Glaucoma

Answer 1

Important Information About Glaucoma You Should Know

Glaucoma, also called the “sneak thief of sight,” is a serious eye disease that can cause permanent blindness if not diagnosed and treated in time. In honor of National Glaucoma Awareness Month every January, we would like to share some very important information about glaucoma that you will benefit from knowing.

Approximately three million people in the United States have some type of glaucoma eye disease. Based on available data, the National Eye Institute projects this number to climb to approximately 4.2 million people by the year 2030.

This important information about glaucoma is for informational purposes. If you suspect you have any of the symptoms of eye glaucoma, we recommend immediately scheduling an appointment with your trusted eye care provider. Let’s start with some basic facts about glaucoma.

Some basic facts about glaucoma:

Only about 50% of the 3 million Americans with glaucoma get diagnosed

Higher rates among people of African-American, Asian or Latino/Hispanic heritage

African-Americans are 5x more likely to get glaucoma and 6x more likely to go blind

Up to 40% of sight can be lost before glaucoma is diagnosed

If undiagnosed and treated, glaucoma can cause permanent blindness

What are the Causes of Glaucoma?

At the present time, the causes of glaucoma are still a mystery. Although pressure on the optic nerve (also called “ocular hypertension”) is considered to be a significant risk factor, even people whose eye pressure is well within the “normal” range get glaucoma too.

Genetic disposition might explain the disproportionately high rate of glaucoma in people with East Asian, Central/South American and African-American heritage. However, at this time researchers still cannot say with any certainty.

Glaucoma Risk Factors

Although the exact cause of glaucoma remains a mystery, we have identified several glaucoma risk factors. Glaucoma risk factors include:

Age (40+)

Family history

Previous eye injury

Far or near-oriented eyesight

Use of steroid-based medication

Diabetes, high blood pressure/hypertension, poor circulation

The Symptoms of Eye Glaucoma

There are two primary types of age-related Macular Degeneration: Wet Form and Dry Form. By performing a retinal eye scan, your optometrist can detect both forms.

normal field of vision

Normal Field of Vision

field of vision with glaucoma eye disease

Field of Vision with Advanced Glaucoma

The symptoms of Glaucoma range significantly depending on the type of glaucoma someone suffers from. Some people do not experience any of the symptoms of eye glaucoma until significant vision loss occurs. For other people, the symptoms of eye glaucoma are very hard to ignore. These symptoms can include:

Vision becomes blurry

The eyes redden permanently

Sensitivity to light and/or soreness of the eyes

Lights appear to have “halos” around them

Sudden onset of visual disturbance, especially in low light

Severe eye pain accompanied by nausea and vomiting

Tunnel vision (toward the later stages of the disease)

It is very important to understand that the symptoms of eye glaucoma can also be caused by other types of diseases and illnesses too. If you have ANY of these symptoms, regardless of severity, we urge you to immediately contact and schedule an appointment with your trusted eye care professional.

The Different Types of Glaucoma Eye Disease

a woman's eye with glaucoma

Acute angle closure glaucoma of the right eye (intraocular pressure was 42 in the right eye). Note the mid sized pupil on the left that was not reactive to light and conjunctivitis. Photo taken by James Heilman, MD.

There are several differing types of glaucoma eye disease:

Low or Normal Tension Glaucoma is still a mystery

Open-Angle Glaucoma (most common) occurs when fluid from the eye passes too slowly for too long through the open drainage “channel” where the iris and cornea meet

Angle-Closure Glaucoma (less common) occurs when the drainage angle closes because part of the iris is blocking it

Congenital Glaucoma occurs at birth, is generally easily diagnosable, and with surgery children can have a good prognosis for vision health in life

Pigmentary Glaucoma (rare) is a complication of pigment dispersion syndrome, which occurs when pigment granules from the iris flake off into eye fluid

Traumatic Glaucoma is the result of injury to the eye by blunt trauma, flying debris and/or bleeding

Additionally, two different types of glaucoma eye disease can occur as the byproduct of associated medical conditions:

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Answer 2

Definition

Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain.

In many cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP).

Alternative Names

Open-angle glaucoma; Chronic glaucoma; Closed-angle glaucoma; Congenital glaucoma; Angle closure glaucoma

Causes, incidence, and risk factors

Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma:

• Open-angle (chronic) glaucoma
• Angle-closure (acute) glaucoma
• Congenital glaucoma
• Secondary glaucoma

The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made in the back of the eye. It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle.

Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye. This pressure is called intraocular pressure (IOP). In most cases of glaucoma, this pressure is high and causes damage to the major nerve in the eye, called the optic nerve.

Open-angle (chronic) glaucoma is the most common type of glaucoma.

• The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve and the retina at the back of the eye
• Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease

Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure within the eye (intraocular pressure).

• Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision
• If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment
• Dilating eye drops and certain medications may trigger an acute glaucoma attack

Congenital glaucoma often runs in families (is hereditary).

