Glaucomacauses, symptoms and treatments

Text size:
Last updated 8/8/2019
Dr. Assil discusses cataracts: symptoms and treatment options.

What is glaucoma?

Glaucoma is a serious group of eye diseases where, if the pressure within the eye (intraocular pressure) is not controlled, it can cause progressive damage to the vital structure that relays visual information to the brain: the optic nerve.

 

If the eye pressure is not controlled, it can ultimately lead to permanent irreversible vision loss. 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.

 

Glaucoma is the leading cause of irreversible blindness in people over 60, with over 67 million cases worldwide. The likelihood of having glaucoma increases with age, in fact, nearly 10% of people age 70 and over have glaucoma.

Glaucoma risk factors

Although glaucoma is a disease most commonly found in middle aged to elderly adults, the risk of getting glaucoma increases due to:

  • Age – your risk of getting glaucoma increases as you age, especially beyond 60
  • Ethnicity – Asians are more likely to suffer from angle closure glaucoma than other ethnic groups. African Americans over 40 and Hispanics over age 60 are at increased risk for open angle glaucoma.
  • Family history of glaucoma
  • Increased intraocular fluid pressure – Although this is an important risk factor, only half all Americans with glaucoma will show increased intraocular pressure when measured at random because eye pressure fluctuates constantly. Thus it's important to screen for glaucoma by taking many measurements of intraocular pressure over time to look for trends of elevated pressure.
  • Severe nearsightedness or farsightedness
  • Thin corneas
  • Diabetes
  • High blood pressure
  • Chronic steroid use
  • Prior eye injury

 

Types of glaucoma

Chronic (primary open angle) glaucoma

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 aging under-functioning eye drainage system. That said, younger people can also get this form of glaucoma, although rarely.

 

Normal tension glaucoma

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

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 are 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

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. 

 

Glaucoma signs and symptoms

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:

 

Open angle glaucoma symptoms

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.

 

Acute angle closure glaucoma symptoms

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 emergent medical attention in order to prevent blindness.

 

Chronic angle closure glaucoma symptoms

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.

 

Glaucoma treatment options

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:

 

Glaucoma medications

The most common treatment for glaucoma are 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.

 

Laser eye surgery for glaucoma

At Assil 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.

 

Types of laser surgery for glaucoma include:

Selective laser trabeculoplasty (SLT) for Glaucoma

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.

 

Laser peripheral iridotomy (LPI) for Glaucoma

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.

 

Transcleral cyclophotocoagulation for Glaucoma

Transcleral cyclophotocoagulation is used to treat open angle glaucoma that has failed other surgical treatments in eyes with poor vision potential. A targeted laser beam is directed through the sclera (white part of your eye) to the ciliary body, which it is the structure that produces intraocular fluid. The beam shrinks this structure in order to decrease its fluid production and thus lowers eye pressure.

 

Conventional microsurgery for Glaucoma

In certain circumstances, patients with early to moderate glaucoma benefit from conventional surgery, where the doctor makes an incision and works on 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.

 

Types of conventional microsurgery for glaucoma include:

Minimally invasive glaucoma surgery (MIGS) 

At Assil 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 Eye Institute include i Stent, I Stent inject, OMNI 360, XEN gel stent, and Endocyclophotocoagulation.

 

Trabectome for Glaucoma

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 for Glaucoma

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.

1258 Total 1st Party Reviews
4.9 out of 5 Stars
  • GatherUp
    Great dr very well equipped and nice Facility
    Max A.
  • GatherUp
    Dr P thoroughly answered all my questions.
    Paul B.
  • GatherUp
    On Oct. 16, 2019, I had my eyes examined by Dr. Gaur and Stacy. They both did a very thorough job. They also gave me important ...
    John S.
  • GatherUp
    Very professional staff and office!
    Tola M.
  • GatherUp
    The staff took care of me well. Everybody was friendly.
    Sheri J.
  • GatherUp
    Is it time for my eye procedures as my current glasses are being less effective at doing my job correctly. Keep up the great wo...
    Steven V.
  • GatherUp
    Check in was great the gentleman that did my preliminary tests was awesome and very professional
    Todd P.
  • GatherUp
    Punctual, thorough, informative and professional
    Ronald S.
  • GatherUp
    Great experience so far
    Ricardo H.
  • GatherUp
    Good services
    Am V.
Look Who Trusts Their Eyes to Assil Eye Institute...
  • LeBron James
    Los Angeles Lakers

    LeBron James is one of the NBA's greatest of all time. He absolutely depends on his vision to perform at the very highest level.

