Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for good vision. This damage is often caused by an abnormally high pressure in your eye.

Glaucoma is one of the leading causes of blindness for people over the age of 60. It can occur at any age but is more common in older adults.

Many forms of glaucoma have no warning signs. The effect is so gradual that you may not notice a change in vision until the condition is at an advanced stage.

Because vision loss due to glaucoma can't be recovered, it's important to have regular eye exams that include measurements of your eye pressure so a diagnosis can be made in its early stages and treated appropriately. If glaucoma is recognized early, vision loss can be slowed or prevented. If you have the condition, you'll generally need treatment for the rest of your life.

Symptoms

The signs and symptoms of glaucoma vary depending on the type and stage of your condition. For example:

Open-angle glaucoma

·         Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes

·         Tunnel vision in the advanced stages

Acute angle-closure glaucoma

·         Severe headache

·         Eye pain

·         Nausea and vomiting

·         Blurred vision

·         Halos around lights

·         Eye redness

If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye within 20 years.

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When to see a doctor

Promptly go to an emergency room or an eye doctor's (ophthalmologist's) office if you experience some of the symptoms of acute angle-closure glaucoma, such as severe headache, eye pain and blurred vision.

Causes

Glaucoma is the result of damage to the optic nerve. As this nerve gradually deteriorates, blind spots develop in your visual field. For reasons that doctors don't fully understand, this nerve damage is usually related to increased pressure in the eye.

Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows throughout the inside of your eye. This internal fluid normally drains out through a tissue called the trabecular meshwork at the angle where the iris and cornea meet. When fluid is overproduced or the drainage system doesn't work properly, the fluid can't flow out at its normal rate and eye pressure increases.

Glaucoma tends to run in families. In some people, scientists have identified genes related to high eye pressure and optic nerve damage.

Risk factors

Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:

·         Having high internal eye pressure (intraocular pressure)

·         Being over age 60

·         Being black, Asian or Hispanic

·         Having a family history of glaucoma

·         Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia

·         Having corneas that are thin in the center

·         Being extremely nearsighted or farsighted

·         Having had an eye injury or certain types of eye surgery

·         Taking corticosteroid medications, especially eyedrops, for a long time

Diagnosis

Your doctor will review your medical history and conduct a comprehensive eye examination. He or she may perform several tests, including:

·         Measuring intraocular pressure (tonometry)

·         Testing for optic nerve damage with a dilated eye examination and imaging tests

·         Checking for areas of vision loss (visual field test)

·         Measuring corneal thickness (pachymetry)

·         Inspecting the drainage angle (gonioscopy)

Treatment

The damage caused by glaucoma can't be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.

Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your options may include prescription eyedrops, oral medications, laser treatment, surgery or a combination of any of these.

Eyedrops

Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, more than one of the eyedrops below may need to be prescribed.

Oral medications

If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

Surgery and other therapies

Other treatment options include laser therapy and various surgical procedures. The following techniques are intended to improve the drainage of fluid within the eye, thereby lowering pressure:

·         Laser therapy. Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option if you have open-angle glaucoma. It's done in your doctor's office. Your doctor uses a small laser beam to open clogged channels in the trabecular meshwork. It may take a few weeks before the full effect of this procedure becomes apparent.

·         Filtering surgery. With a surgical procedure called a trabeculectomy (truh-bek-u-LEK-tuh-me), your surgeon creates an opening in the white of the eye (sclera) and removes part of the trabecular meshwork.

·         Drainage tubes. In this procedure, your eye surgeon inserts a small tube shunt in your eye to drain away excess fluid to lower your eye pressure.

·         Minimally invasive glaucoma surgery (MIGS). Your doctor may suggest a MIGS procedure to lower your eye pressure. These procedures generally require less immediate postoperative care and have less risk than trabeculectomy or installing a drainage device. They are often combined with cataract surgery. There are a number of MIGS techniques available, and your doctor will discuss which procedure may be right for you.

After your procedure, you'll need to see your doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.

Treating acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. If you're diagnosed with this condition, you'll need urgent treatment to reduce the pressure in your eye. This generally will require both medication and laser or other surgical procedures.

You may have a procedure called a laser peripheral iridotomy in which the doctor creates a small opening in your iris using a laser. This allows fluid (aqueous humor) to flow through it, relieving eye pressure.


 


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