pigment waste products that form like a sediment. It is more common in African-American, Hispanics, corticosteroid users, older ages, and people with high blood pressure or diabetes, and those with a family history of glaucoma.
• Angle Closure (or Narrow Angle) – this occurs when the iris (the colored part of the eye) physically blocks the drainage channels inside the eye. Because the blockage can occur suddenly, the intraocular pressure can rise rapidly, resulting in intense eye pain, blurry vision, halos, nausea, vomiting, and rapid vision loss. This condition is a true emergency and requires immediate treatment to prevent permanent vision loss. It is more common in Asian-Americans, women, farsighted (hyperopic) people, and older ages.
• Secondary – this type refers to the blockage of the internal drainage channels by something else, such as trauma to the eye, blood in the eye, infection, inflammation inside of the eye, or other causes. The symptoms may be like either Open Angle or Angle Closure Glaucoma.
• Pediatric – children can be born with elevated intraocular pressure, which can cause corneal problems and blindness. It is usually genetic. The diagnosis will usually be made by a pediatric ophthalmologist shortly after birth or during infancy.
• Normal or Low Tension – sometimes people get glaucoma with intraocular pressure in the low or normal range. In these cases, the culprit is most likely poor blood flow to the optic nerve. However, since there is no method available presently to increase blood flow to the nerve, the only available treatment is the same as with all other types of glaucoma, namely, to lower the eye pressure further. We see this type of glaucoma in Japanese people, those with a history of cardiovascular disease, and those with a family history of glaucoma.

Glaucoma Treatment

There are generally three main ways to treat glaucoma: medication, laser, and surgery.

• Medication – this can be either via eye drops or sometimes oral medication.
• Laser – Open Angle Glaucoma types can be treated by using a laser (“SLT” or “ALT”) to stretch the drainage channels inside the eye to help improve the fluid outflow and thereby decrease the intraocular pressure. Angle Closure Glaucoma is treated with a YAG laser to make a small opening in the iris (“peripheral iridotomy”), which allows the angle to open and thus the eye fluid can drain, and the intraocular pressure will fall.
• Surgery – there are several types of surgical procedures to treat advanced cases of glaucoma, and they involve creating a new drainage area inside the eye to allow the eye fluid to escape. Some procedures involve the use of a small plastic or metallic drainage shunt. Depending on the specific situation, the ophthalmologist will decide what type of procedure is best.

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