What is glaucoma?
Glaucoma is a disease that ultimately results in damage to the optic nerve, which can result in vision loss if not treated appropriately. Most commonly, it is thought to be related to high pressure inside the eye (this is different from your blood pressure). However, not all forms of glaucoma have high eye pressure. The vision loss starts peripherally, and in early stages, is often asymptomatic. It is the second leading cause of blindness worldwide after cataracts.
Does my blood pressure affect my eye pressure?
No, they are independent of one another. Just because your primary care doctor diagnoses you with high blood pressure, this does not mean you have high eye pressure. The inverse applies, as well.
What are the risk factors for developing glaucoma?
There are several risk factors for developing glaucoma. High intraocular pressure is the most common, and only modifiable, risk factor. Age is another important risk factor, as we age, our risk for glaucoma increases. Thin corneal thickness can also impart a higher risk for developing glaucoma – although, it is not clear if this is a result of falsely low-pressure readings or a direct risk factor. Race is another important risk factor – risk of developing glaucoma is highest in patients of African-Caribbean descent, followed by Hispanics and then Caucasians. Family history in a first-degree relative (mother, father or sibling) is also a risk factor. Patients who are nearsighted (myopic) may also be at higher risk for developing glaucoma, but this connection is not definitive.
Is it true there are different kinds of glaucoma?
Yes. Most glaucoma falls into the category of primary open angle glaucoma. This is a painless and largely asymptomatic (you will not know you have it), form of glaucoma. Normal tension glaucoma is a form of open angle glaucoma where pressures stay within the normal range, but nerve damage still occurs. These types of glaucoma are often asymptomatic and require identification and management by your eye doctor.
Angle closure glaucoma is a form of glaucoma where the drainage system of the eye (the trabecular meshwork) is occluded by the iris (the colored part of the eye) and pressure can fluctuate significantly throughout the day. If blockage is complete, the pressure can get high enough to prevent adequate blood flow to the eye. This is often accompanied by eye pain, headache, nausea/vomiting and decreased vision – this is a medical emergency and needs to be seen immediately.
How will I know if I have glaucoma?
Often times, you will not know you have glaucoma. Early stages of glaucoma are often painless, and vision loss is not noticeable. Unfortunately, in these early stages, you will not have any indication you have glaucoma. Glaucoma can only be diagnosed by your eye doctor and requires routine screening determine if glaucoma is present.
If my parents had glaucoma, does that mean I will get it?
Several genes are thought to be associated with glaucoma, and family history is a risk factor. We think that glaucoma development is complex and has numerous causes including inheritance and environmental factors.
Is there a cure for glaucoma?
Glaucoma is treatable, but there is no cure for glaucoma. With the right treatment and monitoring, glaucoma progression can be slowed or even halted. Discuss the treatment options with your eye doctor to ensure you are on the right treatment, and that your glaucoma is under control.
How will glaucoma affect my life?
Early on in the disease course, you will likely have no symptoms or perceptible vision loss. However, in later stages, vision loss can be profound and even complete if not treated. More importantly, vision loss from glaucoma is the result of nerve damage, which is permanent and cannot be restored. It is important to see your eye doctor to ensure that if you have glaucoma, your treatment is adequate to prevent progression. Typically, this will require visits every 3-6 months for pressure checks. In addition to checking eye pressure, tests that evaluate the function and structure of the optic nerve, such as visual fields and special pictures of the nerves need to be performed every 6-12 months.
How do you treat glaucoma?
The first line of therapy for glaucoma is eye drops or laser therapy. Typically, eye drops are applied 1-3 times daily (depending on the class of medication you are prescribed). If eye drops do not adequately control pressure, or you cannot tolerate or comply with the advised regimen, further laser treatment or incisional surgery may be required.
What other treatments are available besides drops?
If drops are ineffective in controlling the pressure adequately, there are additional treatments that can be performed. The first are laser-based treatments – these are called Laser Trabeculoplasty (SLT or ALT). They are often effective at reducing pressure but may require repeated treatments if the effect wears off after a few years. Surgery may be required for glaucoma that cannot be controlled with drops or laser. Recently, minimally invasive glaucoma procedures called MIGS (micro-invasive glaucoma surgery) have become available. These offer quicker visual recovery with smaller incisions and a lower risk profile. These can often be performed at the time of cataract surgery. If a MIGS procedure is inadequate, more invasive surgical options exist, such as a filtering bleb or tube shunt device. In all of these cases, you may still need to use eye drops to fully control your pressure.
My friend had cataract surgery, and they told her they treated her glaucoma as well. Does cataract surgery treat glaucoma?
The short answer is no. Cataract surgery can lower intraocular pressure in around 50% of cases, but the amount of pressure reduction may be inadequate to control glaucoma. There are procedures that can be performed at the time of your cataract surgery, that can lower your pressure and potentially make you less dependent on eye drops for pressure control. These procedures are called MIGS, or microinvasive glaucoma surgery. You may be a candidate for MIGS, so ask your surgeon if this option is right for you.