Columnists

Glaucoma, Sneak Thief Of Sight

Issue 48.15

With all of the advances in medicine that we have witnessed over the past 30 years, one common eye disease that affects two to four percent of Americans is still largely a mystery.   So mysterious, it has earned the nickname “sneak thief of sight.”  Often, glaucoma smolders undetected in the background for many years until it becomes obvious that there is a problem, when much of the damage that can be done to the visual system has already occurred, and vision begins to deteriorate at a quicker pace.  When glaucoma begins, almost no one will detect it.  Consensus only builds among physicians as glaucoma progresses to later, more obvious stages.

Among the many types of glaucoma, the most common is called “open angle glaucoma.”  Our previously oversimplified view of glaucoma is that too much pressure inside the eye puts stress on the optic nerve, gradually killing it, which leads to eventual blindness if not treated.

But the truth is much more complicated than that.  Here are the challenges we face, followed by the good news.

Almost inexplicably, some patients can have above-normal eye pressure and not have a problem.  Conversely, some patients can have normal or below normal eye pressure and still have glaucoma.  In spite of all that, all treatment options are focused on lowering eye pressure, which is usually affective for all types of glaucoma!  As if that weren’t sneaky enough, it is possible for the nerves inside your eye to have the appearance that they have glaucoma when they don’t, and look like they don’t when they do.  Additionally, there is enough redundancy in the system to allow for significant nerve loss before it affects our vision—which is why it can go undetected for so long.

Fortunately, we have become better at understanding risk factors and measuring sensitive indicators that can reveal glaucoma in earlier stages.  For example, we have testing technologies that can detect retinal nerve thinning down to the micron.  We can measure the speed and strength of your vision signal down two major visual pathways to your brain in each eye; and we can measure extremely minute changes to how your pupils react to light.  The standard testing for peripheral vision is still used extensively, but doesn’t pick up the earliest stages of glaucoma because of the redundancy in the optic nerve that masks early damage.

Ultimately, diagnosing glaucoma today is an art that relies on what we know about your health history, your race, your lifestyle, and your family history along with several critical measurements of your visual system.  With today’s medicines and surgery options, treatment is quite simple—and for most people is as easy as taking a very safe eye drop before bedtime each night.  We know that the earlier we intervene, the easier it is to protect  your vision, and so we work to find the balance in early cases between how much risk we can detect against the cost of treating vs the cost of waiting for more certainty.

With the aging of the baby boomers and increasing longevity, the incidence of glaucoma is on the rise.  After the age of 40, seeing your eye doctor regularly is the best defense that there is for fending off glaucoma’s sneaky theft of the precious gift of sight.

See you out there!

Dr Gooch and Dr. Robison  can be contacted at 435-414-1616.

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