Glaucoma
Glaucoma is one of the leading causes of preventable blindness in the United States—and thousands of Arizonans are affected every year.
What is Glaucoma?
Glaucoma is a group of eye diseases that damage the optic nerve, the vital link between your eye and brain. This damage is often caused by increased intraocular pressure (IOP) — the buildup of fluid inside the eye — but can also occur with normal eye pressure. Over time, glaucoma can lead to progressive vision loss and even blindness if untreated. It is one of the leading causes of irreversible blindness worldwide.
Although anyone can develop glaucoma, it’s more common in older adults and individuals with a family history of the disease. Because early glaucoma often has no noticeable symptoms, regular comprehensive eye exams are crucial for early detection.
Types of Glaucoma
Primary Open-Angle Glaucoma (POAG)
The most common form, POAG, develops gradually as fluid drains too slowly from the eye. Pressure builds, damaging the optic nerve over time. There are usually no symptoms early on—vision loss begins in the peripheral (side) vision and progresses slowly.
Angle-Closure Glaucoma
Angle-closure glaucoma, also known as narrow-angle or acute glaucoma, is a less common but serious form of glaucoma. It occurs when the drainage angle between the iris and cornea becomes too narrow, preventing proper fluid outflow and causing a sudden rise in eye pressure. This can happen rapidly, especially if the pupil dilates too quickly, allowing the iris to block the drainage canals. It’s considered a medical emergency.
Normal-tension Glaucoma
In some individuals, optic nerve damage occurs even with normal eye pressure. Factors such as poor blood flow to the optic nerve or increased sensitivity may play a role.
Congenital Glaucoma
Present at birth, this rare condition occurs when a baby’s eye drainage system doesn’t develop properly. Signs include cloudy eyes, excessive tearing, and sensitivity to light.
Secondary Glaucoma
This form develops due to another eye condition, such as inflammation (uveitis), trauma, advanced cataracts, or use of certain medications like steroids.
Signs and Symptoms
Glaucoma is often referred to as the “silent thief of sight” because vision loss occurs gradually and often painlessly.
Early stages typically have no symptoms, but as the disease progresses, patients may experience:
- Loss of peripheral (side) vision
- Tunnel vision in advanced stages
- Blurred or patchy vision
- Halos around lights
- Eye pain (in acute cases)
Causes & Risk Factors
Glaucoma develops when fluid (aqueous humor) builds up in the front part of the eye. This fluid normally drains through a mesh-like channel. When the drainage system doesn’t work properly, pressure rises and damages the optic nerve.
Common Risk Factors Include:
- Age over 60 (or over 40 for African Americans)
- Family history of glaucoma
- High eye pressure (IOP)
- Thin corneas
- Severe nearsightedness or farsightedness
- Long-term steroid use
- Eye injury or previous surgery
- Diabetes or high blood pressure
How Glaucoma Is Diagnosed
Tonometry
Ophthalmoscopy
Perimetry (Visual Field Test)
Gonioscopy
Pachymetry
Advanced Glaucoma Treatment Options
Why and When Is Glaucoma Surgery Recommended?
The Goal of Surgery
Timing and Decision Factors
When to Consider Surgery in Arizona
- If your glaucoma is progressing despite maximal tolerated medical and laser therapy
- If there’s intolerance or side effects from multiple eye drops
- If your optic nerve damage is significant and you need aggressive pressure lowering
- If combining glaucoma surgery with cataract surgery is beneficial (often possible with MIGS)
- After evaluating risks particular to your ocular anatomy, systemic health, and lifestyle
Preparing for Surgery & What to Expect
Preoperative Steps
- A complete eye exam, imaging, and diagnostic testing to assess optic nerve, drainage angle, and ocular anatomy.
- Review your full medical history, including systemic diseases (e.g. diabetes, hypertension), medications (especially blood thinners), and lifestyle factors.
- You may need to stop certain medications (NSAIDs, aspirin, anticoagulants) before surgery to reduce bleeding risk.
- Arrange for a driver post-surgery, as sedatives or anesthesia may impair your ability to drive.
- You may need to fast (no food or drink) for several hours prior to surgery, depending on anesthesia.
During Surgery
- Laser treatments are often done in the physician’s office under topical anesthesia.
- Incisional, MIGS, and tube shunt surgeries typically occur in an operating room, under local anesthesia, sedation, or sometimes general anesthesia.
- The surgery duration depends on the procedure type: many laser procedures take minutes, whereas incisional surgeries may take up to an hour.
Postoperative Care and Recovery
- After surgery, you’ll likely receive eye drops (antibiotic, steroid, IOP-lowering) to prevent infection, inflammation, and manage pressure.
- Eye patching or shield use may be necessary temporarily.
