Patient Information

Glaucoma

 

Glaucoma is a condition that damages your eye's optic nerve. 

Glaucoma often occurs when the increased pressure of the fluid within your eye, called intraocular pressure, builds up which can then damage your optic nerve. The optic nerve sends images to your brain. If the damage to your optic nerve is left untreated, glaucoma can cause permanent vision loss or even total blindness within a few years. Glaucoma is broadly of two types Open Angle Glaucoma and Angle Closure Glaucoma.

 

Most people with glaucoma have no early symptoms.

If you lose vision from Glaucoma, it can not be brought back - but lowering eye pressure can help you prevent ongoing damage to the optic nerve. Most people with glaucoma who follow their treatment plan and have regular eye examinations are able to maintain good vision.

Regular eye check ups at Hills Eye Surgery will ensure that your intraocular pressure is within the acceptable range. Your Optic nerve will also be carefully examined to ensure that there are no signs of Glaucoma progression. Treatment options for Glaucoma include eye drops to lower eye pressure, laser treatment or surgery, which is usually required in patients who are not responding to conservative treatment.

 

What causes Glaucoma? 

The fluid inside your eye, called aqueous humour, usually flows out of your eye through a mesh-like channel. If this channel becomes blocked, the fluid builds up. Experts still do not know what causes this channel to become blocked. but we do know it can be inherited.

Less-common causes of glaucoma include a blunt or chemical injury to your eye, severe eye infection, blocked blood vessels inside your eye, and inflammatory conditions. It’s rare, but eye surgery to correct another condition can sometimes bring it on. It usually affects both eyes but it may be worse in one eye than the other.

 

What are Risk Factors for glaucoma?

It mostly affects adults over 40, but young adults, children, and even infants can have Glaucoma.

You’re more likely to develop Glaucoma if you:

  • Are of African American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
  • Are over 40 years old
  • Have a family history of glaucoma
  • Have diabetes
  • Take certain steroid medication such as Prednisone
  • Have had an injury to your eye or eyes
  • Have corneas that are thinner than usual
  • Have high blood pressure
  • Are very short sighted (Myopic)
  • Have a history of Migraine or Sleep Apnoea

Types of Glaucoma

There are two main types of Glaucoma:

Open-angle glaucoma. This is the most common type. The drainage structure in your eye (called the trabecular meshwork) looks fine, but fluid doesn’t flow out like it should.

Angle-closure glaucoma. This is more common in Asia. You may also hear it called acute or chronic angle-closure or narrow-angle glaucoma. Your eye doesn’t drain like it should because the drain space between your iris and cornea becomes too narrow. This can cause a sudden build up of pressure in your eye. 

Less common types of glaucoma include:

Secondary glaucoma. This is when another condition, like cataracts or Pseudoexfoliation of the lens capsule, causes added pressure in your eye.

Normal-tension glaucoma. This is when you have blind spots in your vision or your optic nerve is damaged even though your eye pressure is within the normal range. 

Pigmentary glaucoma. With this form, tiny bits of pigment from your iris, the coloured part of your eye, gets into the fluid inside your eye and clogs the drainage channels.

What are the symptoms of Glaucoma?

Most people with Open-angle glaucoma don’t have symptoms. If symptoms do develop, it’s usually late in the disease. That’s why glaucoma is often called the "sneak thief of sight." The main sign is usually a loss of side or peripheral field of vision.

Symptoms of Angle-closure glaucoma usually come on acutely due to a rapid rise in the intraocular pressure and are more obvious. Damage can happen quickly. These symptoms, include:

  • Seeing halos around lights
  • Blurred vision
  • Redness in your eye
  • Dilated pupil
  • Upset stomach or vomiting
  • Eye pain

How is Glaucoma diagnosed?

At Hills Eye Surgery we perform 5 significant tests which are needed to correctly diagnose Glaucoma. These include:

  1. Measuring your eye pressure  (IOP)
  2. Measuring your corneal thickness (Pachymetry)
  3. Performing a Visual Field examination (to assess your side vision)
  4. Performing an OCT scan (to assess your optic nerve)
  5. Examining the back of your eye, after dilating drops are instilled.

With all this information together, we will then be able to see if Glaucoma is present and/or the extent of Glaucoma.

How is Glaucoma Treated?

Eye drops: These days there are a number of Glaucoma eye drops available, which can successfully lower a patients eye pressure, without resorting to laser treatment or surgery. These work by either lowering the creation of fluid in your eye or increasing its out flow to lower eye pressure. Sometimes it is a matter of trial & error before the right drop is found that works for you. If drops are unsuccessful at lowering the eye pressure then laser or surgery might be suggested.

Laser treatment: This procedure can slightly increase the flow of fluid from your eye if you have open-angle glaucoma. It also can stop fluid blockage if you have angle-closure glaucoma. Procedures include:

  • Selective Laser Trabeculoplasty (SLT)- This allows more fluid to drain out of the eye.
  • Laser Iridotomy- This makes a tiny hole in your iris to let fluid flow more freely, in people with narrow angles.
  • Cyclodiode-This treats areas of the middle layer of your eye to lower fluid production.

Surgery: When eyedrops and /or laser have been unsuccessful then Glaucoma surgery like a MIGS (Minimally Invasive Glaucoma Surgery) procedure or filtration surgery known as a Trabeculectomy, may be suggested. This involves creating a new channel to drain the fluid and ease eye pressure. 

Glaucoma Prevention/ progression

You can not prevent glaucoma. But if it is detected early you can lower your risk of permanent eye damage/ vision loss. Therefore it is important to:

  • Have regular eye examinations. The sooner any signs of glaucoma are noted , the sooner you can start treatment. If you’re over age 40 and have a family history of the disease, have a full eye examination every 1 to 2 years. If you have health problems like diabetes or are at risk of other eye diseases, you may need to go more often.
  • Learn your family history. Ask your first degree relatives whether any of them have been diagnosed with glaucoma
  • Be compliant with your eyedrops  If you have been told to use eye drops for Glaucoma or high intraocular pressure, it is very important that you use your eye drops exactly as prescribed and do not to miss any drops. Patients who do not follow instructions correctly are only increasing their chances of their optic nerve from becoming irreversibly damaged from Glaucoma.