Glaucoma is a group of conditions characterized by excessive pressure in the eyes, which can result in pain, distorted vision and vision loss, up to and including blindness. There are several different types of glaucoma, as well as various causes and treatment options. Glaucoma can happen to anyone at any age and any damage done is irreversible, so it's important to be screened regularly regardless of your age. Understanding this condition and your risk factors can help you avoid developing the disease, while being cognizant of the treatment options is important for proper management of your condition if you’ve already received a diagnosis.
You may or may not be educated about the inner workings of your eyes, but awareness is essential to understanding the dangers of glaucoma. Inside the eye is a fluid called aqueous humor. This fluid needs to be able to flow into the eye and flow out again to maintain a normal pressure. When a person has glaucoma, too much aqueous humor is trapped inside the structure of the eyeball, leaving the pressure dangerously high. This damages the optic nerve and can result in pain, vision loss and, eventually, blindness.
Types of Glaucoma
There are two main types of glaucoma. The type you have affects your prognosis and have a large impact on the treatments that are available to you.
- Primary open angle glaucoma, also called wide-angle glaucoma, is the most common type of glaucoma. This is the type of glaucoma you may associate with the elderly. While older people have a higher risk of developing the disease, it can strike people of all ages. With wide-angle glaucoma, there is very little warning that damage is occurring until it’s too late, making early detection and treatment crucial. What’s worse, wide-angle glaucoma usually affects both eyes. With this type, all structures of the eye appear normal, but the fluid is not draining properly and pressure is building up over time.
- Primary angle closure glaucoma, also called narrow-angle glaucoma or acute glaucoma, happens when the area between the iris, which is the colored ring of the eye, and the cornea, the clear, curved section on the front of the eye, is too narrow. Fluid can build up quickly with no way to escape, causing a painful eye and an emergency situation. If acute glaucoma isn’t diagnosed and treated within a few days of the onset, vision could be permanently lost in the eye. This type of glaucoma can strike anyone at any time, including infants and young people, so it’s important to never disregard a painful eye. If you cannot be seen by your own doctor or vision specialist, proceed to the emergency room.
Other types of glaucoma include secondary glaucoma, which is caused by an underlying eye condition, normal tension glaucoma, where the eye’s pressure remains normal, and congenital glaucoma – this rare form of glaucoma occurs in young children and is caused by abnormalities.
Risk Factors for Developing Glaucoma
There are several risk factors that will increase your chances of developing glaucoma.
- Your ethnic heritage. Those of Scandinavian, Asian, Irish, Japanese, Russian, Native/First Nations, Hispanic and African descent have a markedly higher risk than those of other ethnicities. If you have a family history of glaucoma, your risk increases even more.
- Your age, weight and overall health. Those over 40, those who are overweight or obese and those with diabetes and high blood pressure are all at higher risk than their younger, average-weight, generally healthy counterparts.
- Your natural vision. Glaucoma is more prevalent in those with poor natural vision, especially those with severe nearsightedness. As nearsightedness, otherwise known as myopia, is common in Asians, wide-angle glaucoma afflicts more people in Asia than anywhere else in the world.
- Trauma to the eye. If you’ve been punched in the eye, involved in a car accident or were bopped in the face by your child, narrow-angle glaucoma can manifest due to the swelling caused by the trauma. See a doctor right away if you develop eye pain after suffering trauma to the eye or your face in general.
Early Warning Signs of Glaucoma
For wide-angle glaucoma, there are often little to no symptoms at all until vision loss happens. Once this occurs, there is no way to regain the lost sight, leading glaucoma to be referred to as a “silent thief” of vision. A yearly checkup with your optometrist is the best way to catch wide-angle glaucoma in its earliest stages. Careful management and vigilant follow-up can bring the disease under control and preserve your vision.
Narrow-angle glaucoma, however, often comes on suddenly and with plenty of symptoms to warn you that something is wrong. Pain in the eye is usual, as is a redness in the eye, blurred vision, seeing halos around lights, narrowing of your visual field and even nausea and vomiting are all common. If you experience any of these symptoms, see an optometrist or ophthalmologist quickly. With only a few days to act, at best, vision could be permanently lost if you delay.
