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There are now a number of excellent therapies to treat Glaucoma and slow down the loss of vision. Although there is no cure for this disease, early detection, treatment and close monitoring can prevent vision loss. Since patients often do not have any symptoms of Glaucoma, regular eye exams are important to detect any vision changes.

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What is Glaucoma?

Glaucoma is a condition that causes damage to the optic nerve over time. It is often characterized by elevated intraocular pressure and frequently shows an inheritance pattern. If left untreated, glaucoma can result in irreversible harm to the optic nerve and permanent vision loss. There are several different types of glaucoma:

Eye diagram showing drainage canal blocked and build up of fluidEye diagram showing how increased pressure can damage blood vessels

The most common form of glaucoma is Primary Open Angle Glaucoma (POAG) and results from a failure of the eye’s drainage system. This leads to a slow development of increased pressures over time. Initial damage to the optic nerve is typically subtle, having very little effect on vision. Over time, increased damage to the nerve enlarges the visual defects and eventually leads to blindness if left untreated. POAG is considered a medical condition and can be treated with medicated eye drops, laser surgery to stimulate the drainage system, or glaucoma surgery to create a new drainage pathway.

The second most common type of glaucoma, Narrow-Angle or Angle-Closure Glaucoma (NAG), is predominately found in patients who have short eyes. As the lens of the eye ages it thickens to cause crowding in the anterior chamber of the eye and partial blockage of the drainage system. Although the condition develops slowly, eye pressure will build very rapidly if enough of the drainage system is compromised. Common symptoms of an angle closure attack include dramatic and sudden onset of blurred vision, severe eye pain, headaches, nausea or vomiting, and halos. NAG can primarily be treated with a laser to reduce crowding. Alternative treatments can include cataract surgery to reduce crowding or glaucoma surgery to create a new drainage pathway if too much scar tissue is present.

Other types of glaucoma include Pseudoexfolative Glaucoma, Traumatic Glaucoma, Congenital Glaucoma, Normal or Low Tension Glaucoma, and Pigmentary Glaucoma.

Glaucoma Risk Factors and Symptoms

Glaucoma Risk Factors

There are many factors your ophthalmologist may consider in determining your risk for developing glaucoma: age, elevated ocular pressure, family history of glaucoma, African Middle Eastern or Hispanic ancestry, farsightedness or nearsightedness, past eye injuries, central corneal thickness, pre-existing thinning of optic nerve, and systematic health problems such as diabetes or poor circulation.

Glaucoma Symptoms

Most forms of glaucoma have no noticeable early warning signs and can only be detected during a comprehensive medical ophthalmic exam. As glaucoma progresses into more advanced stages, common symptoms may include blurred vision or loss of vision, severe eye pain, or rainbow-colored halos around lights with nausea or vomiting.

Below is a simulation of how the progression in Glaucoma can affect your vision over time if left untreated.

Glaucoma Vision Simulation Showing Flowers With Increasing Darkness Around Edges

Glaucoma Diagnostic Testing

There are several advanced tests performed in addition to a comprehensive medical eye examination. These tests are used to screen and monitor progression of the disease. For patients with multiple risk factors, initial testing can be performed as a baseline or point of comparison for future testing. These tests include the Optical Coherence Tomography for the optic nerve and the Visual Field Analyzer.

Cirrus Optical Coherence Tomography Machine

The CIRRUS™ Optical Coherence Tomography for the optic nerve provides extensive images producing a panoramic profile of the posterior segment. The images include a detailed assessment of the optic nerve and optic nerve fibers. These images allow physicians to view irregularities ranging from patients with pre-glaucoma to patients with advanced glaucoma.

Humphrey Field Analyzer Machine

The Humphrey® Field Analyzer (HFA) measures the visual field plane a patient maintains throughout the progression of glaucoma. The HFA determines the percentage of field loss due to nerve damage with every scan. This information provides the physician with a clear analysis of the patient’s field of vision.

Glaucoma Treatments

Common Treatment Options

Prescription Eye Drops

Medical treatment of glaucoma entails the daily use of prescription drugs to lower and stabilize the eye pressure. Many patients will take eye drops one to three times per day to control their glaucoma. However, ocular glaucoma medications can have systemic side effects, compliance issues, and cost issues for patients. It is very important to take glaucoma medications exactly as directed or the disease will progress resulting in loss of vision. Furthermore, the effectiveness of medications can change over time and close monitoring with comprehensive medical eye exams, visual field testing, and nerve imaging (OCT) is imperative. Nevertheless, treatment by medication is the most common treatment for glaucoma in the United States and is generally very successful when followed properly.

Select Laser Trabeculoplasty
Diagram showing Select Laser Trabeculoplasty ProcedureSLT (Selective Laser Trabeculoplasty) is a safe and simple laser treatment that effectively reduces the eye pressure for most patients with Primary Open Angle Glaucoma. The SLT mechanism of effect does not rely on medicines and is considered equal to medicine as a first line therapy for mild to moderate glaucoma. The SLT is performed on a structure known as the trabecular meshwork, which plays a vital role in the balance of internal eye pressure. As a result, the drainage system of the eye is stimulated and function usually improves. Although the effects of the laser will wear off over time, it can be safely repeated. In 2008, Eyes of York was the first facility in York to offer SLT. If you have glaucoma and are using medicated eye drops, ask your doctor about the SLT procedure at Eyes of York.


iStent Inject & Hydrus

iStent ExampleEyes of York also performs MIGS (Minimally Invasive Glaucoma Surgery) procedures in combination with Cataract Surgery. These devices are implanted during cataract surgery for patients who have mild to moderate open angle glaucoma and are using at least one prescription eye drop to lower their intraocular pressure. These devices work to increase the natural outflow of fluid through the eye by creating a permanent opening in what is known as the trabecular meshwork. They are placed during cataract surgery and cannot be seen, or felt, afterwards.  The ultimate goal of these devices is to reduce the pressure in the eye without the need for prescription eye drops. Not all patients with glaucoma are candidates. If you are nearing cataract surgery and have interest in this procedure, ask your doctor if the iStent Inject or Hydrus Microstent are right for you.

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