Glaucoma

Glaucoma is caused by a buildup of fluid pressure inside the eye, which gradually damages the optic nerve. The optic nerve is made up of millions of tiny fibers that carry visual information from the eye to the brain. When these fibers are damaged, blind spots can appear in the field of vision, often without the patient noticing until substantial damage has occurred. Unfortunately, once vision is lost to glaucoma, it cannot be restored.

The eye produces a clear fluid called aqueous humor, which circulates through the eye and drains out via tiny channels. If these drainage channels become blocked or do not function properly, pressure builds up inside the eye. The normal eye pressure is between 12 and 22 mmHg, and when the pressure exceeds this range, it can gradually damage the optic nerve.

There are several different types of glaucoma, each with distinct characteristics. The most common forms include:

   
• Primary open-angle glaucoma: The most common form, it affects about 90% of people with glaucoma. It develops slowly as the drainage channels become gradually blocked, leading to a slow loss of vision.

   

• Normal-tension glaucoma: This form causes damage to the optic nerve even though eye pressure remains within the normal range.

   

• Angle-closure glaucoma: This type occurs when the drainage angle in the eye becomes blocked, often suddenly, which can be a medical emergency.

   

• Secondary glaucoma: Caused by other factors, such as inflammation, steroid use, or eye trauma, secondary glaucoma can result from pre-existing conditions.

   

• Congenital glaucoma: A rare form of glaucoma present at birth or in early childhood, requiring specialized treatment.

While glaucoma can affect anyone, certain risk factors increase the likelihood of developing the condition. Factors such as age, family history, and ethnic background can play a role in determining an individual’s risk for glaucoma.

   
• Aging, particularly individuals over the age of 40, with the risk increasing significantly after the age of 60.

   

• Family history of glaucoma, especially if one has parents or siblings with the condition.

   

• Ethnic backgrounds, with higher risk among individuals of African American or Afro-Caribbean descent for open-angle glaucoma, and individuals of Asian descent for angle-closure glaucoma.

   

• Conditions such as diabetes, heart disease, or high blood pressure can increase risk.

   

• Previous eye injuries or long-term use of steroids can also contribute to the development of glaucoma.

Unfortunately, glaucoma cannot be fully prevented. However, early detection through regular eye exams can help slow or even halt its progression, preserving vision. Early treatment is key in preventing significant damage.

The target eye pressure for each patient varies depending on the severity of the disease and individual risk factors. Our ophthalmologists set personalized pressure goals and adjust treatment to maintain pressure at a safe level, aiming to protect the optic nerve and prevent further damage.

Prescription eye drops are typically the first line of treatment for glaucoma. These drops work either by improving the drainage of fluid from the eye or by reducing the production of fluid. Most patients will need to use eye drops regularly for the rest of their lives.

   
• Prostaglandin analogs: Help increase fluid outflow and may cause redness, eyelash growth, or darkening of the iris.

   

• Beta-blockers: Reduce fluid production but can affect heart rate and breathing in some patients.

   

• Alpha agonists and carbonic anhydrase inhibitors: Lower pressure using different mechanisms.

   

• Rho-kinase inhibitors: Help increase outflow and may cause redness or other mild effects.

Laser treatments, such as selective laser trabeculoplasty, are used to improve fluid drainage or reduce fluid production. These treatments are often effective as a first-line approach and can be performed in-office with minimal recovery time.

Minimally invasive glaucoma surgeries (MIGS) offer a way to lower eye pressure using smaller incisions and faster recovery times than traditional surgeries. These procedures are often done alongside cataract surgery and involve the use of micro-devices to improve drainage.

When other treatments don't control eye pressure adequately, traditional surgeries may be necessary. Procedures such as trabeculectomy or tube shunts create new drainage channels or use devices to lower pressure, though they come with higher risks and longer recovery times.

For angle-closure glaucoma, laser peripheral iridotomy can be performed to create a small hole in the iris and allow fluid to drain more freely. This is a crucial step in preventing sudden pressure increases. Additional treatments may be necessary depending on the severity of the condition.

In difficult cases that don't respond to other treatments, cyclophotocoagulation may be used. This procedure, which uses laser or freezing techniques, reduces fluid production and is typically reserved for advanced stages of glaucoma.