Glaucoma

Glaucoma is actually a group of eye diseases that lead to damage of the optic nerve (the bundle of nerve fibers that carries information from the eye to the brain), which can then lead to vision loss and the possibility of blindness.

Glaucoma is a leading cause of blindness among African Americans and Hispanics in the United States. African Americans experience glaucoma at a rate of three times that of Caucasians and experience blindness four times more frequently. Between the ages of 45 and 64, glaucoma is fifteen times more likely to cause blindness in African Americans than in Caucasians.

High-risk factors for open-angle glaucoma, the most common form of the disease, include being an African American and over 40, having a family history of the disease, and being over 60 for the general population. Those who are very nearsighted have a history of diabetes have experienced eye injury or eye surgery, or take prescription steroids also have an increased risk of developing glaucoma. It has also been suggested that individuals with Japanese ancestry may be at a greater risk for normal-tension glaucoma, and that those of Asian and Eskimo descent may have a greater risk for closed-angle glaucoma.

Open-angle glaucoma, by far the most common form, has no symptoms at first. At some point, side vision (peripheral vision) is lost and without treatment, total blindness will occur.

Closed-angle glaucoma (acute glaucoma) results from a sudden, complete blocking of the fluid flowing out of the eye. Symptoms may include severe pain, nausea, vomiting, blurred vision, and seeing a rainbow halo around lights. Closed-angle glaucoma is a medical emergency and must be treated immediately or blindness could result in one or two days.

Currently, there is no “cure” for glaucoma; however, early diagnosis and treatment can control glaucoma before vision loss or blindness occurs.

There are several tests that can help your eye care professional detect glaucoma; these include a visual acuity test, visual field test, dilated eye exam, tonometry (which measures that pressure inside of the eye), and pachymetry (which uses ultrasonic waves to help determine cornea thickness). Individuals at high risk for glaucoma should have a dilated pupil eye examination, including a visual field test, at least every two years.

Early treatment for open-angle glaucoma will usually begin with medications (pills, ointments, or eyedrops, for example) that either help the eye to drain fluid more effectively or cause it to produce less fluid. Several forms of laser surgery can also help fluid drain from the eye. Incisional surgery to create a new opening for fluid to drain is usually performed after the other treatment options have failed.

When a patient has glaucoma or is at high risk for developing the disease, physicians may document how the optic nerve changes over time by making drawings, taking photographs, or using a new technique called optic nerve imaging. Scanning laser polarimetry (GDx), confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph or HRT II), and optical coherence tomography (OCT) are all examples of optic nerve imaging techniques. The patient’s eye care professional will make the determination as to which method(s) to use.

New research is focusing not only on lowering pressure inside the eye, but is also exploring medications that will protect and preserve the optic nerve from the damage that causes vision loss as well as the role of genetic factors. There has been progress in understanding the genetics of glaucoma in the last few years. Genes have been found that are associated with congenital glaucoma, juvenile glaucoma, normal-tension glaucoma, adult-onset open-angle glaucoma, pigmentary glaucoma, and other conditions that are associated with secondary glaucoma.