Glaucoma is an irreversible condition where the optic nerve, which helps your brain form a picture for you to see, becomes damaged by a buildup of pressure in the eye
(intraocular pressure)
If the eye pressure is not controlled, it can ultimately lead to permanent irreversible vision loss. Thus it's critically important to treat early.
This being said, there are some types of glaucoma where eye pressure can be within the normal range and evidence of glaucoma can still be present.
It is estimated that there are currently over 67 million cases of glaucoma worldwide. The likelihood of having glaucoma increases with age. In fact, nearly 10% of people age 70 and over have glaucoma.
Glaucoma is a progressive disease caused by damage to the optic nerve. Although glaucoma is a disease most commonly found in middle-aged to elderly adults, the risk of getting glaucoma increases due to:
While there are no ways to prevent glaucoma, you can take steps to lower your risk of developing the condition. These include:
This is the most common type of glaucoma in which ocular fluid drains too slowly, or is over-produced, causing pressure inside the eye to build up. It usually results from an aging under-functioning eye drainage system. That said, younger people can also get this form of glaucoma, although rarely.
This is a form of open-angle glaucoma where eye pressure is “within the normal range;” however, there is evidence of optic nerve damage. No one knows the exact reason for this, but it is thought that reduced blood flow to the optic nerve may play a role in normal-tension glaucoma.
Acute angle-closure glaucoma (also referred to as narrow-angle glaucoma) occurs when the drainage system within the eye suddenly becomes blocked, causing a rapid rise in eye pressure. Because this can result in blindness, it is an emergency requiring immediate urgent medical attention.
The onset of symptoms is immediate and can include blurred vision, severe headaches, eye pain, nausea, vomiting, or seeing rainbow-like halos around lights.
A non-emergent variation of this condition (known as chronic angle-closure glaucoma) may present gradually with mild symptoms; similar to open-angle glaucoma. Those of Asian and Native American descent are at higher risk for this type of glaucoma.
Secondary glaucoma may occur as the result of another eye disease or condition, such as diabetes, chronic steroid use, inflammation, injury, or a tumor. For example, uveitis is an inflammatory condition that can cause secondary glaucoma.
Unfortunately, half of the people with the disease are not aware that they have any eye health issues as there are typically no early warning signs. This is the reason glaucoma is commonly referred to as “Silent Thief of Sight”, because vision is preserved until late in the disease and when it is detected late, the irreversible and permanent damage has already occurred. This highlights the importance of regular eye exams, especially if there is a strong family history of glaucoma.
Glaucoma symptoms depend on the type of glaucoma and include:
Patchy blind spots typically arise in the peripheral vision, often affecting both eyes. Patients with advanced disease experience tunnel vision with nearly complete loss of peripheral vision.
A sudden rapid increase in IOP results in severe eye pain, eye redness, blurred vision, and seeing colored halos around bright lights. Headache, nausea, and vomiting are common. This condition requires emergency medical attention in order to prevent blindness.
Chronic angle-closure glaucoma is rarely symptomatic, making it difficult to diagnose. Some patients report short episodes of mild symptoms occurring in the evening and resolving by morning.
While there is no cure for glaucoma, its progression can be slowed down through a variety of means. Treatment options are influenced by how advanced the disease is, as well as whether the patient is an appropriate candidate for a given treatment.
Treatment options fall into one of 3 categories:
The most common treatment for glaucoma is eye drops (pills are also used, but as a temporary measure prior to surgery). The goal of these medications is to decrease intraocular pressure by either promoting drainage of excess eye fluid or by reducing eye fluid production.
Although medications are extremely effective in lowering eye pressure, they can come with a myriad of other issues such as intolerable side effects, difficulty applying eye drops, or adhering to the dosing schedule. Your doctor will advise you on the best medications to fit your particular needs and offer other alternatives if medications are not the best option.
At Assil Gaur Eye Institute, we utilize a variety of lasers to treat both open and closed-angle glaucoma, tailoring our approach to each patient's particular need.
SLT is used in the treatment of open-angle glaucoma in order to “stimulate” the eye's natural drainage pathway to work more efficiently in removing excess intraocular fluid. It uses a low energy laser to target specific (trabecular) cells and succeeds in lowering eye pressure in about 85% of patients. This procedure is painless, is done in 5 minutes, and has a fast recovery with no restrictions after it is performed.
In closed-angle glaucoma, the angle located in the front inner corner of the eye between the iris (colored part of the eye) and cornea is too narrow. This blocks the site where ocular fluid must drain out of the eye. The LPI uses a laser to make a small opening in the iris, creating a second channel through which ocular fluid can flow to the front of the eye and out through the drainage system. This procedure has a success rate of 98% with a fast recovery and no restrictions after it is performed.
Transscleral cyclophotocoagulation is used to treat open-angle glaucoma that has failed other surgical treatments in eyes with poor visual potential. A targeted laser beam is directed through the sclera (white part of your eye) to the ciliary body, which is the structure that produces intraocular fluid. The beam shrinks this structure in order to decrease its fluid production and thus lowers eye pressure.
