Glaucoma – Explained:
Glaucoma is optic nerve damage and loss of visual field. With the older population, glaucoma is seen as one of the primary causes of severe eye issues. Many experts believe that glaucoma results from elevated eye pressure and/or decreased blood supply to the eye tissues. The pressure in the eye is determined by the balance of some type of liquid, entering the eye and leaving the eye through the normal drainage channels (called the trabecular meshwork).
What Are The Causes Of Glaucoma?
You can think of a stream of watery liquid. When the eye is healthy, the fluid flows without obstruction or “clogging”. However, when this flow from the eye’s liquid has issues, it might cause some risks to your optic nerve.
How Can Someone Detect You Have Glaucoma?
Ask your ophthalmologist or optometrist. Typical tests include measurement of intraocular pressure (also called Tonometry), inspection of the drainage angle within the eye (gonioscopy), optic nerve evaluations (ophthalmoscopy), and visual field test (perimetry).
Many times your doctor may note a compression of the nerve fibers and blood vessels in the optic nerve. This condition is called “cupping”. This cupping can be identified through diagnostic tests that allow your doctor to look at the condition of the optic nerve. The optic nerve in patients with glaucoma is paler and more indented. As glaucoma progresses, the optic nerve will appear more pale and indented.
Who Is At Risk? What Are The Risk Factors?
Glaucoma can occur in people of all ages. However, primary open-angle glaucoma generally occurs in people over the age of 40 and the likelihood of developing the disease increases with age. Approximately two-thirds of Americans with glaucoma are over the age of 65.
Ultimately, the ophthalmologist will treat each case individually and weigh risk factors accordingly. Only the ophthalmologist is qualified to decide how to proceed. If your doctor believes you are at high risk due to certain issues, I highly suggest you take further procedures.
The Variations of Glaucoma
Open-Angle Glaucoma: The usual glaucoma is called Chronic Open Angle Glaucoma. It affects over 90% of adult glaucoma patients. Aging population usually has it. The drainage angle of the eye, as other sources say it, will slowly lose functionality and the pressure in the eye slowly increases.
Angle-Closure Glaucoma: In contrast to open angle glaucoma, where the increase in pressure progressed slowly, angle-closure glaucoma is caused by blockage of the drainage angle by the iris. The rise in pressure occurs much more rapidly. The sudden pressure can cause extreme pain, resulting in motion sickness or even worse. The intraocular pressure in these cases can be four to five times normal pressure.
Neovascular Glaucoma: Is a rare but critical form of glaucoma. The condition results in a rapid increase in pressure to abnormally high levels as a result of inflammation and abnormal blood vessels infiltrating the drainage system. This is most often related to systemic disease such as advanced diabetes.
How Can We Treat Glaucoma?
Once the optic nerve is damaged, it cannot be repaired. Vision loss due to optic nerve damage usually is simply permanent. However, there is some good news. If diagnosed and treated early visual loss is almost always prevented. Following the instructions and treatments outlined by your doctor is critical to controlling the devastating effects of glaucoma.
Treatment of Open-Angle Glaucoma
Medical Therapy => Laser Therapy => Surgical
Treatment of Angle-Closure Glaucoma Laser Therapy
Laser Therapy => Surgical Therapy
Treatment of Angle-Closure Glaucoma
Surgical Therapy + Medical Therapy
Medical therapy for glaucoma lowers the pressure inside the eye by either decreasing the amount of aqueous produced by the eye or by positively affecting the function of the drainage angle of the eye. Medications for glaucoma come in many forms: eye drops, pills and ointments. All medications may have slight to moderate side effects.
Laser therapy may be effective when other therapies fail to halt the effects of glaucoma. In Open-Angle Glaucoma, a laser is used to enlarge the drainage angle of the eye to facilitate aqueous flow. This is typically called a trabeculoplasty. In Angle-Closure Glaucoma, the treatment will cause a spot in the tissue layer forcing away the blockage preventing fluid flow. This is called an iridotomy.
If medical and laser therapy fail, or if your physician deems surgery as the best initial therapy, the surgeon will perform surgery to control pressure and optic nerve damage. These procedures are typically called filtering surgeries. The surgeon creates a hole in the drainage angle to allow aqueous flow. A very small blister, or bleb, forms under the outside lining of the eye as the fluid drains through the hole. This can potentially relieve the intraocular pressure and provide the necessary blood flow to the optic nerve.
In cases of neovascular glaucoma, or when traditional therapy is deemed to fail, a surgeon may recommend the use of a glaucoma drainage shunt or implant. The implant is sutured inside the at the periphery of the iris; the tube is inserted into the area housing the aqueous. This area is called the anterior chamber.
The function of the implant is to deliver the aqueous fluid through the tube to the area of the plate. When the plate fills with the fluid a bleb or small blister forms around the plate. As with other filtering surgeries, this can potentially relieve the pressure and provide more stability to your eye.
As with all conditions and surgeries, your physician is your best form of information. Compliance with your physician’s instructions and therapies is crucial to treating glaucoma.