Glaucoma is a disease that causes loss of vision by damaging the optic nerve, the part of the eye that delivers the images you see to the brain. It is the second leading cause of blindness according to the World Health Organization. Over 3 million Americans have glaucoma, and it causes blindness in over 100,000 people annually. Because it can strike without warning or symptoms, it is often called the Sneak Thief of Sight. Due to this fact, most people with glaucoma are not aware they have it. Glaucoma cannot be cured, and the vision loss it causes cannot be regained. But with proper treatment, it is possible to slow the progression of glaucoma and potentially halt further loss of vision.
About the disease Glaucoma typically results from an abnormally high amount of pressure inside the eye (known as intraocular pressure or IOP). The eyes natural drainage system becomes blocked and the fluid inside (called the aqueous humor) cannot drain, causing pressure to build up. As a result, excessive pressure is put on the sensitive optic nerve, which can cause vision loss. The first sign of glaucoma is often the loss of peripheral or side vision. Untreated glaucoma can lead to tunnel vision, and eventually can cause total blindness. Glaucoma can be grouped into two major categories: -Primary open-angle glaucoma accounts for ~ 90% of all cases. It exhibits few symptoms, if any, until it reaches an advanced stage. -Angle-closure glaucoma is less common but more severe, and is marked with a rapid rise in eye pressure and severe vision loss. People at the highest risk of getting glaucoma: -Adults over 60 are 6 times more likely to have glaucoma than the general population -African-Americans are 6 to 8 times more likely than Caucasians to have glaucoma -People with a family history of glaucoma or diabetes are at greater risk for glaucoma -About 800,000 Americans 40 to 50 years of age have elevated IOP from glaucoma -Approximately 2,000,000 Americans over 70 have elevated IOP from glaucoma
Diagnosis Since glaucoma comes with few warning signs, regular eye exams are essential for detecting glaucoma early enough to allow successful treatment. A routine glaucoma exam usually includes a test to measure pressure and an examination of the inside of the eye, primarily the optic nerve . A visual field test may be used to monitor peripheral vision, helping the doctor determine the extent of vision loss and the effectiveness of treatment. Treatment Medications are the most common form of glaucoma treatment today. Approximately 50% of glaucoma patients are on two or more medications to reduce IOP. There are many penetrating surgical or laser interventions that have the common characteristic of lowering IOP with different degrees of success and permanently damaging the anatomic structures of the eye. These include: trabeculectomy, iridectomy, iridotomy, laser trabeculoplasty and glaucoma implant procedures. Canaloplasty is the newest non-penetrating interventional procedure today that does not permanently alter the anatomy of the eye and leaves all other treatment options available if needed. Canaloplasty
ECP Endoscopic CycloPhotocoagulation or ECP, is an exciting development in the management of many types of glaucoma including open-angle glaucoma and narrow-angle glaucoma. ECP is performed on an outpatient basis, often at the same time as cataract surgery. In this procedure, the ciliary body of the eye, which creates fluid, is treated with a laser. This reduces fluid production that in turn, reduces intra-ocular pressure. All of the surgeons at Ohio Eye Alliance are qualified to perform ECP.
SLT Selective Laser Trabeculoplasty (SLT) is a non-scarring treatment for glaucoma. The laser targets pigmented cells in the trabecular meshwork, a sponge-like drainage system in the eye. SLT, unlike other types of laser surgery, may be safely repeated many times. SLT may also be an alternative for those who have been treated unsuccessfully with traditional laser surgery or with pressure lowering eye drops.
Trabecular meshwork after SLT (top) and after more destructive ALT (bottom)