What Is Glaucoma? Symptoms, Surgery Types, And Treatment

What Is Glaucoma?

Glaucoma is a common, chronic, and progressive eye condition, where the optic nerve of the eye becomes damaged and slowly deteriorates.

The optic nerve is a group of nerve fibers located at the back of the eye, connecting the eye to the brain, and transmitting visual messages or ‘images’ from the retina to the brain.

When fluid builds up inside the eye, the intraocular pressure or IOP (pressure inside the eye) can become too high and damage the nerve, and result in glaucoma.

While it can affect people of all ages, the condition is most common in adults in their 70s and 80s.

If not diagnosed and treated early, glaucoma can lead to loss of vision.

Symptoms Of Glaucoma

Glaucoma usually doesn’t start with many symptoms. It tends to develop slowly over several years and affects your peripheral vision first.

Therefore, many patients do not realize they have glaucoma, and often find out during a comprehensive routine eye exam. Both eyes are usually affected, although it may be worse in 1 eye.

Some symptoms of glaucoma, if you do notice them, may include:

  • Blurred vision
  • Rainbow-colored circles around bright lights

Very occasionally, glaucoma can develop suddenly and cause:

  • Intense eye pain
  • Nausea and vomiting
  • A red eye
  • A headache
  • Tenderness around the eyes
  • Seeing rings around lights
  • Blurred vision

Causes Of Glaucoma

Glaucoma can occur due to several reasons. When the fluid in the eye can’t be drained properly and gets built-up, the pressure in the eye increases and results in glaucoma. This can then damage the optic nerve that is responsible for transmitting visual messages from the eye to the brain. This condition is known as Ocular Hypertension.

While it’s often unclear why ocular hypertension happens, certain things can increase the risk, including:

  • Your age – glaucoma becomes more common as you get older
  • Your ethnicity – people of African, Caribbean or Asian origin are at a higher risk
  • Your family history – you’re more likely to develop glaucoma if you have a parent or sibling with the condition
  • Other medical conditions – such as short-sightedness, long-sightedness, and diabetes

Also, sometimes glaucoma can occur even when the pressure inside the eye (IOP) is normal.

Some recent studies have shown, that having low intracranial pressure (the pressure that surrounds the brain) can also increase risks for developing glaucoma.

There are yet no proven methods that help you in preventing glaucoma, but having regular eye check-ups should pick it up as early as possible.

Types of glaucoma

There are several different types of glaucoma.

The most common type is known as Primary Open-Angle Glaucoma. This condition usually develops slowly over many years and is due to the blockage of the drainage channels in the eye.

Other types of glaucoma include:

  • Acute Angle-Closure Glaucoma – an uncommon type caused by the drainage in the eye becoming suddenly blocked, which in result can raise the eye pressure very fast.
  • Secondary Glaucoma – caused by an underlying eye condition, such as inflammation of the eye (uveitis)
  • Congenital Glaucoma (Childhood Glaucoma) – a rare type affecting very young kids, this is caused by an abnormality of the eye

When To See Your Doctor

Without treatment, glaucoma can eventually lead to blindness. If you have glaucoma, early diagnosis and treatment are vital to the health of your eye and can help prevent your vision from getting worse.

The best way for early diagnosis is to go to regular eye check-ups. Also, If you develop symptoms of glaucoma suddenly, go to your eye doctor as soon as possible.

If you have questions about your condition or treatments, you can always ask our medical experts for guidance, by using our free medical consultation services.

How It’s Diagnosed

If during a routine eye test your optometrist detects signs of glaucoma, many fast and pain-free exams can be performed to diagnose glaucoma. 

Eye pressure test

During routine eye exams, you may undergo a test called tonometry (eye pressure test), where a small instrument is used to measure your intraocular pressure (IOP). During this test, your eye doctor may use eye drops to make your cornea less sensitive.

Normal intraocular pressure typically is considered to have readings below 21 mmHg. Higher IOP rates can indicate a higher risk of developing glaucoma.

1.  Gonioscopy

Gonioscopy is an eye exam performed by a specialist and allows them to take a look at the front part of your eye that contains the fluid-filled space, The cornea, and the iris.

This part of the eye is where the fluid should drain out. By performing this test, your optometrist can determine what type of glaucoma you have.

 

2.  Visual field test

A visual field test (perimetry) is performed to evaluate any areas of missing vision.

The test starts with your doctor showing you a sequence of light dots. They will ask you to confirm or deny whether you can see these spots by pressing a button.

Some of these spots are designed to appear at your peripheral vision, (the edge of your vision). If glaucoma is present, your peripheral vision is usually the first location to get affected by it, and if you are unable to see those spots, it may indicate the advancement of glaucoma.

3.  Optic Nerve Assessment

The optic nerve assessment is performed to see whether the nerve is healthy or not and to evaluate if it has become damaged due to glaucoma.

Before the exam begins, your doctor will give you eye drops to widen your pupils.

There are a couple of instruments used for this exam:

  • A slit lamp which is a microscope with a bright light
  • Optical coherence tomography – which is a type of scanning instrument that scans the back of your eye using special light rays, and then produces a picture of it.

