What is Glaucoma

Glaucoma is a disease that can damage the eye’s optic nerve and result in blindness.  It is a complex eye disease often, but not always associated with elevated intraocular pressusre. The production, flow, and drainage of intraocular fluid is an active, continuous process that is needed to maintain a healthy level of pressure within the eye. With glaucoma, the fluid does not flow through the trabecular meshwork properly. Over time, eye pressure increases, damaging the optic nerve fibers. The optic nerve delivers visual information from the eye to the brain like a telephone cable. Once the optic nerve is damaged, permanent vision loss can occur.

In the vast majority of cases, especially in the early stages of the disease, there are few signs or symptoms. [Glaucoma usually occurs in both eyes, but extra fluid pressure often starts to build up in one eye first.] At first, glaucoma has NO symptoms. Vision is normal, and there is no pain. If glaucoma remains untreated, people may notice that although they see things clearly in front of them, they miss objects to the side and out of the corner of their eye.  Without treatment, people with glaucoma may find that they have lost most of their side vision. It may seem as though they are looking through a tunnel. Over time, the remaining central vision may decrease until there is no vision left.

In later stages of the disease, symptoms can include:

• Slow loss of side or peripheral vision
• Hazy vision
• Eye and head pain
• Nausea or vomiting
• Sudden sight loss
• An inability to adjust the eye to darkened rooms
• Difficulty focusing on close work
• Rainbow-colored rings or halos around lights
• Frequent need to change eyeglass prescriptions

Glaucoma Diagnosis & Treatments:

Glaucoma is diagnosed through a series of tests that include:

• Visual Acuity
• Tonometry
• Pachymetry
• Visual Field
• Gonioscopy
• HRT
• Dilation

A number of patients ask why we advise certain tests, such as Visual Fields or optic nerve imaging, “HRT”, on a regular basis. These tests are done on individuals with glaucoma and those at risk for glaucoma or other serious eye diseases.

The goal of frequent testing is to detect and treat vision loss or optic nerve damage before it affects a person’s life and becomes permanent.

The visual field test detects unnoticed side (peripheral) vision loss before it affects a person's daily life. This test may need to be repeated every 3 to 12 months depending on your risk of developing vision loss as determined by your doctor.

The optic nerve is the part of the eye damaged by glaucoma. Photographing or examining the optic nerve with the “HRT” computer at regular intervals allows your doctor to detect early damage to the optic nerve.

Untreated glaucoma can cause optic nerve damage and loss of peripheral vision that can result in blindness. The tests described above are the best way to detect and monitor this disease. If these tests show abnormalities, your doctor can then start or modify treatment to prevent further damage and loss of vision.

It is important to remember that in diseases like glaucoma, early identification and treatment is important. Any associated loss of vision is permanent, it cannot be recovered later.  Persons with glaucoma are usually unaware of the damage that is occurring. Cooperating with your doctor’s recommendation for regular testing to detect this damage helps to maintain your vision.

Glaucoma medications are used to treat elevated pressure inside the eye and can be effective in delaying the onset of glaucoma. Glaucoma medications are prescribed to be used at various times during the day depending on the type. Be compliant with your medication by following the prescribed medication schedule that is given. Compliance is extremely important and while frequently using drops may seem simple enough, it is often difficult for patients to apply the drops correctly. A how-to video and several tips to properly administer glaucoma medications can be seen below.

If necessary, your physician may recommend surgery and in most cases, you will continue to use glaucoma medications even after laser surgery.

• LPI (Laser Peripheral Iridotomy)
• ALT (Argon Laser Trabeculoplasty)
• SLT (Selective Laser Trabeculoplasty)
• Conventional or Incisional Surgery

“Getting your eye drops in your eyes”

The Ritch-Sussman Technique