Spotlight on Glaucoma: Causes, Types and Treatments

Spotlight-on-Glaucoma (1) Glaucoma effects anywhere between 2 to 3 million Americans and is the second leading cause of blindness, just behind cataracts. It’s suspected that more than 3 million Americans have glaucoma with a great number of those people going undiagnosed.

Glaucoma is a group of complex diseases, which in most cases are caused when there is an increase in liquid production. If the eye’s trabecular meshwork becomes blocked or constricted there is a backup of fluid in the eye that, over time, injures the optic nerve. The liquid buildup creates too much pressure within the eye.

There are three primary types of glaucoma: primary open-angle glaucoma, angle-closure glaucoma, and normal-tension glaucoma. Here we’ll focus just on the two most-common types of glaucoma: primary open-angle and angle-closure glaucoma.

The third, normal-tension glaucoma, is a condition where the optic nerve is damaged without any extra pressure. Those at most high-risk of this much more rare condition are those with a family history, a history of irregular heart rhythm and those of Japanese ancestry. Migraines, Raynaud’s disease and sleep apnea are some of the other risk factors to look out for.

Primary Open-Angle Glaucoma

This is most common form of glaucoma and happens when the eye’s drainage canals develop clogs over time. This type of glaucoma is the most difficult to diagnose as it develops slowly and there are rarely any early warning signs.

According to the Glaucoma Research Foundation, open-angle glaucoma can be distinguished by the following symptoms:

  • Slow clogging of the drainage canals, resulting in increased eye pressure
  • Loss of peripheral vision
  • In advanced stages, tunnel vision

Regular visits to your eye doctor can prevent long-term damage and if detected early enough the disease typically responds well to treatment.

Angle-Closure Glaucoma

A less common form of glaucoma, but still the second most common form, is angle-closure glaucoma – sometimes referred to as narrow angle or acute glaucoma. With this type of glaucoma, eye pressure typically rises very quickly and the iris is not as wide and open as it should be.

Narrow angles can go undetected just like open angle, except when there is an acute attack). If the pupil increases in size too much or too quickly, it can cause the rim of the iris to gather over the drainage canals, resulting in a radical increase in eye pressure.

Acute angle-closure glaucoma develops very quickly with symptoms and damage that are very noticeable. This type of glaucoma demands immediate attention to prevent irreversible damage to vision.

Symptoms of Acute Angle-Closure Glaucoma can include:

  • Nausea and vomiting
  • Eye pain
  • Abrupt onset of visual disturbance
  • Distorted or hazy vision
  • Halos or rainbows around light
  • Reddening of the eye

Who is At-Risk for Glaucoma?

Glaucoma can affect everyone. Hereditary glaucoma remains the most common form, but studies have shown high-risk individuals include African Americans over the age of 40 and people over the age of 60, especially Hispanics. High-risk individuals should have regularly scheduled eye exams at least every two years.

Glaucoma Treatment

Unfortunately, there is no cure for glaucoma and any damage caused is permanent, but the disease is manageable and most people retain their eyesight. There are several options for treatment based on the type of glaucoma you may have and include everything from eye drops to surgical procedures.

Open-Angle Glaucoma

For those with primary open-angle glaucoma the following treatment options are available:

  • Eye drops – depending on the severity of the glaucoma, eye drops are typically the first step in treatment.
  • Medication – these are given to patients as an effort to bring down overall pressure on the eye. According to the American Academy of Ophthalmology, possible side effects of medication include stinging or itching, dry mouth, red eyes, and altered energy level. It is imperative that medicine is taken as prescribed to avoid any vision-threatening damage.
  • Surgical Procedures – when medications are unsuccessful or have intolerably adverse side effects, surgery is often the best option. Two common surgical options for primary open-angle glaucoma are argon laser trabeculoplasty and selective laser trabeculoplasty. Incisional surgery is also a secondary option if the laser surgery doesn’t quite complete the job.

Argon Laser Trabeculoplasty (ALT) – Only used with open-angle glaucoma patients, the procedure creates small and evenly spaced burns in the trabecular meshwork giving the extra fluid access to new drainage. If this procedure is successful most patients continue taking glaucoma medications to maximize surgery results, though not at the same dosage as before.

Selective Laser Trabeculoplasty (SLT) – This procedure uses a newer, low-energy laser. It treats targeted cells in the drainage angle. Standard post-operative treatment includes close observation, eye drops or an oral non-steroidal anti-inflammatory drug. Combining SLT with regular glaucoma medications usually produces better results, though again at different dosage levels than before.

Angle-Closure Glaucoma

People suffering from angle-closure glaucoma typically have laser or conventional surgery. It’s not uncommon for doctors to perform surgery on both eyes as a safety measure. These surgeries are successful and typically long-lasting afterward. The main surgical option for angle-closure glaucoma is laser iridotomy.

This surgery is usually a preventative measure and is always recommended for narrow angles, many times before the patient is started on glaucoma medications. However, glaucoma medications are usually effective, as well.

Laser iridotomy makes a tiny hole approximately the size of a pinhead through the iris to improve the flow of fluid to the drainage angle. This option is the surgery most people will have. However, if the glaucoma is complicated or especially severe, incisional surgery may be needed at the doctor’s discretion.

Incisional surgery comes in two forms, spelled almost the same. A trabeculotomy is surgery where incisions are made but no eye tissue is removed to clear the eye for drainage. A trabeculectomy requires partial removal of the eye drainage system. As the glaucoma is usually more severe with incisional surgery, the doctor might also implant a valve in the eye to allow proper drainage.

Incisional surgery requires a longer visit. With surgery plus recovery time it can take 4 to 8 hours, compared to about one hour for laser surgery.

Regular checkups remain important as more common forms of glaucoma can occur after surgery. Staying on top of your eye health can prevent serious damage and even vision loss. With regular visits to Barnet Dulaney Perkins Eye Center you can catch early signs of glaucoma and you’ll receive expert eye care to maintain your overall eye health for years to come.

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