3 Facts to Know About Glaucoma
It is Glaucoma Week. As a result, this week’s blog will feature three facts you should know about glaucoma.
What is glaucoma?
Glaucoma is a progressive disease of the optic nerve that can lead to vision loss or blindness. The optic nerve is a bundle of over one million nerve fibers that transports our visual information from the eye to the back of the brain where it is processed. In the early stages of glaucoma, there are often no visual symptoms. This has led to it being called “the silent thief of sight”. Studies have shown that up to half of the nerve tissue needs to be damaged before changes are noted in one’s vision. Unfortunately, once damage occurs, it is permanent. Thus, early detection is critical to preserving one’s vision. A dilated eye exam is critical to early detection. Some studies show that as many as 50% of those with glaucoma are unaware that they have glaucoma.
Who is at risk of developing glaucoma?
The risk of developing glaucoma increases with age. Everyone over the age of 50 should have yearly dilated eye exams to aid in detecting early signs of glaucoma.
Having a family history of glaucoma increases one’s risk of developing glaucoma. The highest risk is if it is a first degree relative such as a parent, sibling or child.
Ethnicity can also be a risk factor for developing glaucoma. Those of African American, Hispanic and Asian heritage all have an increased risk of developing glaucoma.
Factors that affect the blood flow to the optic nerve can increase the risk of developing glaucoma. Having a high eye pressure is associated with an increased risk of glaucoma. Conditions such as vasospasm and hypotension are also associated with an increased risk of glaucoma. Diabetes and migraine are specific conditions thought to increase one’s risk of developing glaucoma.
Some injuries to the eye can increase the risk of developing glaucoma. Also, long-term treatment with steroids may increase one’s risk of developing glaucoma.
How is glaucoma treated?
There are numerous treatment options for glaucoma ranging from medication, laser to surgical options. Diagnosing glaucoma early in the disease process allows for the most successful management of glaucoma. Ultimately, the treatment of glaucoma, which involves lowering the pressure within the eye, consists of either increasing the outflow of fluid from within the eye, decreasing the production of fluid within the eye or a combination of both.
The most common initial medical treatment for glaucoma is an eye drop within the prostaglandin class of medications. These drops are dosed once daily in the evening and work to increase the outflow of fluid from within the eye. Beta-blockers are a class of medication that is typically dosed once daily in the morning and work to decrease the production of fluid within the eye. Alpha agonists are another class of medication that are does two to three times per day, working to both decrease the production of fluid within the eye and also increase the drainage of fluid. Carbonic anhydrase inhibitors decrease the production of fluid within the eye and are dosed two to three times per day. Rho kinase inhibitors are the newest class of medication. They increase the outflow of fluid from within the eye, being dosed once daily in the evening.
Selective laser trabeculoplasty is an office-based laser treatment that increases the outflow of fluid from within the eye. This procedure is effective in about 80% of patients. Due to its good safety profile, it can be considered a first-line treatment instead of an eye drop or used in addition to an eye drop to better manage a patient’s eye pressure.
MIGS, minimally invasive glaucoma surgery, is a relatively new group of surgical procedures that combine a good safety profile with the ability to lower a patient’s eye pressure. These procedures can reduce the number of medications that a patient needs to use and also decrease the need to move on to more aggressive surgical procedures.
Trabeculectomy and tube shunt surgery are procedures that can greatly reduce the pressure within a patient’s eye and possibly eliminate the need for medications. These procedures are more aggressive than the procedures stated earlier in this blog and therefore carry more risk for complication.