Glaucoma is one of the leading causes of blindness in the United States, especially for older people. Glaucoma is a disease of the optic nerve, the part of the eye that carries the images from the eye to the brain. When damage to the optic nerve occurs, blind spots develop in our field of vision. These blind spots usually go unnoticed until the optic nerve becomes severely damaged. If the entire nerve is destroyed, blindness results. Early detection and treatment are the keys to preventing optic nerve damage and blindness from glaucoma. Loss of sight from glaucoma can often be prevented with early treatment.  However, once vision is lost due to glaucoma, it cannot be restored.

What Causes Glaucoma?

Just as a basketball requires the proper pressure to bounce, the eye requires certain internal pressure to maintain its shape and function. Clear liquid called aqueous humor circulates inside the front portion of the eye. In order to maintain a healthy level of pressure within the eye, a small amount of this fluid is continually produced while an equal amount flows out of the eye through a drainage system. If the drainage area for the aqueous humor is blocked, the excess fluid cannot flow out of the eye. Fluid pressure within the eye builds up, pushing against the optic nerve and causing damage.  This is usually a painless process that occurs over years.

What Are the Different Types of Glaucoma?

Chronic open-angle glaucoma is the most common form of glaucoma in the United States. The risk of developing chronic open-angle glaucoma increases with age. The drainage of the eye becomes less efficient with time, and pressure within the eye gradually increases.  This pressure can damage the optic nerve. In some patients, the optic nerve becomes sensitive even to normal eye pressure as with normotensive glaucoma and is at risk for damage. Treatment is necessary to prevent further vision loss. Usually, open-angle glaucoma has no symptoms in its early stages, and vision remains normal. As the optic nerve becomes more damaged, blind spots appear in your field of vision. You typically won't notice these blank spots in your daily activities until the optic nerve is significantly damaged and these spots become large. If all the optic nerve fibers die, blindness results. Closed-angle glaucoma is much less common than open angle glaucoma.  Some eyes develop with the iris (colored part of the eye) too close to the drainage angle. In these eyes, the iris can be drawn into the drainage angle and block it completely. Since the fluid cannot exit the eye, pressure inside the eye builds rapidly and causes an acute closed-angle attack in which the pressure gets extremely high in a very short amount of time.  The earliest symptoms might be seeing colored halos around lights.  As the pressure rises, the vision becomes blurred and severe eye pain follows.  This might be accompanied by nausea and vomiting.  This is truly an emergency requiring immediate attention.

How Is Glaucoma Detected?

A glaucoma screening that checks only the pressure of the eye is not an adequate test for glaucoma.  The only way to detect glaucoma is to have a comprehensive eye examination.  During that examination the eye pressure is measured, the drainage angle is checked and the pupil is dilated so as to examine the optic nerve.  In most cases the optic nerve is scanned with a laser and the contour is mapped and analyzed (optic nerve tomography).  In addition, the peripheral vision is tested with computerized perimetry.

How Is Glaucoma Treated?

The treatment options, once the diagnosis is assured, are eye drops, laser surgery, and surgery in the operating room.  The goal of each of these approaches is to lower the eye pressure.  In general, eye drops are the first modality as it is the easiest to do with the least risk and it usually is successful in lowering the pressure.  There are numerous eye drops available and the goal is to achieve a new lower pressure with the least number of different eye drops and ones that do not cause side effects.  If the patient is determined to be worsening due to poorly controlled pressure (the drops don’t work) then either laser surgery or operating room surgery are options.  Argon Laser Trabeculoplasty and selective laser trabeculoplasty are laser options.

When it comes to surgery, we have been quite satisfied with the results using the Express MiniShunt which is a tiny valve surgically placed in the eye during a 15 minute procedure.  This valve releases a controlled amount of internal fluid (aqueous humor), thus maintaining the eye pressure in a normal range.

Dr. Gelber has been offering consultations in glaucoma for more than 25 years.  He has published and lectured internationally in the areas of laser treatment for glaucoma as well as advanced techniques with trabeculectomy.  If you seek an opinion based on a long history of treating complex glaucoma problems, Dr. Gelber may be of significant help to you.

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