Columnists

Glaucoma—The Silent Thief . . .

Issue 40.16

Glaucoma is a disease that damages your eye’s optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve.

It is estimated that three million Americans have glaucoma, but only about half of them know that they have it. Though glaucoma is a leading cause of blindness for people over 60 years old it has no symptoms early on. In this way, glaucoma can steal your sight very gradually (the silent thief). Fortunately, early detection and treatment (with glaucoma eyedrops, glaucoma surgery or both) can help preserve your vision.

The optic nerve is connected to the retina — a layer of light-sensitive tissue lining the inside of the eye — and is made up of many nerve fibers, like an electric cable is made up of many wires. The optic nerve sends signals from your retina to your brain where these signals are interpreted as the images you see.

There are several types of glaucoma.  By far the most common form is primary open-angle glaucoma. It occurs when the trabecular meshwork of the eye gradually becomes less efficient at draining fluid. As this happens, your eye pressure, called intraocular pressure (IOP), rises. Raised eye pressure leads to damage of the optic nerve.

Typically, open-angle glaucoma has no symptoms in its early stages and your vision remains normal.  This is why it is important, especially as you get older, to have regular medical eye exams by an Ophthalmologist.  Adults with no symptoms of or risk factors for eye disease should have a complete eye disease screening by age 40. Adults 65 or older should have an eye exam every one to two years.  (At age 60 one has four times the risk of glaucoma as he had at 40).  As the optic nerve becomes more damaged, blank spots eventually begin to appear in your field of vision. If all of the optic nerve fibers die, you will be blind.

Half of patients with glaucoma do not have high eye pressure when first examined. Eye pressure is not always the same – it rises and falls from day to day and hour to hour. So a single eye pressure test will miss many people who have glaucoma. In addition to routine eye pressure testing, it is essential that the optic nerve be examined by an ophthalmologist for proper diagnosis.

Treatment options:  Glaucoma damage is permanent—it cannot be reversed. But medicine and surgery help to stop further damage. To treat glaucoma, your ophthalmologist may use one or more of the following treatments:

1. Medicated eye drops are the most common way to treat glaucoma. These medications lower your eye pressure either by reducing fluid production or by improving drainage.

2.  Laser and Surgical Therapy

  1. A surgery called laser trabeculoplasty is often used to treatopen-angle glaucoma. The newest, called selective laser trabeculoplasty (SLT) is repeatable, and uses a newer, lower-energy laser to make the drain work better.
  2. Up until about a year ago the only laser option we had to decrease the production of fluid inside the eye was cyclophotocoagulation which caused selective damage to the fluid production structure within the eye. Unfortunately this was associated with often severe side effects.  Approximately a year ago the FDA approved MicroPulse technology which “chops” the continuous-wave cyclophotocoagulation laser beam into repetitive short pulses allowing tissue to cool between pulses.  This accomplishes the decrease of fluid production and reduction of pressure while preventing tissue damage.  We have been using this new laser at Richens Eye Center for the last six months.  It has allowed us in many cases to decrease the number of glaucoma medications our patients are on.  More importantly it has decreased the number of patients that otherwise would have needed to proceed to more invasive surgical procedures to control their glaucoma.

In summary, glaucoma is an insidious disease with no symptoms that causes progressive loss of optic nerve fibers.  If unchecked this process eventually results in blindness.  The good news is that modern technology has given us many effective ways to control or prevent continuing damage.  The phrase “The good old days” is baloney—the good old days of glaucoma are RIGHT NOW.  In order to bring this wonderful technology into play, however requires the discovery of the problem.  This is accomplished with a baseline evaluation at age 40 and an annual exam after age 65.  After all, your car gets routine maintenance . . . aren’t you (and your vision) at least as important? If you are interested in finding out more about proper vision care or have any questions, please call Richens Eye Center, 435.216.1226 or visit us online at richenseyecenter.com. We welcome the opportunity to serve you.

 

 

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