Questions and Answers About Glaucoma

Glaucoma is an eye disorder that results when too much fluid pressure builds up inside of the eye. Most people with glaucoma have no early symptoms or pain from increased pressure. If left untreated, however, glaucoma can lead to permanent visual loss and blindness.

Q. What are the symptoms of glaucoma?
A. For most patients, there are usually few or no symptoms at all. The first sign of glaucoma is often the loss of peripheral or side vision – which can go unnoticed until late in the disease. This is why you should have a complete exam with an eye specialist every one to two years. Occasionally, intraocular pressure can rise to severe levels. In these cases, sudden eye pain, headache, blurred vision or the appearance of halos around lights may occur. If you have these symptoms, seek immediate medical care.

Symptoms of glaucoma:

• Seeing halos around lights
• Narrowing of vision (tunnel vision)
• Vision loss
• Redness in the eye
• Eye that looks hazy
• Nausea or vomiting
• Pain in the eye

Q. Who gets glaucoma?
A. Each year, about 80,000 Americans are blinded by glaucoma. With proper treatment to reduce intraocular pressure, however, people with glaucoma can maintain good vision. Glaucoma most often occurs in adults over age 40, but it can also occur in young adults, children and even infants. In African Americans, glaucoma occurs at an earlier age and with greater loss of vision.

You are at an increased risk of glaucoma if you:

• Are of African American, Irish, Russian, Japanese, Hispanic, Inuit or Scandinavian descent.
• Are over age 40.
• Have a family history of glaucoma
• Have poor vision
• Have diabetes
• Take corticosteroid (i.e. prednisone) medications

Q. What causes glaucoma?
A. Glaucoma results from the blockage of the watery fluid (aqueous humor), as it flows normally between the cornea and the lens of the eye. The direct cause of this blockage is unknown, but we do know that it most often is inherited. Less common causes of glaucoma include a blunt or chemical injury to the eye, severe eye infection, blockage of blood vessels in the eye, inflammatory disorders of the eye and occasionally eye surgery to correct another condition. Glaucoma usually occurs in both eyes, but it may involve each eye to a different extent

Q. What are the types of glaucoma?
A. There are two main types of glaucoma in adults:

• Open-angle glaucoma (also called wide-angle glaucoma): This type of glaucoma is the most common. Structures of the eye appear normal, but fluid in the eye does not flow properly through the drain of the eye called the trabecular meshwork.
• Angle-closure glaucoma (also acute or chronic closed-angle or narrow-angle glaucoma): This type of glaucoma is less common, but can cause a sudden buildup of pressure in the eye. Drainage may be poor because the angle between the iris and the cornea (where a drainage channel for the eye is located) is too narrow. Or, the pupil opens too wide also narrowing the angle and blocking the flow of the aqueous humor through that channel.

Q. What causes pressure to rise in the eye?
A. Intraocular pressure increases when the fluid pressure in the eye’s anterior chamber, in the area between the cornea (the clear, dome-shaped, outer layer of the eye) and the iris, rises. Normally, this fluid (called aqueous humor) flows out of the eye through a mesh-like channel. If this channel becomes blocked, fluid builds up. The pressure that results can damage fibers of the optic nerve, which transmits images to the brain. If damage to the optic nerve from high eye pressure continues, vision will worsen. Without treatment, glaucoma can cause blindness within a few years.

The following usually have little or no effect on increasing eye pressure:

• Caffeine
• Antihistamines
• Cold medicines
• Anticholinergic medications – these include certain drugs used to treat Parkinson’s disease, pain, depression, allergies, incontinence, migraine and irritable bowel syndrome (IBS).

Usually glaucoma patients can safely use these with out concern. Alcohol and exercise slightly reduce eye pressure.

Q. How is glaucoma diagnosed?
A. An ophthalmologist (a medical doctor who has done additional specialty training in treating eye disease) will test your vision and examine your eyes through dilated pupils. He or she will also perform tonometry to check for eye pressure and may perform other tests such as a visual field examination. Glaucoma tests are painless and take very little time. Lastly, your ophthalmologist will discuss with you your diagnoses and treatment plan.

Q. How is glaucoma treated?
A. Treatment may include prescription eye drops, laser, or microsurgery. Open-angle glaucoma is most commonly treated with various combinations of eye drops, laser trabeculoplasty, and microsurgery. Traditionally in the United States, medications are used first, but there is increasing evidence that some patients may respond better with early laser or surgery.

Eye drops: These either reduce the formation of fluid in the front of the eye or increase its outflow.  Side effects of glaucoma drops may include allergy, redness of the eyes, brief stinging or visual blurring, and irritated eyes. Some medications may affect the heart and lungs. Be sure to tell your doctor about any medication you are currently taking or are allergic to.

Laser surgery: Laser lightly increases the outflow of the fluid from the eye in open-angle glaucoma or eliminates fluid blockage in angle-closure glaucoma. Types of laser surgery include trabeculoplasty – in which a laser is used to pull open the trabecular meshwork drainage area; iridotomy – In which a tiny hole is made in the iris, allowing the aqueous humor to flow more freely; and cyclophotocoagulation – in which a laser beam treats areas of the ciliary body, reducing the production of aqueous humor.

Glaucoma surgery: Creates a new outflow channel by microsurgery to reduce intraocular pressure.  Complications with surgery may include a failure and need for reoperation for glaucoma, some temporary or permanent loss of vision, and bleeding or infection.

Q. What is the outlook for people with glaucoma?
A. At this time, loss of vision caused by glaucoma is irreversible and cannot be restored. However, successfully lowering eye pressure can prevent further visual loss from glaucoma. Most people with glaucoma do not go blind.

Q. How often should I be screened for glaucoma?
A. Early detection is very important in preventing visual loss associated with glaucoma. If you are over the age of 45 and especially if you have a family history of glaucoma, you should have a complete exam with an ophthalmologist every one to two years. If you have health problems such as diabetes or a family history of glaucoma or are at risk for other eye diseases, you may need to visit your eye doctor more frequently.