In certain circumstances, patients with early to moderate glaucoma benefit from conventional surgery, where the doctor makes an incision and works on the inner structures of your eye.
Infant or congenital glaucoma (meaning you are born with it) is primarily treated with surgery because the cause of the problem is a very distorted drainage system that requires delicate repair.
At Assil Gaur Eye Institute, we go one step beyond conventional surgery and perform state of the art Minimally Invasive Glaucoma Surgery (MIGS) which uses microscopic instruments allowing for a smaller incision surgery. As a result, it provides a safer option to reduce eye pressure with the added benefit of a higher success rate and faster recovery time than conventional surgery.
The goal of MIGS procedures is to improve fluid drainage out of the eye, thus reducing elevated eye pressure that damages the optic nerve. MIGS procedures are often performed in combination with cataract surgery for the appropriate patients. The types of MIGS performed at the Assil Gaur Eye Institute include iStent, I Stent inject, OMNI 360, XEN gel stent, and Endocyclophotocoagulation.
The FDA Approved OMNI® Glaucoma Treatment System is the next-generation Minimally Invasive glaucoma surgery. Developed by Sight Sciences, the OMNI 360 is the only device that combines two well-established minimally invasive glaucoma surgery (MIGS procedures) into one using a single device and a single clear corneal incision. The procedure is implant-free, allowing the eye’s natural drainage system to safely restore pressure.
Trabectome is a procedure for open-angle glaucoma patients in which the doctor uses tiny instruments to remove a piece of the trabecular meshwork where intraocular fluid normally drains from, thereby widening the opening for intraocular fluid to exit the eye.
iStent Is the smallest FDA approved device for use in the human body, measuring 1mm in length, like the tip of a ballpoint pen! It's a specially coated titanium tube that is inserted between the cornea and the lens to create a secondary channel for draining off intraocular fluid. This stent is used for a wide variety of glaucoma patients.
Glaucoma can be diagnosed through a comprehensive eye exam with several tests and procedures. These may include:
The most common type, called primary open-angle glaucoma (POAG), can have a genetic component. Not everyone who has a genetic predisposition to glaucoma will develop the condition. Other factors, such as age, race, and overall health, also play a role in the development of glaucoma.
Glaucoma can cause gradual and permanent vision loss, starting with the peripheral (side) vision and then affecting the central vision.
As the condition progresses, you may begin to experience the following symptoms:
Yes, glaucoma can cause blindness if it is not detected and treated early. Glaucoma is a leading cause of irreversible blindness worldwide. It is estimated that up to 10% of people with glaucoma who receive appropriate treatment still experience vision loss. If left untreated or if treatment is delayed, glaucoma can lead to complete blindness.
In general, glaucoma itself is not painful. And because it often has no symptoms in its early stages, it can be very challenging to diagnose glaucoma early. However, some forms of glaucoma can cause discomfort, particularly when intraocular pressure is elevated.
No, glaucoma is not a type of cancer. Glaucoma is a group of eye diseases that damage the optic nerve, which is the nerve that carries visual information from the eye to the brain. This damage is usually caused by increased pressure within the eye, known as intraocular pressure.
Glaucoma can cause headaches through increased eye pressure, a common symptom of the disease. This increased pressure can lead to eye pain and discomfort, which may result in headaches. It's important to note that not all people with glaucoma experience increased eye pressure, and even if they do, it may not necessarily cause headaches.
Unfortunately, there is currently no cure for glaucoma, and the damage to the optic nerve caused by the disease cannot be reversed. However, with early diagnosis and appropriate treatment, it is often possible to slow or halt the progression of the disease and prevent further damage to the optic nerve.
While diabetes does not cause glaucoma, it is a risk factor for developing the disease. This is because high blood sugar levels associated with diabetes can damage blood vessels in the eye, leading to changes in the optic nerve and an increased risk of glaucoma.
Glaucoma can affect one or both eyes. However, it's important to note that having glaucoma in one eye also increases the risk of developing the condition in the other eye. This is because the risk factors for glaucoma, such as high intraocular pressure, tend to be similar in both eyes.
In some cases, glaucoma may be more severe in one eye than the other, and the progression of the disease may differ between the two eyes. This can lead to differences in vision between the two eyes.
The success rate of glaucoma surgery depends on several factors, including the type of surgery, the severity of glaucoma, and the individual patient's response to the surgery. In general, however, glaucoma surgery can effectively lower intraocular pressure (IOP) and slow or halt the progression of the disease.
While cataracts themselves do not cause glaucoma, the two conditions can be linked in several ways:
Dr. Gaur's training and work experience at renowned ophthalmic institutions, including Tufts Medical Center and Boston-Mass Eye and Ear Infirmary, have given her extensive experience in state-of-the-art medical, laser and surgical management of glaucoma and cataracts. It is no exaggeration to report that she has performed thousands of sucessful cataract, glaucoma and LASIK surgeries.