• It is present at birth
• It results from the abnormal development of the fluid outflow channels in the eye

Secondary glaucoma is caused by:

• Drugs such as corticosteroids
• Eye diseases such as uveitis
• Systemic diseases

Symptoms

OPEN-ANGLE GLAUCOMA

• Most people have NO symptoms until they begin to lose vision
• Gradual loss of peripheral (side) vision (also called tunnel vision)

ANGLE-CLOSURE GLAUCOMA

• Symptoms may come and go at first, or steadily become worse
• Sudden, severe pain in one eye
• Decreased or cloudy vision
• Nausea and vomiting
• Rainbow-like halos around lights
• Red eye
• Eye feels swollen

CONGENITAL GLAUCOMA

• Symptoms are usually noticed when the child is a few months old
• Cloudiness of the front of the eye
• Enlargement of one eye or both eyes
• Red eye
• Sensitivity to light
• Tearing

Signs and tests

An eye exam may be used to diagnose glaucoma. The doctor will need to examine the inside of the eye by looking through the pupil, often while the pupil is dilated. The doctor will usually perform a complete eye exam.

Checking the intraocular pressure alone (tonometry) is not enough to diagnose glaucoma because eye pressure changes. Pressure in the eye is normal in about 25% of people with glaucoma. This is called normal-tension glaucoma. There are other problems that cause optic nerve damage.

Tests to diagnose glaucoma include:

• Gonioscopy (use of a special lens to see the outflow channels of the angle)
• Tonometry test to measure eye pressure
• Optic nerve imaging (photographs of the inside of the eye)
• Pupillary reflex response
• Retinal examination
• Slit lamp examination
• Visual acuity
• Visual fieldmeasurement

Treatment

The goal of treatment is to reduce eye pressure. Depending on the type of glaucoma, this is done using medications or surgery.

Open-angle glaucoma treatment:

Most people with open-angle glaucoma can be treated successfully with eye drops. Most eye drops used today have fewer side effects than those used in the past. You may need more than one type of drop. Some patients may also be treated with pills to lower pressure in the eye. Newer drops and pills are being developed that may protect the optic nerve from glaucoma damage.

Some patients will need other forms of treatment, such as a laser treatment, to help open the fluid outflow channels. This procedure is usually painless. Others may need traditional surgery to open a new outflow channel.

Angle-closure glaucoma treatment:

Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. Drops, pills, and medicine given through a vein (by IV) are used to lower pressure. Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new channel in the iris. The new channel relieves pressure and prevents another attack.

Congenital glaucoma treatment:

This form of glaucoma is almost always treated with surgery to open the outflow channels of the angle. This is done while the patient is asleep and feels no pain (with anesthesia).

Expectations (prognosis)

Open-angle glaucoma:

With good care, most patients with open-angle glaucoma can manage their condition and will not lose vision, but the condition cannot be cured. It's important to carefully follow up with your doctor.

Angle-closure glaucoma:

Rapid diagnosis and treatment of an attack is key to saving your vision. Seek emergency care immediately if you have symptoms of an angle-closure attack.

Congenital glaucoma:

Early diagnosis and treatment is important. If surgery is done early enough, many patients will have no future problems.

Calling your health care provider

Call your health care provider if you have severe eye pain or a sudden loss of vision, especially loss of peripheral vision.

Call for an appointment with your health care provider if you have risk factors for glaucoma and have not been screened for the condition.

Prevention

There is no way to prevent open-angle glaucoma, but you can prevent vision loss from the condition. Early diagnosis and careful management are the keys to preventing vision loss.

Most people with open-angle glaucoma have no symptoms. Everyone over age 40 should have an eye examination at least once every 5 years, and more often if in a high-risk group. Those in high-risk groups include people with a family history of open-angle glaucoma and people of African heritage.

People at high risk for acute glaucoma may opt to undergo iridotomy before having an attack. Patients who have had an acute episode in the past may have the procedure to prevent a recurrence.

References

Burr JM, Mowatt G, Hernandez R, Siddiqui MA, Cook J, Lourenco T, et al. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess. 2007 Oct;11(41):iii-iv, ix-x, 1-190.

Kwon YH, Figert JH, Kuehn MH, Alward WL. Primary open-angle glaucoma. N Engl J Med. 2009 Mar 12;360(11):1113-24.

Vass C, Hirn C, Sycha T, Findl O, Bauer P, Schmetterer L. Medical interventions for primary open angle glaucoma and ocular hypertension. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003167.

Answer 3

Glaucoma is the development of increased pressure within the eye. If left untreated, glaucoma may damage the optic nerve, resulting in visual impairment and eventually blindness.

Reviewed By

Review Date: 09/14/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 4

Definition

Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve. This nerve carries visual information from the eye to the brain.

In most cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP).

