Glaucoma

Glaucoma

Glaucoma is a group of conditions characterized by excessive pressure in the eyes, which can result in pain, distorted vision, and vision loss, up to and including blindness. There are several different types of glaucoma, and various causes and treatment options. Approximately 8 million people around the world have vision loss due to Glaucoma, it can affect anyone at any age, and any damage done is irreversible, so it's important to be screened regularly regardless of your age. 

Understanding this condition and your risk factors can help you avoid developing the disease and being aware of the treatment options is important for proper management of your condition if you’ve already been diagnosed with Glaucoma.

Understanding Glaucoma

You may or may not be familiar with the inner workings of your eyes, but awareness is helpful to understanding the dangers of glaucoma. Inside the eye is a fluid called aqueous humor. This fluid needs to be able to flow into the eye and flow out again to maintain normal pressure. When a person has glaucoma, too much aqueous humor is trapped inside the structure of the eyeball, which can cause the pressure inside the eye to become dangerously high, this damages the optic nerve and can result in pain, vision loss and, if not treated will eventually lead to blindness. 

Types Of Glaucoma

There are two main types of glaucoma. The type you have affects your prognosis and has a large impact on the treatments that are available to you.

• Primary open-angle glaucoma - also called Wide-Angle Glaucoma, is the most common type of glaucoma. This is the type of glaucoma you may associate with the elderly. While older people have a higher risk of developing the disease, it can strike people of all ages. With wide-angle glaucoma, there are very few signs that damage is occurring until it’s too late, making early detection and treatment crucial. With this type of glaucoma, all structures of the eye appear normal, but the fluid is not draining properly and pressure is building up over time. Wide-angle glaucoma usually affects both eyes.
• Primary angle closure glaucoma - also called Narrow-Angle Glaucoma or Acute Glaucoma, happens when the area between the iris, (the coloured ring of the eye) and the cornea, (the clear, curved section on the front of the eye), is too narrow. Fluid can build up quickly with no way to escape, causing a painful eye and an emergency. If acute glaucoma isn’t diagnosed and treated within a few days of the onset, vision can be permanently lost in the eye. This type of glaucoma can strike anyone at any time, including infants and young people, so it’s important to never disregard a painful eye. If you have a painful eye and cannot be seen by your doctor, or optometrist, then go to the Accident and Emergency room.

Other types of glaucoma include Secondary Glaucoma, which is caused by an underlying eye condition, Normal Tension Glaucoma, where the eye’s pressure remains normal, and Congenital Glaucoma – this rare form of glaucoma occurs in young children and is caused by abnormalities.

Risk Factors For Developing Glaucoma

There are several risk factors that will increase your chances of developing glaucoma.

• Your Ethnic Heritage - People of Scandinavian, Asian, Irish, Japanese, Russian, Indigenous/First Nations, Hispanic and African descent have a markedly higher risk than those of other ethnicities. If you have a family history of glaucoma, your risk increases even more.
• Your Age, Weight, and Overall Health - People over 40, those who are overweight or obese, and those with diabetes and high blood pressure are all at higher risk than the younger, average-weight, generally healthy population.
• Your Natural Vision - Glaucoma is more prevalent in those with poor natural vision, especially those with severe nearsightedness. As nearsightedness, otherwise known as myopia, is common in Asians, wide-angle glaucoma afflicts more people in Asia than anywhere else in the world.
• Trauma to the Eye - If you’ve been punched in the eye, involved in a car accident or were bopped in the face by your child, narrow-angle glaucoma can manifest due to the swelling caused by the trauma. See a doctor right away if you develop eye pain after suffering trauma to the eye or your face in general.

Early Warning Signs Of Glaucoma

Wide-angle glaucoma is often referred to as a “silent thief” of vision because it often presents little to no symptoms until vision loss happens. Once this occurs, there is no way to regain the lost sight.

Glaucoma does not usually cause any symptoms to begin with it tends to develop slowly over many years and affects the edges of your vision (peripheral vision) first.

A yearly checkup with your optometrist is the best way to detect wide-angle glaucoma in its earliest stages. Careful management and vigilant follow-ups can bring the disease under control and preserve your vision.

Narrow-angle glaucoma, however, often comes on suddenly and with plenty of symptoms to warn you that something is wrong such as

• Pain in the eye
• Redness in the eye
• Blurred vision
• Seeing halos around lights
• Narrowing of your visual field
• Nausea and vomiting 

If you experience any of these symptoms, see an optometrist or ophthalmologist quickly. With only a few days to act, at best, vision could be permanently lost if you delay.

Tests To Detect Glaucoma

Glaucoma can usually be detected during a routine eye test at an optician's, often before it causes any noticeable symptoms or damage.

Tonometry - is the most common diagnostic test for glaucoma - When you last had your eyes tested you may recall gazing into a machine that blows a puff of air onto your eyes, or your eye doctor may have pressed a small tool that looked similar to a mechanical pencil against your eye, these methods are used to measures the intraocular pressure (IOP) of your eye.