Testing Procedures for Glaucoma
When you go to the optometrist, you may recall gazing into a machine that blows a puff of air onto your eyes, or your doctor may have pressed a small tool that looked similar to a mechanical pencil against your eye. No matter which type of test your optometrist conduced, he or she was testing the pressure inside your eye. This is called tonometry and is conducted routinely.
The second test for glaucoma involves dilating the pupils with special eye drops and using an instrument called an opthalmoscope. This allows your optometrist or ophthalmologist to peer into the eye and see all of the structures inside of it, primarily the optic nerve, which will show signs of damage or distress if glaucoma is present. This test is also useful for finding other ocular problems and diseases, so it’s important to make time to have it done regularly. Your close vision may be blurry for several hours afterwards, so be prepared. It is becoming increasingly common for the Optometrist to take a photo of the inside of the eye, which is an excellent way of not only seeing, but recording, what is happening in the eye.
A visual acuity test is also helpful for detecting glaucoma, as it helps find holes in vision that may not be obvious yet. Reading from an eye chart and testing peripheral vision are both important for finding the early warning signs of several eye diseases, including glaucoma.
The Optometrist may also measure your visual fields. He will use a machine to present various targets in front of you, while you stare straight ahead, to determine if you miss any during the test. Visual fields area very sensitive method for detecting glaucomatous loss, and can detect loss in many cases before any other symptoms present to the Optometrist.
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Potential Treatment Options
The type of treatment offered to you will vary greatly, depending on the type of glaucoma you have.
For acute, narrow-angle glaucoma, surgery is almost always a necessity. This is especially true for cases of infant and pediatric glaucoma, where the drainage system is malformed and must be corrected by way of microsurgery or laser surgery. For adults with sudden-onset, acute glaucoma, surgery may also be necessary because a blockage has formed in the already-narrow space between the iris and cornea.
For wide-angle glaucoma, eye drops and certain medications can help bring down ocular pressure and relieve the glaucoma without surgical intervention. Making lifestyle changes can also negate the need for surgery for some patients. Your optometrist or ophthalmologist will be able to explain the options for your specific case in detail, should you have any questions.
Your ethnicity, a family history of glaucoma or severe farsightedness doesn’t necessarily mean you will certainly develop the disease. There are steps you can take to reduce your risks, and all of them are also good for other aspects of your health, too.
Manage your weight. Being overweight or obese increases your risk for certain cancers, heart attacks, strokes, joint problems and a host of diseases, including glaucoma. If you are having trouble managing your weight, consider meeting with a nutritionist or dietician to retool your diet and speak to your general practitioner or trainer about weight loss through exercise. Don’t let extra pounds threaten your health.
Manage your diabetes or avoid the disease. Ignoring health problems will not make them disappear. If you are diabetic, take pains to carefully monitor and control your blood sugar levels. Not only does uncontrolled blood sugar affect circulation, liver function and a host of other issues, it places your eyes at risk for both diabetic retinopathy and glaucoma. If you are not diabetic, talk to your doctor about steps you can take to mitigate the risk of being diagnosed in the future.
Living with Glaucoma
For those with narrow-angle glaucoma, surgery often resolves the issue entirely. While careful check-ups will be needed for life, there is usually nothing more that needs to be done one normal pressure levels have been established, other than to follow the recommendations for reducing the risk of developing wide-angle glaucoma listed above.
If you’ve been diagnosed with wide-angle glaucoma, there are steps you can take to avoid the progression of the disease. Follow your doctor’s recommendations for scheduled appointments. Take any medications prescribed to you as directed, and advise your doctor right away if you are experiencing side effects. Finally, taking care of your overall health and managing any other diseases you have will help keep your condition from worsening.
Glaucoma is a serious group of conditions that have the potential to rob you of your sight. Understanding this disease, the risk factors, symptoms, treatments and how to lower your risk are all integral to making good choices and keeping yourself informed about your ocular health. If you have additional questions or concerns, make an appointment to see your doctor of optometry or ophthalmology today.
Author: John Dreyer Optometrist Bsc(Hons), MCOPTOM, DipCLP
Created: 5 Nov 2016, Last modified: 4 Mar 2020