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What is Glaucoma?
Glaucoma is a group of disorders. What they all have in common is an increase in
the pressure inside the eye. When the pressure is too high, damage occurs to the
optic nerve. The optic nerve is made up of a bundle of nerve fibers which sends
signals to the brain. Damage to the optic nerve can initially cause blind spots
at the outer edges of the field of vision called peripheral or side vision. This
is the main sign of glaucoma. As damage to the optic nerve gets worse, the
visual field can shrink leading to tunnel vision or even loss of central vision
affecting a patients ability to read. Fortunately, this occurs only in patients
with very severe disease.
Who gets Glaucoma?
Glaucoma is an important cause of blindness in the United States. At least two
million Americans have glaucoma. Almost 900,000 of these people are visually
impaired due to their glaucoma. Almost 80,000 Americans are legally blind due to
their glaucoma, with legal blindness being a visual acuity of 20/200 or worse
with correction in the better eye. It is the most frequent cause of blindness in
black Americans.
The genetic inheritance of glaucoma is still unclear. However, a family history of glaucoma has been found in up to 50% of patients with the most common type of glaucoma, known as primary open-angle glaucoma.
One type of glaucoma occurs in people who have had a history of being hit in the eye (e.g. soccer ball). Not only can they get a rise in pressure initially after the injury, but they also may develop glaucoma years later. All of these things stress the importance of regular eye exams.
How do I know if I have glaucoma?
Unfortunately glaucoma is typically associated with painless and progressive
loss of vision that may escape detection by the
patient. This once again
stresses the importance of a thorough eye history and examination, especially in
patients with a family history of glaucoma. Only one type of glaucoma called
angle-closure glaucoma is associated with a red, painful eye with blurred vision
and even possibly nausea and vomiting. This is due to very high pressures
resulting from a block in the drainage system of the eye. Most patients at risk
for this type of glaucoma have structural differences in their eye which could
be identified prior to an attack and preventative treatment could be performed.
Rarely do patients with other types of glaucoma develop pressure high enough to
have pain and redness.
How is glaucoma treated?
The primary goal of treatment is to preserve vision. The typical first line of
treatment is eye drops which lower the intraocular pressure by helping fluid
leave the eye or by reducing the amount of fluid produced in the eye. Some
patients may need to take multiple different types of eye drops or even eye
drops plus medications in pill form to effectively lower the pressure. In
addition, there are laser treatments for both angle closure and open angle
glaucoma. Laser treatment for angle closure glaucoma is usually performed to
prevent an acute attack as described above; while laser treatment for open angle
glaucoma is performed when medications are not effective enough or the patient
has difficulty taking medications. Surgery, which involves making a drainage
system for the fluid in the eye, is usually performed when medications and
lasers are ineffective.
Who diagnoses and treats glaucoma?
Eye physicians and surgeons [Ophthalmologist] are medical doctors (M.S), who have undergone specialized training in order
to treat eye diseases and to perform surgery. They are best qualified to
diagnose glaucoma. Some ophthalmologists undergo subspecialty training in
glaucoma and are the best qualified to treat advanced glaucoma.
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