Glaucoma
Introduction
Glaucoma affects an estimated 3 million Americans, with
120,000 blind due to the condition. It is one of the leading
causes of vision impairment people over age 65. Because most
forms do not have symptoms until serious impairment, it is known
as a "silent" disease, and can progress undetected for years. About
half of Americans with chronic glaucoma don't know they have it.
With early diagnosis through appropriate medical eye
examinations, visual loss is highly preventable.
What is glaucoma?
Glaucoma is a constellation of diseases that all result in damage
to the optic nerve. The optic nerve is a "cable," made up of about a
million nerve cells, that takes information from the eye to the
brain. As an extension of the brain, an optic nerve injury
responds very much like a brain or spinal cord injury. Usually
damage is irreversible. In glaucoma, the optic nerve is
progressively injured. The first part of the area of vision, or visual
field to be affected is peripheral or side vision; the center of vision
is spared until the late stages of the disease.
Glaucoma is a disease that is sensitive to pressure inside the eye
or intraocular pressure (IOP). The front part of the eye is filled
with a clear, nourishing fluid called aqueous. Aqueous is
constantly being produced and drained away inside the eye. The
IOP therefore, will depend on the balance of production and
removal, and can be measured. High IOP is the result of a
deficiency in drainage. Typically, the higher the IOP, the more
rapid the glaucoma progression. And high IOP (like high blood
pressure) is usually painless, unless is rises suddenly and
severely. The mainstay of glaucoma treatment is to reduce the
IOP.
*In summary, glaucoma is a pressure-sensitive optic nerve injury
that causes progressive loss of visual field without symptoms. *
Should I be tested for glaucoma?
You are at a higher risk for glaucoma with advancing age, so every
one over the age of 40 should be evaluated for glaucoma. If you
have ever been told that you are a "glaucoma suspect" (see below)
you should be evaluated every 6 months. Some people are at a
higher risk for developing glaucoma and should also be evaluated
at regular intervals. Specifically, the presence of family history,
African-American race, medical conditions such as diabetes,
hypertension and heart disease, and certain eye conditions can
increase your risk of glaucoma.
How is glaucoma diagnosed?
A complete eye exam is necessary in the diagnosis of glaucoma. If
you have been to a glaucoma screening in the community, you
may have preliminary results, but this is not enough to give a
definite answer as to whether or not you have glaucoma.
Along with a complete eye exam, your ophthalmolgist may need to
perform several ancillary tests to aid in the diagnosis of glaucoma.
Some of these tests include peripheral vision test, photographs of
the optic nerve, digital 3-D Optic nerve imaging, and
measurement of the central corneal thickness.
A "glaucoma suspect" is a patient who has several risk factors or
preliminary evidence that might suggest early glaucoma without
conclusive evidence.
Dr. Baroody is proficient in every aspect of glaucoma diagnosis
and treatment. Dr. Baroody offers state-of-the-art diagnostic tests,
including: Humphrey Visual Field Analyzer (HVF), Ocular
Coherence Tomography (OCT), and ultrasonic pachymetry.
Glaucoma affects an estimated 3 million Americans, with
120,000 blind due to the condition. It is one of the leading
causes of vision impairment people over age 65. Because most
forms do not have symptoms until serious impairment, it is known
as a "silent" disease, and can progress undetected for years. About
half of Americans with chronic glaucoma don't know they have it.
With early diagnosis through appropriate medical eye
examinations, visual loss is highly preventable.
What is glaucoma?
Glaucoma is a constellation of diseases that all result in damage
to the optic nerve. The optic nerve is a "cable," made up of about a
million nerve cells, that takes information from the eye to the
brain. As an extension of the brain, an optic nerve injury
responds very much like a brain or spinal cord injury. Usually
damage is irreversible. In glaucoma, the optic nerve is
progressively injured. The first part of the area of vision, or visual
field to be affected is peripheral or side vision; the center of vision
is spared until the late stages of the disease.
Glaucoma is a disease that is sensitive to pressure inside the eye
or intraocular pressure (IOP). The front part of the eye is filled
with a clear, nourishing fluid called aqueous. Aqueous is
constantly being produced and drained away inside the eye. The
IOP therefore, will depend on the balance of production and
removal, and can be measured. High IOP is the result of a
deficiency in drainage. Typically, the higher the IOP, the more
rapid the glaucoma progression. And high IOP (like high blood
pressure) is usually painless, unless is rises suddenly and
severely. The mainstay of glaucoma treatment is to reduce the
IOP.