A Visual check - The optometrist may dilate the pupils with special eye drops and using an instrument called an ophthalmoscope physically look into your eye. This allows your optometrist or ophthalmologist to see all of the structures inside of the eye, primarily the optic nerve, which will show signs of damage or distress if glaucoma is present. This test is also useful for finding other ocular problems and diseases, so it’s important to have it done regularly.

Your close vision may be blurry for several hours afterwards, so be prepared. 

Optical coherence tomography (OCT) - is a non-invasive and non-painful imaging test. It uses light waves to take cross-section pictures of your retina. This allows your ophthalmologist to see the retina’s distinctive layers of the retina and the optic nerve fiber layer, allowing them to map and measure the thickness and changes over time. These measurements help with the diagnosis of glaucoma and other retinal disease, such as age-related macular degeneration (AMD) and diabetic eye disease.

A visual acuity test is also helpful for detecting glaucoma, as it helps find holes in vision that may not be obvious yet. Reading from an eye chart and testing peripheral vision are both important for finding the early warning signs of several eye diseases, including glaucoma.

The Optometrist may also measure your visual fields. He will use a machine to present various targets in front of you, while you stare straight ahead, to determine if you miss any during the test. Visual fields are a very sensitive method for detecting glaucomatous loss and can detect loss in many cases before any other symptoms are present to the Optometrist.

Check here to see if you are eligible for a free NHS eye test.

Glaucoma Treatment Options

The type of treatment offered to you will vary greatly, depending on the type of glaucoma you have been diagnosed with.

Acute, Narrow-Angle Glaucoma -  Surgery is almost always a necessity. This is especially true for cases of infant and pediatric glaucoma, where the drainage system is malformed and must be corrected by way of microsurgery or laser surgery.
For adults with sudden-onset, acute glaucoma, surgery may also be necessary because a blockage has formed in the already narrow space between the iris and cornea.

Wide-Angle Glaucoma - Eye drops and laser therapy can help bring down ocular pressure and relieve the glaucoma without surgical intervention. Making lifestyle changes can also reduce the need for surgery for some patients. Your optometrist or ophthalmologist will be able to explain the options for your specific case in detail, should you have any questions.

How to Help Prevent Glaucoma

Your ethnicity, a family history of glaucoma, or severe farsightedness doesn’t necessarily mean you will certainly develop the disease. There are steps you can take to reduce your risks, and all of them are also good for other aspects of your health.

Managing weight -. Being overweight or obese increases your risk for certain cancers, heart attacks, strokes, joint problems, and a host of diseases, including glaucoma. If you are having trouble managing your weight, consider meeting with a nutritionist or dietician to retool your diet and speak to your general practitioner or trainer about weight loss through exercise. Don’t let extra pounds threaten your health.

Managing diabetes - Ignoring health problems will not make them disappear. If you are diabetic, carefully monitor and control your blood sugar levels. Not only does uncontrolled blood sugar affect circulation, liver function, and a host of other issues, it places your eyes at risk of both diabetic retinopathy and glaucoma. If you are not diabetic, talk to your doctor about steps you can take to mitigate the risk of becoming diabetic in the future.

Regular sight test - Having regular sight tests is a great way of detecting early onset glaucoma so treatment can start before much damage is done.

A Healthy Diet - A diet rich in fruit and veg rich in vitamins A, and C, and the antioxidants lutein and zeaxanthin, as according to glaucoma.org these are known to protect against oxidative stress associated with damage to the optic nerve and other tissues of the eye in glaucoma.

Regular exercise - Brisk walks and regular moderate exercise can lower eye pressure as well as improve overall health, but be cautious as intensive exercise can raise eye pressure. 

Living with Glaucoma

For those with narrow-angle glaucoma, surgery often resolves the issue entirely. While careful check-ups will be needed for life, there is usually nothing more that needs to be done once normal pressure levels have been established, other than to follow the recommendations for reducing the risk of developing wide-angle glaucoma listed above.

If you’ve been diagnosed with wide-angle glaucoma, there are steps you can take to avoid the progression of the disease. Follow your doctor’s recommendations for scheduled appointments. Take any medications prescribed to you as directed, and advise your doctor immediately if you are experiencing side effects. Finally, taking care of your overall health and managing any other diseases you have will help keep your condition from worsening.

Glaucoma is a serious group of conditions that have the potential to rob you of your sight. Understanding this disease, the risk factors, symptoms, treatments, and how to lower your risk are all integral in helping to prevent the onset of glaucoma and to increase the chances of early detection and a positive outcome.

Early detection is essential, so regular eye exams are recommended along with an awareness of anything changing with your vision. To find out more about Glaucoma check out the NHS and Glaucoma UK websites, or make an appointment to see your optometrist or ophthalmologist today.