What is glaucoma?

What is glaucoma?

Glaucoma is a serious eye condition that can cause blindness. It damages the optic nerve, which carries information from your eyes to the visual centre in your brain. This damage can result in permanent vision loss.

The most common type of glaucoma has no early warning signs and can only be detected during a comprehensive eye exam. If undetected and untreated, glaucoma first causes peripheral vision loss and eventually can lead to blindness.

By the time you notice vision loss from glaucoma, it is too late. The lost vision cannot be restored, and it’s very likely you may experience additional vision loss, even after glaucoma treatment begins.

The only way to protect yourself and your family from vision loss and even blindness from glaucoma is to visit an eye doctor for routine comprehensive eye exams.

Only an optometrist or ophthalmologist is trained to spot the early warning signs of glaucoma and to begin glaucoma treatment before vision loss occurs.

What causes glaucoma?

In most cases, glaucoma is caused by higher-than-normal pressure inside the eye — a condition called ocular hypertension.

But sometimes glaucoma can occur even when pressure inside the eye — called intraocular pressure or “IOP” — is normal.

In most types of glaucoma, optic nerve damage and vision loss occurs because the pressure inside the eye (IOP) is too high.

A quick review of eye anatomy will help describe what causes glaucoma:

The space between the clear front surface of the eye (the cornea) and the lens inside the eye is filled with a clear fluid called the aqueous humor. This fluid nourishes the inside of the anterior part of the eye. It also maintains the shape of the eye by keeping the eyeball properly pressurized.

The aqueous humor is constantly being produced by a structure called the ciliary body that surrounds the lens, and it drains from the eye through a mesh-like channel called the trabecular meshwork that’s located in the angle formed inside the eye where the cornea and iris meet.

If something causes this “drainage angle” to close down or the trabecular meshwork to become clogged, the aqueous humor cannot drain from the eye fast enough, and pressure inside the eye (IOP) increases.

Glaucoma usually occurs when too much pressure inside the eye causes damage to the optic nerve at the back of the eyeball, leading to permanent vision loss.

Recent studies also have implicated low intracranial pressure (the pressure that surrounds the brain) as one of the risks for glaucoma.

Glaucoma symptoms

Most types of glaucoma typically cause no pain and produce no symptoms until noticeable vision loss occurs.

This is one reason why routine eye exams are so important — typically, an eye exam is the only way to detect glaucoma before permanent vision loss occurs.

However, a less common type of glaucoma — called acute angle-closure glaucoma — causes sudden, often severe symptoms of blurry vision, halos around lights, eye pain, nausea and vomiting.

If you experience these symptoms, see an eye doctor near you immediately so steps can be taken to reduce your IOP, alleviate symptoms and prevent permanent vision loss.

Types of glaucoma

The two main types of glaucoma are:

1. Primary open-angle glaucoma

This is the most common type of glaucoma and typically is the type that eye doctors describe to their patients. In primary open-angle glaucoma (POAG), the drainage angle that leads to the trabecular meshwork looks normal, but aqueous fluid exits the eye too slowly.

2. Angle-closure glaucoma

This is a less common type of glaucoma where the drainage is too narrow or begins to close, impeding the normal outflow of aqueous humor.

Angle-closure glaucoma can be either chronic (an anatomically narrow angle or temporary episodes of angle closures over time) or acute (the angle narrows or closes suddenly).

The term narrow-angle glaucoma often is used to describe glaucoma that occurs when the drainage angle is too small or is partially closed.

Other glaucoma types

Other types of glaucoma include:

Low-tension or normal-tension glaucoma

In these types of glaucoma, optic nerve damage and vision loss occurs even though IOP remains normal. Low blood pressure may be a risk factor.

Congenital glaucoma

Some children are born with a defect in the drainage angle that prevents the aqueous fluid from exiting the eye normally. Usually there are obvious symptoms, such as cloudy corneas, light sensitivity and watery eyes.

Secondary glaucoma

This type of glaucoma develops due to complications of certain medical conditions (including diabetes and high blood pressure) or because of other eye conditions (such as cataracts and uveitis), side effects of medications, or trauma to the eye.

