Patient’s Guide to Glaucoma
What is glaucoma?
A disease in which there is degeneration of the Optic Nerve or Nerve of vision. This results in gradual loss of sight and, without treatment, may cause complete blindness. In many cases glaucoma is associated with a raised eye pressure.
Eye pressure and glaucoma
The eye can be thought of as a ball, which is divided into two compartments. The front compartment is filled with a watery fluid, which drains out through special channels. The pressure in the eye depends on the balance between the flow of fluid into and its drainage from the eye. In glaucoma there is obstruction of the drainage that results in accumulation of fluid leading to an increase in the pressure within the eye.
How does glaucoma damage the eye?
It is thought that glaucoma damages sight by interfering with the circulation to the retina and optic nerve. Damage is shown by decrease in the field of vision. Treatment limits the amount of damage either by directly decreasing the eye pressure or by improving the circulation or both.
What are the types of glaucoma?
- Chronic glaucoma is the common form — painless and asymptomatic in the early stages.
- Acute glaucoma is less common and associated with pain, redness and dimness of vision.
- Congenital – Children may be born with glaucoma or it may develop later in life.
- Hereditary — a family history of glaucoma results in a higher risk of disease.
- Secondary glaucoma is associated with other disease, injury and some types of drugs.
Who gets glaucoma?
AGE — all ages can have it, glaucoma usually occurs in the older adult (over 35) and the risk increases with age.
RACE — chronic open angle glaucoma occurs more commonly and is more aggressive in coloured races especially those of African descent
EYE DISEASE — e.g. near-sighted, past eye injury
FAMILY HISTORY — those with parents, brothers or sisters or other family member. It can, however, skip generations.
MEDICATIONS — Steroid eye medications can induce glaucoma in about 7 per cent of persons. Your Ophthalmologist will monitor your eye pressure closely if you are using this steroid eye medication.
How often should I have my eyes examined?
• Every 3 to 5 years if you are over 40 years.
• Every 1 to 2 years if you have
• Family history of glaucoma
• Had a serious eye injury in the past
• On steroid medication
How is glaucoma detected?
Most people with glaucoma do not have any eye problem e.g. decreased vision and pain until the disease is far advanced.
Treatment is most effective in the early stage of the disease. The way therefore to prevent vision loss is to have a comprehensive eye examination by an ophthalmologist. This includes:–
• Family history questions
• Examination of the optic nerve (may include pictures)
• Eye pressure check. This test alone is not an adequate glaucoma test.
• Visual Field Test — test of your side vision (visual field test)
• OCT scans of the optic nerve.
Other special tests advised by your Ophthalmologist.
The eye pressure is measured at each visit to the ophthalmologist.
Visual Fields and OCT scans are repeated every year.
Treatment of glaucoma
FACT:
• glaucoma cannot be cured! It can be controlled and blindness prevented with proper treatment.
• Vision loss due to glaucoma cannot be restored.
• Treatment for glaucoma helps to slow down or prevent further damage by decreasing the pressure on the optic nerve.
• glaucoma a leading cause of preventable permanent blindness in the world.
Treatment of glaucoma employs the use of medications (drops).
When these do not work, laser glaucoma treatment and glaucoma surgery are also available.
(Note: the first glaucoma operation done in Trinidad was over 50 years ago.)
Because the prevalence of glaucoma is relatively high in the Caribbean and there are no symptoms in the early stages, the way to reduce the blindness rate is to have routine screening especially in those at higher risk from the disease e.g. over 35 years of age, or with a positive family history or other identifiable risk factors.
Once diagnosed with glaucoma, it is necessary to apply medication as prescribed every day, attend regularly for eye examinations and follow the advice of your Ophthalmologist.
Dr. Terrence Allan is a member of the Ophthalomogical Society of the West Indies
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