What Is Glaucoma?
Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve fibers, much like an electric cable with numerous wires. Glaucoma damages these nerve fibers, which can cause blind spots and vision loss.
Glaucoma is often associated with the pressure inside the eye, known as intraocular pressure (IOP). When the aqueous humor—a clear liquid that normally flows in and out of the eye—cannot drain properly, pressure can build up inside the eye. Increased IOP can damage the optic nerve and lead to vision loss.
Types of Glaucoma
Primary Open-Angle Glaucoma
Primary open-angle glaucoma is the most common form of glaucoma. In this condition, aqueous fluid is blocked from flowing back out of the eye at a normal rate through the eye’s drainage system.
Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.
Ocular Hypertension
Ocular hypertension is often a forerunner to open-angle glaucoma. When eye pressure is above normal, the risk of developing glaucoma increases.
Several risk factors can affect whether glaucoma develops, including the level of IOP, family history, and corneal thickness. If your risk is high, your ophthalmologist may recommend treatment to lower your IOP and help prevent future damage.
Angle-Closure Glaucoma
In angle-closure glaucoma, the iris—the colored part of the eye—may move over and completely close off the drainage angle. This can abruptly block the flow of aqueous fluid and lead to increased IOP and optic nerve damage.
In acute angle-closure glaucoma, there is a sudden increase in IOP due to the buildup of aqueous fluid. This condition is considered an emergency because optic nerve damage and vision loss can occur rapidly.
Symptoms can include:
- Nausea
- Vomiting
- Seeing halos around lights
- Eye pain
Normal-Tension Glaucoma
Some people with “normal” IOP can still experience vision loss from glaucoma. This condition is called normal-tension glaucoma.
In this type of glaucoma, the optic nerve is damaged even though the IOP is considered normal. Normal-tension glaucoma is not well understood, but lowering IOP has been shown to slow progression of this form of glaucoma.
Childhood Glaucoma
Childhood glaucoma, which starts in infancy, childhood, or adolescence, is rare. Like primary open-angle glaucoma, there may be few, if any, symptoms in the early stage. Blindness can result if it is left untreated. Like most types of glaucoma, childhood glaucoma may run in families.
Signs may include:
- Clouding of the cornea, the clear front part of the eye
- Tearing
- An enlarged eye
Who Is at Risk for Glaucoma?
Your ophthalmologist may tell you that you are at risk for glaucoma if you have one or more risk factors, including:
- Elevated intraocular pressure
- A family history of glaucoma
- Use of certain medications
- A thin cornea
- Certain ethnic backgrounds
- Advanced age
Regular examinations with your ophthalmologist are important if you are at risk for glaucoma.
How Is Glaucoma Treated?
The goal of glaucoma treatment is to lower eye pressure to prevent or slow further vision loss. Your ophthalmologist will recommend treatment when the risk of vision loss is significant.
Treatment often begins with eye drops but may also include laser treatment or surgery to improve drainage or reduce the production of fluid inside the eye.
Glaucoma is a chronic disease that can be controlled but not cured. Ongoing monitoring—sometimes as often as three or four times a year—may be necessary to watch for changes.
At Connecticut Eye Specialists, we utilize several procedures to lower eye pressure when eye drops have not adequately controlled the problem.
Glaucoma Procedures at Connecticut Eye Specialists
Laser Iridotomy and Laser Trabeculoplasty
Procedures include:
- Laser Iridotomy
- Laser Trabeculoplasty, including Diode and SLT
These procedures are performed either in the office or, for SLT, at a surgical center near the office.
There is no pre-operative testing needed and no special preparation required. These procedures are generally not painful, and normal activity can usually be resumed immediately.
Patients typically do not need post-operative drops for recovery. Patients may be able to drive after the procedure, although having someone available to drive is ideal.
Iridex Micropulse and Continuous Wave Cyclophotocoagulation
Procedures include:
- Iridex Micropulse
- Continuous Wave Cyclophotocoagulation
These procedures are performed under light sedation in the surgical center.
They require no pre-operative testing, but patients do need to fast before the procedure. Medications aside from those for diabetes can be taken the day of the procedure with a small amount of water.
Patients must have someone available to drive them home. Normal activity can generally be resumed after the first post-operative visit.
Glaucoma Surgery
Procedures include:
- Hydrus Microstent
- Trabeculectomy, with or without cataract surgery
- Glaucoma drainage device implant surgery
These surgeries are performed under topical anesthesia with mild sedation as outpatient procedures at a hospital or ambulatory surgery center.
They require no pre-operative testing, but patients do need to fast before the procedure. Medications aside from those for diabetes can be taken the day of the procedure with a small amount of water.
Patients must have someone available to drive them home.
Patients may resume light activity after surgery until given further instructions. Heavy lifting and straining should be avoided. An eye shield may need to be worn while sleeping for several weeks.
Some procedures involve sutures that are later removed in the office, usually without significant discomfort.
Learn More About Your Glaucoma Risk
For more information, take Dr. Sokol’s Glaucoma Patient Survey.
