Glaucoma

What is glaucoma?

Glaucoma is an eye disease in which the normal fluid pressure inside the eyes slowly rises, leading to vision loss – or even blindness. This discussion is about open-angle glaucoma, the most common form of the disease.

What causes it?

At the front of the eye, there is a small space called the anterior chamber. Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues. In glaucoma, the fluid drains too slowly out of the eye or too much fluid is produced by the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye and loss of vision.

Who is most likely to get it?

Nearly 3 million people have glaucoma, a leading cause of blindness in the United States. Although anyone can get glaucoma, some people are at higher risk. They include:

Blacks over the age of 40.
Anyone over the age of 60.
People with a family history of glaucoma.

Among Blacks, studies show that glaucoma is:

Five times more likely to occur in Blacks than in Whites.
About four times more likely to cause blindness in Blacks than in Whites.
Fifteen times more likely to cause blindness in Blacks between the ages of 45-64 than in Whites of the same age group.

What are the symptoms?

At first, there are no symptoms. Vision stays normal, and there is no pain. However, as the disease progresses, a person with glaucoma may notice his or her side vision gradually failing. That is, objects in front may still be seen clearly, but objects to the side may be missed. As the disease worsens, the field of vision narrows and blindness results.

How is it detected?

Many people may know of the “air puff” test or other tests that are used to measure eye pressure test for the risk for glaucoma. But this test alone cannot detect glaucoma, it is just a screening tool doctors use to determine the need for further testing. There is no one test that determines whether or not a person has glaucoma. To diagnose glaucoma, an eye doctor will perform many different types of tests and examine the results from all of the different tests to assess the risk for glaucoma.

How can it be treated?

Although open-angle glaucoma cannot be cured, it can usually be controlled. The most common treatments are:

Medications

These may be either in the form of eye drops or pills. Some drugs are designed to reduce pressure by slowing the flow of fluid into the eye. Others help to improve fluid drainage.

For most people with glaucoma, regular use of medications will control the increased fluid pressure. As with any medications, glaucoma drops may have side effects and their effectiveness can decrease over time.

If a medication has side effects or cannot lower the pressure enough, your eye care professional may select other drugs, change the dose, or suggest other treatments for glaucoma.

Laser Surgery

During laser surgery, a strong beam of light is focused on the part of the anterior chamber where the fluid leaves the eye. This results in changes to that structure, making it easier for fluid to exit the eye. Over time, the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking glaucoma medications.

Trabeculectomy Surgery

This surgery can also help fluid escape from the eye and thereby reduce the pressure. This type of surgery is usually reserved for patients whose pressure cannot be controlled with eye drops, pills, or laser surgery.

What can you do to protect your vision?

Studies have shown that early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease. So, if you fall into one of the high-risk groups for the disease, make sure to have your eyes examined through dilated pupils every two years or more often if your eye care professional recommends.

If you have been diagnosed with glaucoma, follow the treatment plan determined by your eye doctor, including taking all of the glaucoma medication that you are prescribed and returning for all recommended appointments to monitor the progression of the disease.

Adapted from the National Eye Institute patient brochure.

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