The eye drops that you receive for your examination can sometimes impair your vision and affect your ability to drive, so remember to make proper arrangements for getting home after the test is performed. 

Remember to make eye appointments for testing at least every 2 years. If you have certain risk factors that increase the chances of glaucoma for you, such as having a close relative with the condition, it may be wise to have more regular check-ups.

Treatments For Glaucoma

Many kinds of treatments are available for glaucoma. Keep in mind that while these treatments are done to prevent additional vision loss, they cannot reverse the parts of your vision you have already lost due to the condition.

The type and severity of your condition, along with the responsiveness of your glaucoma to treatments, determine the kind of treatment plan your doctor recommends.

These treatments include:

  • Eye Drops: Early glaucoma is generally treated by prescription eye drops. The treatments work by reducing IOP to prevent vision loss.
  • Laser Treatment: This procedure opens up the blocked drainage tubes and can also reduce the production of fluid in your eyes
  • Surgery: The purpose of surgery is to help improve the drainage of fluid in the eye

Your doctor will recommend that you schedule regular appointments to further monitor any changes in your condition and check to see whether the treatments are effective.

It’s important to have regular eye tests so conditions such as glaucoma can be diagnosed and treated at the early stage.

Eye Drops

Eye drops are usually the main treatment suggested by your doctor for glaucoma. Several different types can be used, but they all aim to reduce the pressure in your eyes.

Your doctor might recommend you to use eye drops between 1 and 4 times daily. Your eyesight is at risk if you don’t stick to the recommended treatment.

With the help of your doctor, you can try and test different types of eye drops until you eventually find the best option for your situation. In some cases, multiple kinds of eye drops are required for the treatment to work.

Not all eye drops are suitable for people with special underlying conditions.

Sometimes, eye drops can cause side effects such as irritation in the eye.

To apply eye drops:

  • Gently pull down your lower eyelid with your finger
  • In the space of the lower eyelid that you have now created, drop the amount of eye drop that your doctor has recommended
  • Close your eye and keep it closed for a few minutes

If you use multiple kinds of eye drops, take 5-minute breaks between using the different types.

To reduce drainage of the drops from the eye, and in result increase its effect, you can gently press on the inside corner of your eye, over the eyelid. This also helps reduce the risk of further side effects.

 

Laser Treatment

If eye drops don’t seem to improve your symptoms, laser treatment may be recommended.

During laser treatment, a high-energy light beam is carefully aimed at a specific part of your eye which helps reduce the amount of fluid that is being produced.

Types of laser treatment include:

  • Selective laser trabeculoplasty (SLT): Using a laser, your doctor opens up the drainage tubes inside your eye, and helps with the drain of the built-up fluid, which in result lowers the pressure inside of the eye.
  • cyclodiode laser treatment: In this type, a laser is used to eliminate certain eye tissue producing liquid, and lower the overall pressure of the eye.
  • laser iridotomy: With a laser, your doctor makes small holes in the iris which can help drain excess fluid from your eye.

In most cases, laser treatments are performed while you are conscious. Local anesthetic drops are used to numb your eyes so you may feel a small amount of pain or heat during the procedure.

According to the Glaucoma Research Foundation, SLT can lower IOP by about 30 percent when used as initial therapy for open-angle glaucoma, but results may take 1-3 months to appear and is only effective for 1-5 years. Although laser surgery can be repeated, results from additional procedures may not be as effective as the initial treatment.

In some cases, you may still need to use eye drops after being treated with lasers. 

 

Types Of Glaucoma Surgery

In the cases where eye drop treatments and laser surgery have not shown effective results, doctors may recommend surgery.

The most common type of surgery for glaucoma is called a trabeculectomy and is performed by removing part of the tubes that drain the eye which makes the fluid drain more easily out of the eyes.

Glaucoma surgery can be performed under local anesthetic while you are conscious,  or under general anesthesia, while you sleep during the process of the surgery.

Depending on your condition, your doctor will recommend different types of surgery to treat your glaucoma.

These types include:

 

1. Minimally-invasive glaucoma surgery (MIGS)

In recent years with the development of technological techniques, many micro-surgical procedures called minimally-invasive glaucoma surgeries (MIGS) have been developed to reduce or eliminate the need for glaucoma medications.

MIGS procedures are minimally invasive and require only small incisions. They also carry fewer risks and cause less trauma to the eye than normal glaucoma surgeries.

2.   Trabecular and shunt glaucoma surgery

While these surgeries are more invasive than new MIGS procedures, their results are generally more effective in lowering IOP and reducing the need for glaucoma medications. These procedures aim to create new ways for the fluid to be drained and in result lower the IOP.

Side effects after your surgery may include:

  • Watery eyes
  • Redness in the eyes
  • Slightly blurred vision

These side effects are temporary and can last for about 6 weeks and return to normal.

After your surgery, your surgical team will instruct you with recovery tips and discuss when you can return to your normal daily activities.

Usually, patients are told to keep their eye dry and avoid driving, reading, and any sorts of strenuous activities like heavy lifting for at least 1 week.

If you have questions about your condition or treatments, you can ask our medical experts for guidance, by using our free medical consultation services.

Looking for affordable eye treatment plans? Check out the list of treatments we offer, to make sure you are choosing the best option for your needs.  

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