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The main objective in treating glaucoma is to lower intraocular pressure (or "IOP") in the eye. A lower IOP can reduce damage to the optic nerve and save your remaining vision.There are two main types of glaucoma, open-angle and angle-closure. Open-angle glaucoma is the most common type of glaucoma and involves fluid in the eye not draining properly through the trabecular meshwork. Angle-closure glaucoma involves a sudden buildup of pressure in the eye and poor drainage because the angle between the iris and the cornea is too narrow.

Glaucoma is the leading cause of blindness and visual impairment in the United States.  It can affect patients of all ages, many of whom do not experience any symptoms and may not be aware that they have the disease. 

 

Glaucoma actually refers to a group of diseases that cause damage to the optic nerve as a result of increased pressure within the eye, but can also be caused by a severe eye infection, injury, blocked blood vessels or inflammatory conditions of the eye.

Many patients do not experience any symptoms during the early stages of glaucoma, including no pain and no vision loss. This leaves most patients unaware that they even have the disease.

Symptoms of Angle-Closure Glaucoma

·         Hazy or blurred vision.
·         The appearance of rainbow-colored circles around bright lights.
·         Severe eye and head pain.
·         Nausea or vomiting (accompanying severe eye pain)
·         Sudden sight loss.

 

Treatment for Glaucoma

Glaucoma eye drops often are the first choice over glaucoma surgery and can be very effective at controlling IOP to prevent eye damage. If you are a good candidate for glaucoma eye drops, you may be prescribed more than one type to achieve the best IOP control. In fact, many types of these drops can enhance the effects of other types.

 

For other patients, laser or traditional surgery is required to lower eye pressure. Common surgeries include:

  • Nd: YAG Laser Cyclophotocoagulation (YAG CP) - For patients with severe glaucoma damage who have not been helped by other surgeries. The ciliary body that produces intraocular fluid is destroyed.
  • 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. ALT is effective in about 75% of patients, and SLT may be repeated.

  • Filtering Microsurgery (Trabeculectomy) - For patients who have not been helped with laser surgery or medications. A new drainage passage is created by cutting a small hole in the sclera (the white part of the eye) and creating a collection pouch between the sclera and conjunctiva (the outer covering of the eye).

  • Tube Shunt Surgery - May be recommended for patients with neovascular glaucoma, failed trabeculectomy or susceptibility to developing scar tissue. A thin, flexible tube with a silicone pouch is inserted in the eye to facilitate drainage.

  •  Laser Peripheral Iridotomy (LPI) - For patients with narrow-angle glaucoma. A small hole is made in the iris to increase the angle between the iris and cornea and encourage fluid drainage.

    Some cases of glaucoma can be treated conservatively with eye drops. Eye drops are used to reduce fluid production in the front of the eye or to help drain excess fluid, but can lead to redness, stinging, irritation or blurry vision. Patients should tell their doctor about any allergies they have to minimize the risk of side effects.

 
What Can I do to Prevent Glaucoma

Currently, regular eye exams are the best form of prevention against significant glaucoma damage.

Early detection and careful, lifelong treatment can maintain vision in most people. In general, a check for glaucoma should be done:

 


·         Before age 40, every two to four years
·         From age 40 to age 54, every one to three years
·         From age 55 to 64, every one to two years
·         Are over the age of 60
·         African Americans over the age of 40
·         Have a family history of glaucoma
·         Have poor vision
·         Have diabetes
·         After age 65, every six to 12 months

Anyone with high risk factors should be tested every year or two after age 35. Those at higher risk include people of African descent, people with diabetes, and people with a family history of glaucoma. You are at increased risk if you have a parent or brother or sister with glaucoma.

Diagnosing Glaucoma

The doctor also can diagnose patients who already have glaucoma by observing their nerve damage or visual field loss. The following tests, all of which are painless, may be part of this evaluation. Tonometry determines the pressure in the eye by measuring the tone or firmness of its surface. While some patients may experience symptoms from glaucoma as the disease progresses, others do not learn that they have the condition until they undergo a routine eye exam. There are several different exams performed to diagnose glaucoma, including a visual field and visual acuity test. 

These tests measure peripheral vision and how well patients can see at various distances. Other tests may also be performed, such as tonometry to measure the pressure inside the eye and the thickness of the cornea.

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