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Glaucoma

Glaucoma is a disease that affects the optic nerve; the nerve that carries information about visual images to the brain. Glaucoma is currently the leading cause of blindness in the United States.

What Are Symptoms of Glaucoma?

Glaucoma is called a "silent disease" because it often has no overt symptoms. Glaucoma usually goes unnoticed until the patient's peripheral vision becomes impaired. With glaucoma, the peripheral vision is the first to be affected. Glaucoma can be detected through intraocular eye pressure (IOP) checks by your ophthalmologist or optometrist. IOP is a measure of the fluid pressure inside the eye. There are several risk factors that increase your risk of developing glaucoma, including high IOP, old age, African-American or Hispanic ethnicity, and a family history of glaucoma.

What is Glaucoma?

Glaucoma is a disease that damages vision by destroying the optic nerve, which connects the eye to the brain and carries visual information to the brain for processing. The optic nerve is damaged when the pressure inside the eye rises and remains high for an extended period of time. The increased eye pressure puts pressure on the optic nerve and causes the enlargement of the optic nerve and optic disc (a collection of cells at the origin of the optic nerve). The high intraocular pressure is caused by the poor reabsorption of aqueous humor. Aqueous humor is the fluid which circulates from the anterior eye chamber to the posterior eye chamber through the pupil. In glaucoma, the aqueous humor circulates through this filter-like system and becomes backed up, leaving excess fluid in eye and causing a pressure increase. Peripheral vision, or side vision, is the first to be destroyed. If the glaucoma remains untreated, the vision loss creeps in toward the center, first causing tunnel vision, and then, eventually, blindness.

How Is Glaucoma Diagnosed?

A thorough examination for glaucoma should include an IOP measurement, a visual field test and an optical coherence tomography (OCT). A high IOP can be an indication of glaucoma but additional tests can help to confirm the diagnosis. Additional tests are also important because a form of glaucoma, called low tension glaucoma, is caused by low IOP and needs to be confirmed by means other than IOP measurements.

A visual field test is used to determine whether there are defects, or areas of low vision, within the patients field of vision. This test is noninvasive, brief and can be performed in the office. Visual defects present in the peripheral areas indicates the beginning stages of glaucoma while defects present in the central vision can indicate more advanced glaucoma.
The OCT uses light to produce high-resolution, cross-sectional images of the retina, macula and optic nerve and can be used to diagnose a variety of eye diseases. An optical coherence tomography (OCT), in the case of glaucoma, is used to visualize the size and condition of the optic nerve and optic disc. The OCT provides accurate measurements of any damaged that has occurred to the optic nerve as a result of glaucoma. This test is also brief and can be performed in the office but requires a mild dilation to achieve quality images of the eye.

How Is Glaucoma Treated?

If you are diagnosed with glaucoma, there is treatment available to help save your vision and slow the progression of the disease. The goal of glaucoma treatment is to lower IOP and stop the damage to the optic nerve. Several treatment options are available to help lower IOP and include eye drops, laser therapy, and surgery.

Glaucoma eye drop medications lower IOP by either reducing the amount of fluid entering the eye or increasing the amount of fluid exiting the eye. There are several different kinds of glaucoma medications, each differing in terms of both its ability to lower IOP and its potential side effects. It is not always possible to know how each individual patient will respond to the drops and so medication adjustments may need to be made during the course of your treatment. There is a wide variety of glaucoma drops currently on the market and the dosage and frequency can vary. Your eye doctor will prescribe a treatment plan for you based on the severity of the glaucoma and also takes into consideration certain risk factors.

Laser therapy is often used as a primary therapy for Glaucoma , or when medications fail to successfully lower IOP. Laser treatment is also an option for patients who cannot tolerate medications due to side effects. Recent advances in laser therapy have produced lasers so safe and effective that for many patients, laser therapy is used instead of medications. Two laser treatments for glaucoma are currently being used to treat the disease. Laser peripheral iridotomy (LPI) involves using a laser to create a small hole on the margin of the pupil to allow increased filtration of aqueous humor and allow for dilation of the eyes for more comprehensive eye examines in the future. LPI treatment is for glaucoma sufferers with narrowed anterior chambers (the front portion of the eye) or individuals without glaucoma than cannot be dilated due to this narrowness in the eye. The second laser treatment in called Selected Laser Trabeculoplasty (SLT) and is used to lower the IOP in glaucoma. The ophthalmologist uses the laser in the angle of the eye to stimulate pigment cells which aid in the natural regulation of eye pressure. Some patients may be able to discontinue the use of their glaucoma drops following this procedure.

Prior to the laser treatment, patients will review the risks of potential complications and receive several eye drops to prepare the eye for treatment. In most cases, the ophthalmologist will treat only one eye initially to evaluate the effectiveness and individual reaction to the laser treatment. Patients typically experience mild discomfort and blurred vision following the treatment and these symptoms usually cease by the following day. You will need a driver to transport you to and from this appointment as your vision may be temporarily impaired afterwards. If your pain increases or vision fails to improve, contact your doctor immediately.

If medications and/or laser therapy fail to bring the IOP down to a safe range, surgery is available to lower IOP. Surgery is usually the last course of action when treating glaucoma.

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