Detecting glaucoma

During routine eye exams, a small instrument is used to measure your intraocular pressure (IOP). During this test (called tonometry), eye drops may or may not be used to make your cornea less sensitive.

In Goldmann applanation tonometry (GAT), numbing eye drops are applied and a lightweight probe gently touches the eye to measure eye pressure. In non-contact tonometry (NCT), a gentle puff of air flattens the center of the cornea briefly to measure eye pressure. No numbing eye drops are needed.

Normal IOP typically is considered to be readings below 21 mmHg (millimeters of mercury) — a unit of measurement based on how much force is exerted within a certain defined area.

Higher IOP readings indicate increased risk of glaucoma.

Other methods of detecting glaucoma involve the use of sophisticated imaging technology to create baseline images and measurements of the eye’s optic nerve and internal structures. These images and measurements are then repeated at successive eye exams to check for changes.

Glaucoma treatment

There are several types of glaucoma treatment, including medicated eye drops, micro-surgery, laser treatments and other eye surgery.

It’s important to realize that glaucoma treatments may prevent additional vision loss, but they will not restore vision already lost to the disease.

Depending on the type, severity and responsiveness of your glaucoma to treatment, your eye doctor may prescribe medical treatment, surgery or a combination of both.

Glaucoma medications

The use of topical medication (prescription eye drops) is the most common treatment for early glaucoma. The purpose of glaucoma eye drops is to reduce IOP to prevent vision loss.

The same medications used to treat glaucoma also are used to treat high eye pressure (without optic nerve damage or vision loss) to prevent the onset of glaucoma.

Types of glaucoma eye drops

There are several categories and many brands of glaucoma eye drops. Your eye doctor will prescribe the medication(s) that he or she feels will be most effective for your individual needs.

In some cases, more than one type of eye drop may be required and prescribed.

Using glaucoma eye drops

Glaucoma typically is a chronic condition — meaning it’s possible you may need to use eye drops every day for the rest of your life to prevent vision loss from glaucoma.

In some cases, your eye doctor may also prescribe oral medicine (pills) to reduce your risk of vision loss.

For your own safety and well-being, it’s important for you to take your daily glaucoma medication(s) as directed. Being careless and failing to comply with glaucoma treatment regimens eye doctors prescribe is one of the main causes of blindness from glaucoma.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

Glaucoma surgery

In some cases, glaucoma surgery may be a better option than medication for the control of glaucoma and prevention of vision loss.

There are a number of types of glaucoma surgery, including:

Minimally-invasive glaucoma surgery (MIGS)

In recent years, a number of micro-surgical procedures called minimally-invasive glaucoma surgery (MIGS) have been developed to reduce or eliminate the need for glaucoma medications. MIGS procedures require only tiny incisions and cause less trauma to the eye than conventional glaucoma surgery. The goal is the same with MIGS and conventional glaucoma surgery: to increase outflow of aqueous humor from the eye to lower IOP and decrease the risk of optic nerve damage and vision loss.

Trabecular and shunt glaucoma surgery

These surgeries are more invasive than MIGS procedures, but often are more effective in lowering IOP and reducing the need for glaucoma medications. The goal of these procedures is to create new exit channels for the aqueous humor to significantly reduce IOP.

Laser glaucoma surgery

The most commonly used laser glaucoma surgery is called selective laser trabeculoplasty (SLT). The SLT procedure has been used worldwide for more than 25 years and can be used as a primary treatment for open-angle glaucoma or if medications are ineffective or cause unacceptable side effects for this type of glaucoma.

According to Glaucoma Research Foundation, SLT can lower IOP by about 30 percent when used as initial therapy for open-angle glaucoma, but it may take one to three months for results to appear, and the effect typically lasts only one to five years. The laser surgery can be repeated, but results from a subsequent procedure may not be as effective.

There are other glaucoma treatments as well. Read more about medical glaucoma treatment and glaucoma surgery.

Preventing glaucoma

Can glaucoma be prevented? Recent research suggests regular exercise reduces glaucoma risk — possibly because it improves blood flow throughout the body, including the eyes.

In addition to regular exercise and an active lifestyle, you also may be able to reduce your risk for glaucoma by not smoking, maintaining a healthy weight, and eating a varied and healthy diet.

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