What Is Glaucoma?
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.
Glaucoma is a leading cause of blindness for people over 60 years old. But blindness from glaucoma can often be prevented with early treatment. In a healthy eye, excess fluid leaves the eye through the drainage angle, keeping pressure stable.
Types of glaucoma
There are two major types of glaucoma
Primary open-angle glaucoma
This is the most common type of glaucoma. It happens gradually, where the eye does not drain fluid as well as it should (like a clogged drain). As a result, eye pressure builds and starts to damage the optic nerve. This type of glaucoma is painless and causes no vision changes at first.
Some people can have optic nerves that are sensitive to normal eye pressure. This means their risk of getting glaucoma is higher than normal. Regular eye exams are important to find early signs of damage to their optic nerve.
Angle-closure glaucoma (also called “closed-angle glaucoma” or “narrow-angle glaucoma”)
This type happens when someone’s iris is very close to the drainage angle in their eye. The iris can end up blocking the drainage angle. You can think of it like a piece of paper sliding over a sink drain. When the drainage angle gets completely blocked, eye pressure rises very quickly. This is called an acute attack. It is a true eye emergency, and you should call your ophthalmologist right away or you might go blind.
Here are the signs of an acute angle-closure glaucoma attack:
- Your vision is suddenly blurry
- You have severe eye pain
- You have a headache
- You feel sick to your stomach (nausea)
- You throw up (vomit)
- You see rainbow-colored rings or halos around lights
Many people with angle-closure glaucoma develop it slowly. This is called chronic angle-closure glaucoma. There are no symptoms at first, so they don’t know they have it until the damage is severe or they have an attack. Angle-closure glaucoma can cause blindness if not treated right away.
Glaucoma Treatment
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.
Medication
Glaucoma is usually controlled with eyedrop medicine. Used every day, these eye drops lower eye pressure. Some do this by reducing the amount of aqueous fluid the eye makes. Others reduce pressure by helping fluid flow better through the drainage angle.
Glaucoma medications can help you keep your vision, but they may also produce side effects.
Some eye drops may cause:
- a stinging or itching sensation
- red eyes or red skin around the eyes
- changes in your pulse and heartbeat• changes in your energy level
- changes in breathing (especially if you have asthma or breathing problems)
- dry mouth
- blurred vision
- eyelash growth
- changes in your eye color, the skin around your eyes or eyelid appearance.
All medications can have side effects. Some drugs can cause problems when taken with other medications. It is important to give your doctor a list of every medicine you take regularly. Be sure to talk with your ophthalmologist if you think you may have side effects from glaucoma medicine.
Never change or stop taking your glaucoma medications without talking to your ophthalmologist. If you are about to run out of your medication, ask your ophthalmologist if you should have your prescription refilled.
Laser surgery
In trabeculectomy, a flap is first created in the sclera (the white part of the eye). Then a small opening is made into the eye to release fluid from the eye.
There are two main types of laser surgery to treat glaucoma. They help aqueous drain from the eye. These procedures are usually done in the ophthalmologist’s office or an outpatient surgery center.
Trabeculoplasty. This surgery is for people who have open-angle glaucoma. The eye surgeon uses a laser to make the drainage angle work better. That way fluid flows out properly and eye pressure is reduced.
Iridotomy. This is for people who have angle-closure glaucoma. The ophthalmologist uses a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.
Operating room surgery
Traditional glaucoma surgery is done in an operating room. It creates a new drainage channel for the aqueous humor to leave the eye.
Trabeculectomy. This is where your eye surgeon creates a tiny flap in the sclera. He or she will also create a bubble (like a pocket) in the conjunctiva called a filtration bleb. It is usually hidden under the upper eyelid and cannot be seen. Aqueous humor will be able to drain out of the eye through the flap and into the bleb. In the bleb, the fluid is absorbed by the tissue around your eye, lowering eye pressure.
Glaucoma drainage devices. Your ophthalmologist may implant a tiny drainage tube in your eye. The glaucoma drainage implant sends the fluid to a collection area (called a reservoir). Your eye surgeon creates this reservoir beneath the conjunctiva. The fluid is then absorbed into nearby blood vessels.
Minimally Invasive Glaucoma Surgery (MIGS)
Compared to traditional glaucoma surgery, MIGS requires shorter operation time and allows for more rapid recovery. MIGS can be combined with cataract extraction (CE) for patients with mild to moderate glaucoma and cataracts. MIGS has been approved for mild to moderate open-angle glaucoma and has a lower risk profile. Though early studies show MIGS may be less effective in lowering IOP than traditional glaucoma surgeries, MIGS do fill a gap in the treatment of patients who would benefit from lower IOP but do not warrant the risk of traditional surgery.
Your role in glaucoma treatment
Treating glaucoma successfully is a team effort between you and your doctor. Your ophthalmologist will prescribe your glaucoma treatment. It is up to you to follow your doctor’s instructions and use your eye drops.
Once you are taking medications for glaucoma, your ophthalmologist will want to see you regularly. You can expect to visit your ophthalmologist about every 3–6 months. However, this can vary depending on your treatment needs. If you have any questions about your eyes or your treatment, talk to your ophthalmologist.
