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  • Glaucoma

    Definition

    Glaucoma is a group of diseases that can damage the optic nerve in the eye and result in blindness. One type of glaucoma, called open-angle glaucoma, is often associated with increased pressure inside your eye. This type of glaucoma can lead to vision loss or even blindness. This fact sheet focuses on open-angle glaucoma, the most common form of the disease.
    Normal Anatomy of the Eye
    IMAGE
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    Causes

    At the front of the eye, there is a small space called the anterior chamber. The anterior chamber lies between the lens and the cornea. Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues and to keep the eye properly formed. In glaucoma, for unknown reasons, the fluid can drain too slowly out of 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, leading to vision loss.

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition.
    Risk factors for glaucoma include, but are not limited to:
    • Age: over 40 years old
    • Race: Black or Hispanic
    • Family members with glaucoma
    • Having diabetes
    • Having hypertension (high blood pressure)
    Note: Risk factors for other forms of glaucoma may differ from these.

    Symptoms

    Glaucoma usually does not cause visual symptoms right away. At first, vision remains normal and there is no pain. However, as the disease progresses, peripheral vision gradually begins failing. 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 complete blindness can result. Glaucoma is usually a slowly progressive disease, causing damage over many years before obvious symptoms occur.

    Diagnosis

    An ophthalmologist or optometrist can often detect glaucoma during an eye examination. During an eye examination your pupils will be dilated to check for glaucoma and other diseases. To accomplish this, drops are put into your eyes during the exam to enlarge your pupils. This allows the eye care professional to see more of the inside of the eye.
    To detect glaucoma, your eye care professional will perform the following tests:
    • Visual acuity—measures how well you see at various distances
    • Visual field—measures your side (peripheral) vision
    • Tonometry—determines fluid pressure inside the eye
    • Pupil dilation—provides a better view of the optic nerve to check for signs of damage

    Treatment

    Although open-angle glaucoma cannot be cured, it can often be controlled.
    Treatments may include:

    Medications

    These may be eye drops, eye ointments, or pills. Some drugs are designed to reduce pressure by slowing the production of fluid into the eye. Others help improve fluid drainage.
    For most people with glaucoma, regular use of medications will control the progression of damage by lowering eye pressure. However, these drugs may stop working over time, may cause side effects, or may not be effective enough to control the progression of damage. If a problem occurs, your eye care professional may select other drugs, change the dose, or suggest other ways to deal with the problem.
    Common glaucoma medications include:
      Drugs that decrease the production of intraocular fluid:
      • Beta-blockers—Timolol, Levobunolol, Carteolol
      • Carbonic anhydrase inhibitors (CAI)—Acetazolamide, Neptazane, Brinzolamide, Dorzolamide
      • Combination CAI/beta-blocker—Cosopt
      Drugs that increase the drainage of intraocular fluid:
      • Miotics—(rarely used) Carbachol, Ocusert Akarpine, E-Pilo-1
      • Prostaglandin—Bimatoprost, Latanoprost, Travoprost
      Drugs that may decrease production and increase drainage of intraocular fluid:
      • Sympathomimetic alpha-adrenergic agonist—Brimonidine, Apraclonidine
      • Sympathomimetic nonselective—(rarely used) Epinal, Glaucon, Dipivefrin

    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 can help fluid 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 drugs.

    Conventional Surgery

    Surgery can also help fluid escape from the eye and reduce pressure. However, surgery is usually reserved for patients who continue to progress despite maximum therapy with eye drops, pills, or laser surgery.

    Observation

    If there is no decrease in the visual field, the patient and physician may decide not to treat glaucoma. Since glaucoma is a very variable disease, treatment decisions are made on an individual basis. In some instances, it may be difficult to diagnose glaucoma. Many people have some signs of the disease, but do not necessarily have the disease. Some physicians decide to monitor patients as “glaucoma suspects” instead of committing them to treatment. Treatment is often initiated once changes consistent with glaucoma are detected.

    Prevention

    There are no guidelines for preventing glaucoma.
    Early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease. Since vision loss is gradual and begins only in peripheral vision, most patients don't notice any visual changes until significant damage has been done.
    Have regular eye examinations, including having your pupils dilated. This is especially important if you are at high risk for glaucoma.

    RESOURCES

    The Glaucoma Foundation http://www.glaucomafoundation.org

    Glaucoma Research Foundation http://www.glaucoma.org

    CANADIAN RESOURCES

    Canadian Association of Optometrists http://opto.ca

    Canadian Ophthalmological Society http://www.cos-sco.ca

    References

    Glaucoma. National Eye Institute. National Institutes of Health website. Available at: http://www.nei.nih.gov/health/glaucoma/glaucoma%5Ffacts.asp. Updated May 2009. Accessed July 6, 2009.

    Miglior S, Zeyen T, et al. Results of the European Glaucoma Prevention Study. Ophthalmology. 2005; 112:366.

    What is glaucoma? Glaucoma Research Foundation website. Available at: http://www.glaucoma.org/glaucoma. Updated September 2008. Accessed July 6, 2009.

    Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363:1711.

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