Glaucoma

What is Glaucoma?

Glaucoma is a group of eye diseases that damage the optic nerve. Damage to the optic nerve is usually a result of increased intraocular pressure (IOP). Increased eye pressure develops when the fluids in the eye improperly drain. Over time, an increase in IOP may damages the optic nerve and cause vision loss and blindness.

Symptoms

Glaucoma is often referred to as the “sneak thief of sight” because it produces no symptoms until later stages. Glaucoma is diagnosed through regular, routine eye examinations, which can help to catch glaucoma before it progresses.

Visual loss from glaucoma is irreversible.  This is why early detection and treatment is very important: they allow measures to prevent progression and preserve remaining vision or slow down the progression of vision loss.

Most Common Types

Acute Closed-Angle Glaucoma

Closed-angle glaucoma occurs when the iris prevents proper intraocular fluid draining. This may result in an acute glaucoma attack when eye pressure may increase rapidly, producing severe headache, eye pain, nausea, and halos and result in significant vision loss in hours.

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Open-Angle Glaucoma

Open-angle glaucoma does not present any symptoms unless it progresses to its later stages. However, patients eventually lose vision; most often peripheral vision is lost first but central vision may also be affected or lost. Open-angle glaucoma can lead to total, permanent vision loss.

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Normal-Tension Glaucoma

Also known as low-tension glaucoma, normal-tension glaucoma is a condition in which vision loss and optic nerve damage occur despite what is usually considered to be normal intraocular pressure levels. This type of glaucoma may also result in peripheral vision loss.

These are more common types, however many other types of glaucoma exist.

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Testing

Frequent, routine eye examinations help detect glaucoma. The trained physicians at Albany Eye Associates use a variety of special glaucoma tests to evaluate the eye’s drainage angle (gonioscopy), measure eye pressure (tonometry), evaluate the optic nerve (ophthalmolscopy), and test visual fields. Information gathered during these evaluations is compared at regular intervals over time to evaluate whether glaucoma is present or how the glaucoma has progressed.

An Intraocular Pressure Check (Tonometry) measures intraocular pressure (IOP) and is used in the diagnosis and monitoring of glaucoma. For this test, an ophthalmologist uses eye drops to numb the patient’s eyes before using a special device to measure IOP. This test is painless and only takes a few minutes to complete.

The Optic Nerve Examination (Ophthalmoscopy) is an examination of the inside of the eye, focusing on the optic nerve and retina. For this test, the pupils are dilated and then magnified using an opthalmoscope, an instrument with a small light on the end). This allows the ophthalmologist to view the color and shape of the optic nerve. If there is any unusual finding to the optic nerve, the ophthalmologist will perform additional tests such as drainage angle inspection, computerized optic nerve imaging and visual field testing.

Drainage Angle Inspection (Gonioscopy) determines if the area where fluid drains of out of the eye is open or closed. If this area, called the drainage angle, is damaged, blocked, or clogged, pressure may increase within the eye.

Visual Field Evaluation primarily measures peripheral vision to reveal areas of vision loss. A decrease in the visual field is often an early glaucoma sign.

The test is conducted by a technician who will ask a patient to look directly ahead at a central target. The patient is instructed to press a button on a buzzer when he or she sees a small, white light appear (or grey shimmery lines depending on the test doctor ordered).

If a patient is unable detect the small, white light it may indicate a decreased visual field.

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Treatment

While there is no recognized cure for glaucoma, there are several treatments available that can help to manage the disease by lowering intraocular pressure. Laser or eye drops are common treatments. If intraocular pressure cannot be managed with laser or eye drops alone, surgery may be recommended. Surgery can help to alleviate pressure by increasing the eye’s existing drainage mechanism, for better intraocular fluid drainage.

Medical treatment of glaucoma

Often initial treatment for glaucoma is the use of eye drops. These work to reduce intraocular pressure by increasing the amount of fluid drainage from the eye or by reducing the amount of fluid produced within the eye. Several types of glaucoma eye drops exist and your doctor will help to select the ones that work the best for you. Oral glaucoma medications may also be prescribed. Oral medications may be used in conjunction with topical medications to reduce intraocular pressure.

Laser treatment of glaucoma

  • Laser Peripheral Iridotomy (LPI) – For patients with narrow-angle glaucoma. A small opening is made in the iris to increase the angle between the iris and cornea and encourage fluid drainage.
  • Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT) – For patients with primary open angle glaucoma (POAG). The trabecular passages are opened to increase fluid drainage.
  • Nd: YAG Laser Cyclophotoablation (YAG CP) – For patients with severe glaucoma damage who have not been helped with other surgeries. The ciliary body that produces intraocular fluid is treated to reduce the amount of intraocular fluid produced.

If intraocular pressure cannot be controlled with oral or topical medications, an ophthalmologist may recommend glaucoma surgery.

Surgical treatment of glaucoma

  • Filtering Microsurgery (Trabeculectomy) – For patients who have not been helped with laser surgery or medications. A new drainage passage is made by creating a small opening in the sclera (the white shell of the eye), creating a collection pouch between the sclera and conjunctiva (the outer covering of the eye).
  • Tube Shunt Surgery –In this procedure, a thin, flexible tube (a shunt) with a silicone pouch is inserted in the eye to facilitate drainage.
  • Endoscopic cytophotocoagulation- This procedure is recommended for several types of glaucoma. For the endoscopic cyclophotocoagualtion (ECP) procedure, an ophthalmologist uses a laser on the ciliary tissue to decrease the production of fluid within the eye. Performed under local anesthesia, the procedure is one of the newest glaucoma surgeries. Studies have shown that the ECP procedure has significant success rate with a relatively low complication risk.

If you are a patient with glaucoma or would like to be examined for glaucoma, call Albany Eye Associates to schedule an appointment

If you would like to read further about glaucoma, you can do so at the American Academy of Ophthalmology or National Eye Institute.

To learn more about Glaucoma contact Albany Eye Associates at 518-434-1042 to schedule an appointment with one of our Board Certified Doctors.