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At The Eye Guys, we’re focused on helping preserve, protect and restore your vision. Because glaucoma remains one of the world’s leading causes of preventable blindness, the surgeons and doctors of The Eye Guys are constantly evaluating the latest trends in treating this vision-threatening condition.
More than half of the estimated 2.2 million Americans over the age of 40 with glaucoma do not even realize they have this vision-threatening disease because there are few – if any – warning symptoms. Because vision loss from Glaucoma is often irreversible, it is important to understand how Glaucoma can silently take away your vision without notice.
Glaucoma is a progressive condition where the internal pressure in the eye increases, causing damage to fibers in the optic nerve that can result in permanent loss of vision. This increase in internal pressure is a result of an eye’s inability to properly drain fluid. Despite tremendous advances in research, technology and surgical treatments, there is still no cure for glaucoma. However, with early detection and treatment, vision loss from glaucoma can usually be prevented.
Thanks to advances in technology we can now add another important step to cataract surgery that allows glaucoma to be treated in a completely new way. The iStent trabecular micro-bypass stent is the world’s tiniest medical device and is 20,000 times smaller than the intraocular lens used at the time of cataract surgery. By increasing the eye’s ability to drain fluid, this technology is designed to improve the aqueous outflow to safely lower your eye pressure. In a US clinical study 68% of patients who received the iStent remained medication free at 12 months. Once the iStent is implanted it will immediately begin working to safely and effectively help manage your eye pressure and glaucoma. If you have glaucoma please talk to your doctor about this exciting new technology.
In most cases, there are no warning signs or symptoms of Glaucoma and many patients have no idea they have Glaucoma or are even at risk for glaucoma. The people with the highest risk of Glaucoma development are people with a history of diabetes or high blood pressure, are over the age of 40 and are of African American decent. African Americans are four times more likely to develop Glaucoma, as are people who have a history of Glaucoma in your family.
If you are diagnosed with Glaucoma, your treatment could last a lifetime. In some cases, surgery is necessary when medical treatment is unable to adequately lower the pressure in the eye. The good news is that today, Glaucoma patients have choices. There are advanced laser procedures that are becoming increasingly more popular and for many, they are more convenient, usually covered by insurance and over time are less expensive than the eye drops.
Early detection is still the best option for preventing loss of sight due to Glaucoma. It is important to have annual eye exams that include a measurement of intraocular pressure, which help early detection and ensures that those undergoing treatment are being treated successfully.
Do not mistake glaucoma screenings, which only check the intraocular pressure of the eye, sufficient for diagnosing glaucoma.
The vast majority of glaucoma patients have primary open angle glaucoma. These patients manifest a chronic, idiopathic disease associated with progressive degeneration of the anterior optic nerve, known as glaucomatous optic neuropathy. Although elevated intraocular pressure is an important causative risk factor, only half of the 2 to 3 million North Americans with glaucoma will manifest elevated intraocular pressure at a single measurement. Therefore, measurement of intraocular pressure alone is a poor screening technique for glaucoma. Like most biologic parameters, eye pressure fluctuates throughout the day and varies with other influences, including hydration, sleep, blood pressure and body position. With multiple measurements at different testing sessions, most, but not all of these glaucoma subjects, will eventually exhibit elevated intraocular pressure at least part of the time.
The rise in intraocular pressure associated with primary open angle glaucoma derives not from a visible obstruction of the trabecular meshwork, but rather from cellular dysfunction of the trabecular meshwork tissue, which leads to increased aqueous humor outflow resistance. Risk factors for primary open angle glaucoma include family history, corticosteroid sensitivity, myopia, African-American race, systemic high blood pressure, high intraocular pressure, diabetes, and age. In addition to these risk factors, early age of onset of disease and poor compliance with a medical regimen and physician visits are associated with a worse prognosis. As mentioned above, some patients with progressive optic nerve damage characteristic of glaucoma never manifest intraocular pressures above the statistically normal range. These patients are commonly diagnosed with “low pressure glaucoma,” “low tension glaucoma,” “or normal pressure glaucoma.” While recognizing that non-pressure risk factors may play a stronger role in these than in than in their high-pressure counterparts, these patients are managed similarly to those with conventional primary open angle glaucoma.
All physicians need be cognizant of another form of glaucoma, closed angle or angle-closure glaucoma, which may present acutely or may be silent and chronic. This disorder, quite unrelated to open angle glaucoma, derives entirely from blockade of the trabecular meshwork by the peripheral iris, either by simple and reversible anatomical apposition, or pressing together, of the two tissues or by generally irreversible scarring and adhesion. These irreversible fibrotic adhesions may occur after unrecognized long-standing appositional angle closure (chronic angle closure glaucoma) or from other ocular conditions, such as uveitis or neovascularization (secondary angle closure glaucomas).
Classically, angle closure glaucoma is the well-known, less common variety of glaucoma that presents acutely with severe eye pain, blurring of vision, colored halos around lights, nausea and vomiting. Angle closure usually occurs in the hyperopic (farsighted) eye, which is smaller than the average eye and thus crowds the iris, cornea, lens and anterior chamber angle into a smaller than average space. Eventually, usually in the fifth to sixth decade of life as the lens gradually increases in size with aging, the lens becomes more firmly applied to the pupillary opening through which aqueous humor from the ciliary body must pass. This obstruction of aqueous humor flow at the pupil, known as relative pupillary block, eventually becomes clinically significant and traps the aqueous behind the pupil, raising the pressure in the posterior chamber above that in the anterior chamber and driving the iris anteriorly to lie against and block the trabecular meshwork. This trabecular meshwork blockade, or angle closure, leads to a sudden and dramatic rise of the intraocular pressure from its baseline normal level in the 10-20 mm Hg range to 60 mm Hg or more. This sudden change in pressure leads to swelling of the cornea with blurring, haloes, and severe ocular pain from iris ischemia and corneal edema. The pupillary margin of the iris becomes most tightly applied to the lens surface when the pupil is in the mid-dilated position; hence, it is often dilation of the pupil by exposure to stress, darkness, or drugs that precipitates an acute attack.
The immediate treatment of acute angle closure is directed toward reversal of the pupillary block, usually by moving the pupil with constriction. Ultimately, however, the pupillary block can be reversed and prevented by creating a new aqueous channel with peripheral iridectomy.
To help prevent vision loss from glaucoma, our doctors here at The Eye Guys encourage routine eye exams for early detection of glaucoma and prevention of optic nerve. Vision loss from glaucoma is irreversible.