What is Glaucoma?
Glaucoma is a group of eye conditions that damage the optic nerves, usually caused by abnormally high eye pressure. Because this nerve connects the eyes to the brain, it is crucial for healthy and clear vision, and damage to this nerve results in vision loss or disturbances. Glaucoma is one of the leading causes of blindness for those over the age of 60, though it can occur at any age.
Glaucoma typically happens when there is an abnormality in the eye’s drainage system, called the drainage angle. If this channel is blocked or stops working, then fluid in the eye, called aqueous humor, will begin to build up. This may be caused by factors in the individual’s eye such as decreased corneal thickness or if someone’s iris is too close to their drainage angle. These factors can end up blocking the drainage angle, making it unable to drain fluids from the eye causing a buildup. Other factors may be if the drainage angle itself becomes insufficient, and suddenly stops draining the eye fluid allowing it to build, or is producing too much fluid for the eye to handle. This is usually the case with forms of glaucoma that show up in infants and children, as their drainage canals may be underdeveloped or have formed incorrectly.
This buildup of fluid leads to excessive eye pressure, which causes severe damage to the optic nerves. Because these nerve fibers connect the retina with the brain, deterioration of this nerve also means deterioration of your vision. Glaucoma usually affects both eyes, but it can be worse in one eye, and it is important to note you can still get glaucoma and have vision loss, even with normal eye pressure, if the optic nerves have been damaged. This is why it is important to maintain regular eye exams, especially past the age of 40.
What are the Symptoms of Glaucoma?
Symptoms of glaucoma vary depending on the type of glaucoma and severity or stage of the condition. The most common form is open-angle glaucoma. Though many experience no symptoms other than slow vision loss, other symptoms can occur including:
- Patchy/blind spots in the peripheral or central vision (often in both eyes)
- Tunnel vision
Other forms of glaucoma include acute-angle closure glaucoma. Although rare, these symptoms tend to be more severe including:
- Severe headache
- Eye pain
- Nausea and vomiting
- Blurred vision
- Halos around lights
- Eye redness
- Sudden visual disturbances
If you are experiencing symptoms of acute-angle closure glaucoma, such as severe headaches, eye pain, and blurred vision, promptly see a doctor or go to urgent care, as acute-angle closure glaucoma is a medical emergency. It is also important to note that with any form of glaucoma, if left untreated, it will eventually lead to blindness.
What are the Causes of Glaucoma?
Glaucoma can be caused for a number of reasons. Most often, it is caused by heredity, and is a gene that can be passed down, or may be a result of other hereditary disorders or underlying medical conditions. Diabetes and high blood pressure, when poorly controlled, leads to damage of the blood vessels in the body and is a common cause of glaucoma, a form called Neovascular glaucoma. Autoimmune and inflammatory disorders may also affect your eye health and pressure or cause damage to your optic nerves and are another common cause of glaucoma, a form known as Uveitic glaucoma. It is important to know your family’s health history, as children and siblings of those with glaucoma or typically the most at risk.
Glaucoma can also be caused by lifestyle. A form called Pigmentary glaucoma can develop as a result of activities such as jogging and other forms of exercise. These activities can stir up small pigment granules, which flake off from your iris, and cause a deposit of granules on the tissue located where the drainage angle is. This leads to a blockage that stops or slows fluid drainage in the eye. Other lifestyle causes may be a result of serious injury from sports or power tools, and it is crucial that you wear eye protection if you are to do so. Less-common causes of glaucoma include chemical or blunt injuries to the eyes, severe eye infections, blocked blood vessels inside the eyes, and other underlying conditions. Eye surgeries to correct another condition can sometimes bring it on as well, though this is rare.
How Will You Know if You Have it? What are the treatment options?
Most forms of glaucoma, including the most common form of open angle glaucoma, have no warning signs or noticeable symptoms in its earlier stages (even blind spots in vision are often not noticeable) and are typically painless. This makes glaucoma very hard to detect without a diagnosis, and many do not know they have it until the damage is quite severe, or they have any attack. Damage to the optic nerves is irreversible, and vision loss from Glaucoma may progress fast and can cause permanent blindness in just a few years, if left untreated. This is why glaucoma is often called the “silent thief of sight”, and is the leading cause of blindness for people over 60 (Though it may occur at any age!)
Though symptoms may be hard to detect, it is helpful to be aware of risk factors for glaucoma:
- Are over age 40
- Have family members with glaucoma
- Are of African, Hispanic, or Asian heritage
- Have high eye pressure
- Are farsighted or nearsighted
- Have had an eye injury
- Use long-term steroid medications
- Take certain drugs for bladder control or seizures, or some over-the-counter cold remedies
- Have sickle cell anemia or other autoimmune or inflammatory diseases
- Have diabetes, migraines, high blood pressure, or poor blood circulation or other health problems affecting the whole body
Fortunately, glaucoma can be maintained and vision loss, or further vision loss and blindness, can be prevented. In fact, most people who follow their treatment plan and maintain regular eye exams are able to keep their vision. However, it is important to remember that if you have any underlying medical conditions at play such as diabetes, you must be following that treatment plan as well.
Regular eye exams are the easiest and most effective way to detect glaucoma and prevent any vision loss or eye damage from happening. Even if you are not experiencing any symptoms, your doctor can check for factors such; eye pressure, inspection of optic nerve health and drainage angle, any fatty deposits or tissue, and corneal thickness. They may also check your peripheral vision for any change. If you are possibly at risk, they will be able to let you know how often you should be examined.
If diagnosed, there are surgeries and medications that can prevent or stop further damage. Glaucoma is usually controlled by prescription eye drops. If used every day, these eye drops are able to lower eye pressure by either reducing the amount of aqueous fluid the eye makes, or by helping fluid flow better through the drainage angle. Keep in mind that all medications have side effects and it may affect you differently than others, or can cause problems when taken with other medications. It is important to give your doctor a list of every medicine you take regularly and never change or stop taking your glaucoma medications without talking to your ophthalmologist first.
Surgeries for glaucoma include two types of laser surgery to help drain aqueous from the eye. Trabeculoplasty is the surgery for people who have open-angle glaucoma and can be used instead of, or in addition to medications. The eye surgeon uses a laser to make the drainage angle work better. The other laser surgery that can be done is Iridotomy. This is for people who have angle-closure glaucoma, and the ophthalmologist will use a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.