- Limit certain activities for weeks: avoid heavy lifting, straining, bending over, or vigorous exercise.
- Avoid rubbing your eye, swimming, or environments that could expose your eye to water or contaminants until cleared by your surgeon.
- Frequent follow-up appointments are critical to monitor IOP, healing, and any complications.
Recovery Timelines Vary:
- For less invasive (laser or MIGS) procedures, many patients resume normal activities within days.
- For incisional and shunt surgeries, recovery may require weeks to a month of careful management.
You should contact your surgeon immediately if you experience sudden worsening pain, loss of vision, excessive redness or discharge, or other concerning symptoms.
Risks and Benefits of Glaucoma Surgery
Benefits
- Can slow or halt further optic nerve damage by achieving lower, more stable IOP.
- Can reduce dependence on medications and their side effects.
- In some cases, more sustainable long-term IOP control than lasers or drops alone.
Risks & Potential Complications
As with any surgery, there are risks. Some include:
- Hypotony (too low eye pressure), which can damage structures of the eye
- Scarring or closure of the surgically created drainage pathways, which may reduce effectiveness over time
- Bleeding or hemorrhage inside the eye
- Infection or endophthalmitis (rare but serious)
- Damage to cornea or other eye structures
- Vision loss or worsening visual field (though the surgery’s goal is to prevent further loss)
- Need for additional surgeries if the initial surgery fails or effects wane over time
Because Arizona’s dry climate may affect ocular surface health and healing, surgeons and patients in the state often take special care with postoperative eye hydration and protection against surface drying.
Special Considerations for Arizona Patients
While the fundamental science of glaucoma surgery is universal, living in Arizona adds a few specific angles to consider:
Dry Climate & Ocular Surface Health
Arizona’s arid conditions may worsen dry eye symptoms, which can affect healing and patient comfort after surgery. Surgeons may prescribe frequent lubricating drops or punctal plugs to mitigate surface dryness.
UV Exposure & Outdoor Lifestyle
Many Arizonans spend significant time outdoors. After surgery, you’ll need to protect the eye from sun, dust, and wind by using wraparound sunglasses, hats, and avoiding direct exposure during early healing phases.
Access to Retina & Glaucoma Specialists
In urban areas (Phoenix, Tucson), advanced glaucoma and surgical care are accessible. In rural parts of Arizona, travel to specialty centers may be necessary. Patients should plan for follow-up travel and coordination.
Prevalence of Comorbidities
Arizona has a large aging population, and conditions like diabetes, hypertension, and cardiovascular disease are common. These systemic diseases may affect surgical planning, healing, and risk stratification.
Water & Sterility during Recovery
Given the importance of avoiding contamination while eyes heal, desert dust and hard water could pose increased risk during cleaning or washing. Following strict instructions for eye care hygiene is vital.
Tips for Finding the Right Surgeon in Arizona
- Look for a fellowship-trained glaucoma specialist with experience in both conventional and MIGS techniques.
- Ask about their complication rates, expected IOP reduction, and follow-up protocol.
- Find out whether the practice provides preoperative counseling and thorough postoperative support.
- Confirm that the facility is equipped for sterile surgery, emergency care, and postoperative monitoring.
- Get referrals from local ophthalmologists and check patient reviews.
What is the first sign of glaucoma?
In most cases, glaucoma develops slowly and without symptoms. The first noticeable sign is often loss of peripheral (side) vision. Because this happens gradually, many patients don’t realize they have glaucoma until significant vision loss has occurred. Routine comprehensive eye exams are the best way to detect it early.
Can glaucoma be cured?
Glaucoma cannot be cured, but it can be effectively managed and controlled. Early diagnosis and consistent treatment can slow or stop further damage to the optic nerve, helping preserve vision for life.
Who is at risk for glaucoma in Arizona?
People over 40, those with a family history of glaucoma, individuals with diabetes or high blood pressure, and those of African American, Hispanic, or Asian descent have a higher risk. Because of Arizona’s high sunlight exposure, residents should also protect their eyes with UV-blocking sunglasses to maintain overall eye health.
Does sunlight or Arizona’s climate affect glaucoma?
While sunlight doesn’t directly cause glaucoma, Arizona’s bright, dry climate can increase glare, eye strain, and irritation—making symptoms more noticeable. Wearing polarized, UV-protective sunglasses helps reduce discomfort and safeguard your eyes.
Where can I get glaucoma treatment in Arizona?
Barnet Dulaney Perkins Eye Center provides expert glaucoma care at multiple locations across Arizona, including Phoenix, Tucson, Mesa, Flagstaff, Show Low, and more. Each center offers advanced diagnostics, laser therapy, and surgical options—all under one roof.