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StahlVision:  Glaucoma

     The clinical diagnosis of Glaucoma describes a number of clinical eye conditions that result in permanent damage to the optic nerve. Most people commonly think of glaucoma as a higher than “normal” intraocular pressure (IOP). While this is often the major contributing factor causing glaucoma, it is not necessarily the only cause of glaucoma. There are a number of different types and different causes of glaucoma. They all share the common problem, that if left untreated, they can cause permanent loss of vision or even blindness. It is estimated that there are between 2,500,000 and 3,000,000 individuals in the United States who have been diagnosed with glaucoma. In addition, it is believed that there are over 1,000,000 individuals who are unaware that they even have glaucoma. In the United States, there are approximately 100,000 people believed to be blind from glaucoma. Glaucoma is considered the second leading cause of blindness in adult Americans between the age 18 to 65. Glaucoma is most dangerous because most people are unaware that they have glaucoma. Usually. Glaucoma is detected by screening eye examinations. Glaucoma screenings are strongly recommended for all patients age 50 and if there is any family history of Glaucoma, screenings should commence at age 40 and yearly thereafter.

     Your eyes produce fluid that supplies oxygen and nutrients to the tissues in the eye. This fluid is called aqueous humor. The aqueous humor is normally drained through a meshwork of tissue that is located at the base of the colored part of the eye called the iris. In most normal patients, the amount of fluid produced is the same as the amount of fluid drained.This results a state of equilibrium and creates a “normal” pressure within the eye.

    The most common type of Glaucoma is called Primary Open Angle Glaucoma. With Primary Open Angle Glaucoma, it is typical to havean abnormally high intraocular pressure(IOP) which may result in damage to the optic nerve. Usually this is due to too little outflow of the fluid from inside your eye. The eye continues to make fluid and since it is closed space, the fluid, which does not drain properly, increases the pressure within the eye. This elevated intraocular pressure(IOP) can cause permanent damage to the optic nerve, which is a structure in the back of the eye that communicates a message between the eye and the brain. Unfortunately, the optic nerve doesn’t regenerate once it is damaged. If left untreated, a high intraocular pressure (IOP) can, over time, lead to slow progressive, permanent damage to the optic nerve that can result in blindness.

     Another type of Glaucoma, which is actually much less common, is called Angle Closure Glaucoma. Angle Closure Glaucoma is really a class of glaucomas that share the common problem of having closure of the drainage structure of your eye, called the trabecular meshwork. The trabecular meshwork is similar to a fine filter-if anything happens that causes the filter to become blocked, it results in fluid buildup and a rise in pressure. If the filter becomes closed suddenly, it will cause an acute rise in the intraocular pressure (IOP). This can cause pain, redness, blurred vision and if left untreated permanent loss of vision. There are several different causes of angle closure glaucoma but the most common is acute angle closure glaucoma due to anatomic variations of the structures within one's eye. This is much more common in far-sighted eyes and is most prevalent between ages of 45 and 60. Acute angle closure glaucoma is best treated with a laser treatment to place a small hole in the peripheral iris to redirect fluid and prevent the trabecular meshwork from closing down.

Glaucoma Risk Factors

There are multiple risk factors for glaucoma which include the following:

o Increased intraocular pressure
o Age
o Race
o Myopia
o Hypertension
o Diabetes
o Family history

Glaucoma Treatment

     Eighty percent of those patients diagnosed with Glaucoma can be treated successfully with a number of different types of eye drops. There are a variety of different eye medications available, some work by decreasing the amount of fluid produced by the eye and others that increase the rate of drainage of fluid from an eye. Most people with Glaucoma can be treated successfully with 1-2 eye drops per eye per day with very little side effects or discomfort. Unfortunately some people can develop reactions to medicines or side effects prevent them from using medicines successfully.

     For those patients who are not able to be successfully treated with eye drops, there are a number of types of lasers that can be used to help control the intraocular pressure (IOP). In fact, today laser treatment for Glaucoma is widely used to help those prevent vision loss. Finally, for those patients who are unable to achieve satisfactory results with either eye drops or laser treatment for Glaucoma, there are surgical procedures that eye surgeons may perform in order to help reduce and stabilize the intraocular pressure (IOP) and prevent vision loss.

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