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Wednesday, Jan. 2, 2019

Glaucoma: The sneaky thief of sight


Treatment options are available

Glaucoma is a leading cause of blindness – it is actually the second leading cause of blindness in the world, according to the World Health Organization. It is a sneaky disease because it is asymptomatic, or shows no symptoms, and causes irreversible damage to vision with a majority of peripheral vision being lost before a person even knows that they have glaucoma. In the United States, there are an estimated 2.25-2.5 million individuals with glaucoma, and one million individuals who are unaware they have glaucoma. There is currently no cure for glaucoma, but the good news is that treatments are available.

What is glaucoma?

Glaucoma is optic neuropathy, or damage to the optic nerve, that causes loss of vision. Elevated intraocular pressure caused by fluid buildup is one of the primary risk factors that can lead to optic nerve damage.

Who is at risk?

People of all ages are at risk for glaucoma. The highest risk groups are adults over age 60, African-Americans over age 40, and individuals with elevated intraocular pressure, diabetes, cardiovascular disease and high myopia (nearsightedness), or a family member who is diagnosed with glaucoma are at a higher risk of being diagnosed with glaucoma. If you are in a higher-risk group or believe you are at high risk of being diagnosed with glaucoma, it is important to talk with your ophthalmologist about this and schedule regular eye exams.

Types of glaucoma:

The main types of glaucoma are primary open-angle (chronic) and angleclosure (acute). There is also childhood and secondary glaucoma.

Characteristics of primary open-angle glaucoma (POAG) are the common optic nerve and visual field damage, onset in adulthood, open anterior chamber angles, and an absence of any secondary causes. There are no symptoms of POAG in its early stages, and it can result in blindness.

Characteristics of angle-closure glaucoma are severe ocular pain and redness, blurred vision, halos around lights, headaches and nausea. Acute angle-closure glaucoma is an emergency and requires long-term follow-up. In the event of an acute glaucoma attack, your ophthalmologist should be contacted immediately.

Childhood glaucoma, also known as congenital glaucoma, occurs in babies and young children. It is often inherited and affects about one in every 10,000 infants. It is asymptomatic in early stages and can result in total optic nerve atrophy and blindness, but when diagnosed early and treated quickly, it is likely the child will not have future vision problems.

Secondary glaucoma refers to any case in which another disease causes or contributes to increased eye pressure, resulting in optic nerve damage and vision loss. Causes can be a trauma, uveitis, chronic steroid use, diabetic retinopathy or ocular vascular occlusion.

How is glaucoma diagnosed?

Regular eye exams are critical to diagnose glaucoma early. In a comprehensive eye exam, eye pressure is measured, a gonioscopy is performed to evaluate the eye’s internal drainage system, and the optic nerve and vision field are evaluated. Early diagnosis is critical so that further vision loss and further optic nerve damage can be halted.

The most effective screening strategy is periodic, comprehensive eye examinations, especially for patients in high-risk groups.

How is glaucoma treated?

There are medical therapies to treat glaucoma from worsening, which are improved with patient education and informed participation in treatment decisions. There are also possible surgical procedures such as laser surgery, filtering surgery, cyclodestructive surgery and drainage device surgery.

It is important to note that glaucoma can be controlled, but it cannot be cured, which is why early detection is so important to begin treatment as soon as possible.

–Megan F. Strecker, Courtesy of LSU Heatlh Shreveport.


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