     

    LeBron trusts his eyes to Assil Eye Institute.

  • Anthony Davis
    Los Angeles Lakers
  • Chris Paul
    Oklahoma City Thunder
  • Dwyane Wade
    Miami Heat (retired)
  • Marlee Matlin
    Actress
  • Michelle Williams
    Actress
  • LaToya Jackson
    Entertainer
  • Lorenzo Lamas
    Actor
  • Philip Bailey
    Earth Wind and Fire
  • Gary Sinise
    Actor
  • Rip Hamilton
    Former NBA player
  • John Salley
    Commentator, former NBA player
  • Blair Underwood
    Actor
  • Tom Arnold
    Comedian/Actor
  • Troy Evans
    Actor
  • John Noble
    Actor
  • Isaac Eddy
    Actor/Director/Teacher
  • Barbara Rush
    Actress
  • John Emerson
    US Ambassador to Germany
  • Shane Mosley
    Former professional boxer
  • Cuttino Mobley
    Former NBA player
  • Seth Gordon
    Director
  • Maurice Evans
    Former NBA player
  • Wang Luoyong
    Actor
  • Jesse Metcalfe
    Actor
  • Ananda Lewis
    Television Personality
  • Rob Brydon
    Comedian
  • Clifton Collins Jr.
    Actor
  • Malinda Williams
    Actress
  • Adrienne Frantz
    Actress
  • Lacey Chabert
    Actress
  • Brad Pitt
    Actor
  • LeBron James
    Los Angeles Lakers
  • Anthony Davis
    Los Angeles Lakers
  • Chris Paul
    Oklahoma City Thunder
  • Courtney Cox
    Actress
  • Paul George
    Los Angeles Clippers
  • Dwyane Wade
    Miami Heat (retired)
  • Marlee Matlin
    Actress
  • Michelle Williams
    Actress
  • Jalen Brunson
    Dallas Mavericks
  • Mychal Thompson
    Commentator, former NBA player
  • LaToya Jackson
    Entertainer
  • Lorenzo Lamas
    Actor
  • Philip Bailey
    Earth Wind and Fire
  • Gary Sinise
    Actor
  • Rip Hamilton
    Former NBA player
  • John Salley
    Commentator, former NBA player
  • Blair Underwood
    Actor
  • Tom Arnold
    Comedian/Actor
  • Troy Evans
    Actor
  • John Noble
    Actor
  • Isaac Eddy
    Actor/Director/Teacher
  • Barbara Rush
    Actress
  • Rudy Garciduenas
    Blue Man Group
  • John Emerson
    US Ambassador to Germany
  • Shane Mosley
    Former professional boxer
  • Cuttino Mobley
    Former NBA player
  • Seth Gordon
    Director
  • Maurice Evans
    Former NBA player
  • Cheri Blauwet
    Physician and Wheelchair Racer
  • Wang Luoyong
    Actor
  • Jesse Metcalfe
    Actor
  • Jeana Wilson
    Actress
  • Courtnee Draper
    Actress
  • Ananda Lewis
    Television Personality
  • Robyn Johnson
    Producer
  • Rob Brydon
    Comedian
  • Cary Schuman
    Actor
  • Roland Buddy Lewis Jr.
    Comedian
  • Clifton Collins Jr.
    Actor
  • Malinda Williams
    Actress
  • Chad Jeffers
    Musician
  • Adrienne Frantz
    Actress
  • Franco Carlotto
    Body Builder
  • Brad Mates
    Musician
  • David Pichette
    Musician
  • Mike Melacon
    Professional Baseball Player
  • Nautica de la Cruz
    Radio Personality
  • Lynn Conkwright
    Body Builder
  • Nely Galan
    Producer
  • Roxanne Galla
    Actress
  • Lacey Chabert
    Actress