Glaucoma is an eye disease in which fluid builds up causing excess pressure that damages the optic nerve. More than 3 million Americans are affected by glaucoma, and it is a top cause of blindness for people over 40 years old. The most common type, called open angle glaucoma, can cause irreversible damage to vision without any prior symptoms. Open angle glaucoma is most common in people over 65, but can develop as young as 40. Since glaucoma can occur with no warning signs, regular eye exams are critical to early detection. If left untreated, glaucoma can cause irreparable vision loss.
The human eye has natural fluid called aqueous humor, which fills the space between the lens and the cornea. In patients with glaucoma, the fluid builds up because the eye’s drainage canal is blocked. The excess fluid creates intraocular pressure, which in turn damages the optic nerve. This pressure is rarely painful, so without regular eye exams glaucoma may go unnoticed until the gradual loss of vision becomes significant.
Causes & Symptoms
Anyone can be affected by glaucoma, but there are genetic, environmental, and lifestyle factors that can contribute to increased likelihood of the disease. Although most common in people over 65, anyone who may be at higher risk should take care to speak with their doctor about checking for glaucoma early and often. High risk categories include those with a family history of the disease, African Americans over 40 years old, people with prolonged use of certain medications such as corticosteroids, and people who have thin corneas, diabetes, or high blood pressure. You may be able to lower your risk of developing glaucoma with lifestyle choices such as maintaining a healthy weight, eating a variety of vitamin rich fruits and vegetables, and avoiding smoking. Regular, comprehensive eye exams are the most important factor in preventing vision loss from glaucoma.
Types & Testing
There are two main types of glaucoma. Open angle glaucoma is the most common form and gradually develops over time. This results from an imbalance between the aqueous fluid and drainage system, causing fluid buildup and abnormal eye pressure. Acute angle closure glaucoma (also called narrow-angle glaucoma), is a less common form of glaucoma that occurs when the iris of the eye arches forward, creating a sudden blockage of the fluid drainage system. This type of glaucoma is characterized by sudden pain in the eye, often accompanied by blurry vision, nausea, and vomiting. Acute angle closure glaucoma requires immediate treatment. In addition to open angle and acute angle closure glaucoma, babies can be born with congenital glaucoma, which is when the drainage openings in their eye(s) develop a defect, preventing proper fluid drainage.
Routine screenings can help monitor your eye health and detect glaucoma in its earliest stages. During these visits, your eye doctor will check your eye pressure, and if it is higher than normal, they will perform further tests to determine if there have been changes in the optic nerve that may indicate glaucoma. By utilizing multiple ophthalmic tools, your doctor can provide an accurate glaucoma diagnosis by examining your eye pressure, side and central vision, and interior structures of your eye. If you are diagnosed with glaucoma, your eye doctor will closely monitor its progress during regularly scheduled visits. Detailed photographs of the optic nerve can show any changes that may indicate surgery is necessary.
Treatment for glaucoma is designed to lower your eye pressure, improve fluid drainage, or reduce fluid production. It is important to note that damage from the disease is irreversible, but when caught early, you can typically avoid severe vision loss. Our eye surgeons in Virginia Beach, Norfolk, and our other locations offer the following forms of treatment to effectively control your glaucoma:
Eye drops are the most common method of controlling the progression of glaucoma. Taken one to four times daily, these medicated eye drops help decrease eye pressure by reducing fluid production or improving the flow of this fluid out of your eye. Pills may also be prescribed along with these eye drops. To ensure you are getting the most out of your treatment, please follow your doctor’s instructions as discussed with you.
- Selective Laser Trabeculoplasty (SLT) is used to treat open angle glaucoma. SLT uses very low energy levels to treat “selective” portions of the eye’s internal drainage system, the trabecular meshwork. This procedure helps enhance drainage of fluid through the eye’s natural drainage system.
- Laser iridotomy is used for the immediate treatment of an angle-closure glaucoma attack, or for those who are at risk of developing one. The procedure involves advanced laser technology to create a hole the size of a pinhead into your iris. This restores your eye’s ability to drain fluid, therefore, relieving the dangerous eye pressure. Learn more about Laser Iridotomy.
Microinvasive Glaucoma Surgery (MIGS)
MIGS is a revolutionary advancement in glaucoma treatment. These surgical procedures have proven to be highly beneficial alternatives to traditional methods of treatment, often with fewer complications and a faster recovery time.
- Glaukos® iStent®: The iStent® improves the eyes outflow of fluid by filtering it through a trabecular micro-bypass device. This implant is so small that you should not be able to see or feel it after it has been inserted. It can reduce your eye pressure by restoring proper function to your eye’s natural drainage system. Learn more about the iStent®.
- Trabectome: Trabectome helps clear the eye’s natural fluid outflow channel by removing diseased tissue. This allows fluid to drain more effectively and stabilizes the eye’s inner pressure, which helps control progression of glaucoma. Learn more about Trabectome.
- ABiC™: The ABiC procedure utilizes an iTrack™ microcatheter to expand the eye’s natural drainage system, allowing increased drainage to promote normalized intraocular pressure and help resolve glaucoma symptoms. This innovative surgery does not necessitate any implants or devices be permanently placed in the eye.
Traditional Glaucoma Surgery
- Trabeculectomy: During a trabeculectomy, a piece of drainage tissue of the eye (trabecular meshwork) is removed, creating a microscopic opening. The opening is partially covered with a flap of tissue from the sclera (the white part of the eye) and the conjunctiva (the clear thin covering over the sclera). This new opening allows fluid (to drain out of the eye, bypassing the clogged drainage channels of the trabecular meshwork. As the fluid flows through the new drainage opening, the tissue over the opening rises to form a little bubble called a bleb.
- Tube Shunt: A tube shunt is a small plastic tube device that is implanted in the eye to aid in the drainage of excess fluid. As this flows out of the eye, surrounding tissues absorb the excess fluid, helping regulate your eye pressure. The tube shunt surgery is done on an outpatient basis. It has proven to help control eye pressure as well as help control the progression of glaucoma that can lead to blindness.
Contact Virginia Eye Consultants
If you have any questions about glaucoma, or would like to set up an eye examination, please contact our office today.