*In summary, glaucoma is a pressure-sensitive optic nerve injury
that causes progressive loss of visual field without symptoms. *
Should I be tested for glaucoma?
You are at a higher risk for glaucoma with advancing age, so every
one over the age of 40 should be evaluated for glaucoma. If you
have ever been told that you are a "glaucoma suspect" (see below)
you should be evaluated every 6 months. Some people are at a
higher risk for developing glaucoma and should also be evaluated
at regular intervals. Specifically, the presence of family history,
African-American race, medical conditions such as diabetes,
hypertension and heart disease, and certain eye conditions can
increase your risk of glaucoma.
How is glaucoma diagnosed?
A complete eye exam is necessary in the diagnosis of glaucoma. If
you have been to a glaucoma screening in the community, you
may have preliminary results, but this is not enough to give a
definite answer as to whether or not you have glaucoma.
Along with a complete eye exam, your ophthalmolgist may need to
perform several ancillary tests to aid in the diagnosis of glaucoma.
Some of these tests include peripheral vision test, photographs of
the optic nerve, digital 3-D Optic nerve imaging, and
measurement of the central corneal thickness.
A "glaucoma suspect" is a patient who has several risk factors or
preliminary evidence that might suggest early glaucoma without
conclusive evidence.
Dr. Baroody is proficient in every aspect of glaucoma diagnosis
and treatment. Dr. Baroody offers state-of-the-art diagnostic tests,
including: Humphrey Visual Field Analyzer (HVF), Ocular
Coherence Tomography (OCT), and ultrasonic pachymetry.
What are the major types of glaucoma?
There are two major types of glaucoma: open-angle glaucoma
(OAG) and angle-closure glaucoma (ACG). There are several
causes and variations within these 2 categories.
The angle refers to the structure inside your eye that drains the
aqueous. The eye doctor can look at the angle with a special
mirror called a gonioscope. Remember that all types of glaucoma
have a deficiency in the drainage of aqueous.
When the angle is open, that means it appears to be structurally
open or normal. In this type of glaucoma the drain doesn't work
well, or there is something clogging the drain at the microscopic
level. Think of OAG like a clog inside the bathtub drainpipe.
Open angle glaucoma is typically slowly progressive and
painless.
When the angle is closed, that means it appears to be closed, or
sealed from the doctors view. Usually, structures inside the eye
such as the iris (colored part) are bowed forward blocking the
aqueous from entering the angle. Think of ACG like someone put
a stopper in the bathtub drain. Angle-closure glaucoma is
typically sudden and painful!
Examples of open angle glaucoma:
Primary open angle glaucoma (POAG) is the most common form of
the disease. The etiology is yet unknown. POAG is slowly
progressive and painless.
Normal-tension glaucoma (also termed normal-pressure
glaucoma, low-tension glaucoma or low-pressure glaucoma) is
like POAG but the IOP remains in the normal range.
Exfoliation Glaucoma is caused by tiny particles deposited
throughout the eye that also deposit and clog the drainage angle.
Exfoliation syndrome (also called pseudoexfoliation) affects
mostly Caucasians, and has a higher risk with advancing age.
This type of glaucoma tend to be more aggressive than POAG.
Pigmentary Glaucoma is caused by the release of pigment from
the back of the iris which in turn clogs the drainage angle.
Pigmentary glaucoma often exhibits no symptoms, or some pain
and blurry vision after exercise. Pigmentary glaucoma affects
mostly white males in their mid-30s to mid-40s.
Examples of Angle-Closure Glaucoma:
Acute angle-closure glaucoma is caused by sudden, complete
blockage of the drainage angle by the iris. Patients can be
predisposed to this by having short, shallow or crowded eyes such
as those who are very far-sighted. Intraocular pressure rises
suddenly and severely with produces symptoms such as eye pain,
headaches, halos around lights, blurry vision, red eyes, nausea
and vomiting. Acute angle-closure glaucoma is a medical
emergency. If the high pressure is not reduced within hours, it
can permanently damage vision. Anyone who experiences its
symptoms should immediately contact an ophthalmologist or go
to a hospital emergency room.
Chronic angle-closure glaucoma is a slowly progressive disease
and therefore can be asymptomatic, or can eventually look like
an attack of acute ACG in the later stages.
Pupil-block glaucoma results in angle closure but is secondary
to forward pressure on the lens in apposition of the pupil. This
can be caused by a severely mature cataract, after chronic eye
inflammation or after eye surgery.
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