Glaucoma

Simply, glaucoma is elevated intraocular pressure of the eye.  Every eye has fluid, called aqueous humor, that is constantly being produce as well as constantly being drained.  In a glaucomatous eye, this fluid does not drain properly resulting in an increase in the pressure inside the eye.  This increased pressure destroys vision gradually, usually starting with the peripheral (side) vision, and if left untreated, will lead to eventual blindness by destroying the optic nerve.  With early diagnosis and treatment, useful vision may be preserved.

There are four types of glaucoma:

• Chronic.  This is the most common type of glaucoma, and occurs slowly over time.  There is no pain, redness or swelling or other symptoms.

• Acute.  This happens suddenly and is very painful.  Victims of an acute glaucoma attack may complain of serious headache and vomiting.  Medical intervention is needed immediately to bring the pressure under control to prevent further vision loss.

• Congenital.  Present at birth, congenital glaucoma is a rather rare condition.

• Secondary.  Occurring as a result of a systemic disease such as diabetes, from medications such as steroids, or from an eye injury.

The following factors increase your risk of developing glaucoma:

• Age (at least 45 years old without regular eye examinations)

• Family history of glaucoma

• African American or Asian descent

• Diabetes

• Nearsightedness

• Steroid use

• Past eye injury

Your doctor will check for the presence of glaucoma during a routine eye examination.  The test is essentially pain-free, and takes only seconds.

Treatment

Glaucoma is treated with both eye drops and occasionally with pills. These medications decrease the eye pressure and help to prevent damage to vision. 

Laser surgery can also be effective in the treatment of glaucoma. In Primary Open Angle Glaucoma the drain pipes are treated with the laser to improve the drainage of the aqueous fluid and lower the eye pressure. In Primary Closed Angle Glaucoma, laser treatment creates an opening in the iris which improves the flow of aqueous fluid to the area of drainage. Operating room microsurgery (or incisional scalpel surgery) is another treatment option for glaucoma. Also called filtering surgery, this creates a new drainage channel for the aqueous fluid. The fluid then drains into a reservoir (called a bleb) which is created in the tissues on the surface of the eyeball. This helps to lower the eye pressure.

An exciting new procedure is now available at Island Eye which uses a special laser to treat the tissues that produce the aqueous. This is a new approach to glaucoma treatment, and may eliminate or significantly reduce the need for eye drops or other more invasive surgical procedures.