GLAUCOMA

 
What is Glaucoma? Back to Top
Glaucoma is a condition in which the pressure inside the eye is elevated. This pressure is not directly related to your blood pressure, but it is actually a result of the balance between the fluid produced inside your eye (aqueous humor) and the rate of drainage through specialized structures inside your eye.
 
 
The optic nerve is located in the back of your eye, along with the retina. This nerve sends all the images perceived by your eye to the brain to be processed. The optic nerve can be sensitive to pressure increases inside the eye. The normal eye pressure ranges between 8 and 20 mmHg and is usually well tolerated by the optic nerve. When there is an increase in the pressure caused by a decrease in the drainage of fluid inside the eye it may result in damage to the optic nerve. That is Glaucoma. It can cause irreversible vision loss and must be carefully followed.
 
There are two types of Glaucoma: Open Angle and Narrow Angle. In Open Angle Glaucoma, there are no mechanical obstructions to the drainage of the aqueous humor, but there is a defective drainage mechanism. This type of Glaucoma is most frequently treated with medical therapy, and, if this fails, then laser and surgical options are available.
 
In Narrow Angle Glaucoma there is a mechanical obstruction to the passage of aqueous humor towards the drainage system. This type of glaucoma can sometimes be treated with a laser procedure (Laser Iridotomy) in the office that creates a small hole in the iris (the colored part of the eye) to help restore the normal anatomy and facilitates the passage of aqueous humor towards the drainage system.
 
Am I at risk for Glaucoma
Back to Top
Certain populations are at increased risk of developing Glaucoma such as African Americans and Asians. Glaucoma has also been determined to be inherited, so if a first degree relative (mother father sister brother son or daughter) has glaucoma you should have your eyes checked more frequently, at least yearly if everything remains stable.
Glaucoma can happen at any stage of life: it can be present from birth (congenital glaucoma), or it can be acquired later in life (juvenile glaucoma or adult glaucoma).
There are also certain conditions that increase the risk of glaucoma, such as some inherited conditions that increase the pressure in the venous drainage of the aqueous humor, Diabetes, and some autoimmune conditions presenting with chronic inflammation of the eye. Certain medications can also increase the pressure inside the eye. Be sure to bring a complete list of your medications when you visit us.
 
How do I know if I have Glaucoma
Back to Top
Open Angle Glaucoma is a very slowly progressive disease. It initially compromises the most peripheral aspect of vision so patients who are affected usually do not notice the change and it may go undetected until it is very advanced and starts to compromise the central vision.
This is why it is so important to have regular eye checks, especially if you have any reason to believe that you might have Glaucoma.
Your doctor can check your Visual Field with a special technology that “maps” your field of vision to the most peripheral points. This technology can detect early changes that you would not be able to perceive which allows us to initiate treatment at an early stage. Ocular Coherence Tomography can also be used to look at the optic nerve to determine if there is damage from increased pressure.
During your regular eye checkups, we will also routinely check your eye pressure, and if there are any indications that your eye pressure is persistently high, you may need to be treated to prevent the compromise of your peripheral vision.
In Narrow Angle Glaucoma, the drainage of the aqueous humor out of the eye can be suddenly interrupted. When this happens, there is an acute onset of severe pain, blurred vision, halos around lights and nausea. If you experience these symptoms contact us or go to the emergency room as soon as possible. You might need immediate treatment to preserve your vision.
 

How is Open Angle Glaucoma treatedBack to Top
The initial approach to glaucoma is medical treatment. Studies have proven that there is no benefit in aggressive surgical treatment until medical treatment has been proven unsuccessful.

There are many options for medical treatment, and they can also be combined to achieve maximal pressure reduction.

In more advanced or more aggressive cases, medical therapy may not be enough to maintain an eye pressure that is healthy for the optic nerve. In these cases, a discussion about the risks and benefits of surgical procedures and / or laser should occur.


What are other types of Glaucoma?  Back to Top
 
In some instances, the anatomy of the drainage angle in the eye is different, due to external causes, such as trauma or inflammation; or due to inherent anatomical variations in each person.
 
In these cases, medical treatment might become insufficient and there might be a need to perform other treatment modalities, either with laser, in order to modify the anatomy of the Iris and allow better drainage of the Acqueous Humor, or with filtrating surgery such as a filtrating Tube or a Trabeculectomy. 

Your doctor will discuss these options with you should they become necessary.