Alternative Names

Open-angle glaucoma; Chronic glaucoma; Chronic open-angle glaucoma; Primary open-angle glaucoma; Closed-angle glaucoma; Narrow-angle glaucoma; Angle-closure glaucoma; Acute glaucoma; Secondary glaucoma; Congenital glaucoma

Causes, incidence, and risk factors

Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma:

• Open-angle (chronic) glaucoma
• Angle-closure (acute) glaucoma
• Congenital glaucoma
• Secondary glaucoma

The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made behind the colored part of the eye (the iris). It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle.

Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye. This pressure is called intraocular pressure (IOP). In most cases of glaucoma, this pressure is high and causes damage to the optic nerve.

Open-angle (chronic) glaucoma is the most common type of glaucoma.

• The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve.
• Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease.

Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye.

• Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision.
• If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment.
• Dilating eye drops and certain medications may trigger an acute glaucoma attack.

Congenital glaucoma is seen in babies. It often runs in families (is inherited).

• It is present at birth.
• It is caused by abnormal eye development.

Secondary glaucoma is caused by:

• Drugs such as corticosteroids
• Eye diseases such as uveitis
• Systemic diseases
• Trauma

Symptoms

OPEN-ANGLE GLAUCOMA

• Most people have no symptoms
• Once vision loss occurs, the damage is already severe
• There is a slow loss of side (peripheral) vision (also called tunnel vision)
• Advanced glaucoma can lead to blindness

ANGLE-CLOSURE GLAUCOMA

• Symptoms may come and go at first, or steadily become worse
• Sudden, severe pain in one eye
• Decreased or cloudy vision, often called "steamy" vision
• Nausea and vomiting
• Rainbow-like halos around lights
• Red eye
• Eye feels swollen

CONGENITAL GLAUCOMA

• Symptoms are usually noticed when the child is a few months old
• Cloudiness of the front of the eye
• Enlargement of one eye or both eyes
• Red eye
• Sensitivity to light
• Tearing

Signs and tests

A complete eye exam is needed to diagnose glaucoma. You may be given eye drop to widen (dilate) your pupil. The eye doctor can look at the inside of the eye when the pupil is dilated.

A test called (tonometry) is done to check eye pressure. However, eye pressure always changes. Eye pressure can be normal in some people with glaucoma. This is called normal-tension glaucoma. Your doctor will need to run other tests to confirm glaucoma.

Some of the tests your doctor may do can include:

• Using a special lens to look at the eye (gonioscopy)
• Photographs or laser scanning images of the inside of the eye (optic nerve imaging)
• Examination of the retina in the back of the eye
• Slit lamp examination
• Visual acuity
• Visual fieldmeasurement

Treatment

The goal of treatment is to reduce eye pressure. Treatment depends on the type of glaucoma that you have.

If you have open-angle glaucoma, you will probably be given eye drops. You may need more than one type. Most people can be treated successfully with eye drops. Most of the eye drops used today have fewer side effects than those used in the past. You may also be given pills to lower pressure in the eye.

Other treatments may involve:

• Laser therapy called an iridotomy
• Eye surgery if other treatments do not work

Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. If you have angle-closure glaucoma, you will receive:

• Eye drops
• Medicines to lower eye pressure, given by mouth and through a vein (by IV)

Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new pathway in the colored part of the eye. This relieves pressure and prevents another attack.

Congenital glaucoma is almost always treated with surgery. This is done using general anesthesia. This means the patient is asleep and feels no pain.

If you have secondary glaucoma, treatment of the underlying disease may help your symptoms go away. Other treatments may be needed.

Expectations (prognosis)

Open-angle glaucoma cannot be cured. However, you can manage your symptoms by closely following your doctor's instructions. Regular check-ups are needed to prevent blindness.

Angle-closure glaucoma is a medical emergency. You need treatment right away to save your vision.

Babies with congenital glaucoma usually do well when surgery is done early.

How well a person with secondary glaucoma does depends on the disease causing the condition.

Calling your health care provider

Call your health care provider if you have severe eye pain or a sudden loss of vision, especially loss of peripheral vision.

Call for an appointment with your health care provider if you have risk factors for glaucoma and have not been screened for the condition.

Prevention

All adults should have a complete eye exam before age 40, or sooner if you have risk factors for glaucoma or other eye problems. You are more likely to get glaucoma if you are African American or have a family history of open-angle glaucoma.

If you are at high risk for acute glaucoma, talk to your doctor about having eye surgery to prevent an attack.

References

Anderson DR. The Optic Nerve in Glaucoma. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 48.

Kwon YK, Caprioli J. Primary Open-Angle Glaucoma. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 52.

Giaconi JA, Law SK, Caprioli J. Primary Angle-Closure Glaucoma. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 53.

Mandelcorn E, Gupta N. Lens-Related Glaucomas. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 54A.

Reviewed By

Review Date: 09/14/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.