Glaucoma Services

What is glaucoma?

Glaucoma is a series of diseases that result is damage to the optic nerves and eventual loss of vision. Glaucoma can affect anyone from newborn infants to the elderly. It is estimated that 3 million Americans have glaucoma. During this time, most people will NOT experience any symptoms. If left untreated, it can affect the vision and ultimately lead to permanent blindness. Glaucoma usually develops slowly over a period of years, but some rare forms can develop over hours.

Causes of glaucoma

Inside the eye, a clear fluid, called the acqeous humor, is produced to nourish the structures within the eye. Normally, this fluid leaves the eye through a drainage system called the trabecular meshwork located in the angle of the eye. In glaucoma, this fluid fails to drain at a normal rate and the intraocular pressure (IOP) rises. When the pressure in the eye is too high (this varies from person to person) this damages the optic nerve, which is responsible for sending visual images from the eye to the brain. When the nerve cells die, permanent damage occurs.

Types of glaucoma

Primary Open Angle Glaucoma

This is the most common type of glaucoma. In these cases, the drainage area inside the eye (the angle) changes for unknown reasons. This causes the fluid to drain too slowly out of the eye. As the fluid builds up, the pressure inside the eye gradually rises.

Acute Angle Closure Glaucoma

This is a rare form of glaucoma where the drainage angle suddenly becomes blocked. As the pressure inside the eye rises, blurred vision, severe pain, and occasionally nausea and vomiting can result. This is an ocular emergency. Prompt laser treatment may help resolve this problem.

Other Types of Glaucoma

Congenital glaucoma, narrow angle glaucoma, chronic angle closure glaucoma, and other types exist.

Diagnosing glaucoma

Glaucomais detected through a complete eye examination. While some patients may experience some symptoms, most patients do not learn they have the condition until they undergo a thorough eye exam. The only way to prevent vision loss is by early detection and treatment. Typically, the physician will check:

Eye pressure
Appearance of the optic nerve
Visual field examination (periodically)
Gonioscopy – looking at the drainage area of the eye (periodically)
Examination of the nerve fiber layer (periodically)
Three dimensional photographs of the optic nerve (periodically)
Pachymetry – measurement of the corneal thickness

Many people think glaucoma and high eye pressure as being the same thing. In reality, the evaluation of the optic nerve and its function are more important. Patients can have glaucoma with seemingly normal eye pressure.

Risk factors for glaucoma

Race – African Americans and Hispanics
Age – individuals over 40
Diabetics
Family history of glaucoma
High blood pressure
Nearsightedness
Long term steroid use
Eye injuries

Symptoms of glaucoma

Early on, there are no symptoms. Vision stays normal and there is no pain. Over time and without treatment, people with glaucoma will experience a loss of peripheral vision, followed by a loss of central vision. Eventually without treatment, blindness can result.

Treatment for glaucoma

Once glaucoma has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision loss. Glaucoma is not cured, but in most cases it can be controlled. Treatment focuses on relieving any symptoms that may be present and preventing further damage from occurring.

The vast majority of patients can be treated successfully with eye drops. Since glaucoma is a progressive disease, eye drops may need to be added or changed to maintain proper control of the pressure in the eyes. It is critical to use the drops daily as directed, and to have routine follow up eye examinations and testing with your eye doctor. Occasionally, if eye drops are not adequately controlling a patient’s glaucoma, other treatment options include:

Selective Laser Trabeculoplasty (SLT) – this is done for patients with open angle glaucoma. The laser is focused on the trabecular meshwork and it stretches open the drainage area of the eye (the angle) to allow more fluid to drain from the eye and therefore lower the eye pressure. This is a highly effective procedure, but usually needs to be repeated every four or five years.
Endocyclophotocoagulation (ECP) – uses a special laser and fiber optic system to treat areas inside the eye (ciliary processes). This procedure decreases the amount of fluid produced inside the eye and thereby lowers the pressure inside the eye. Typically, this surgery is done in combination with cataract surgery
Laser Peripheral Iridotomy (LPI) – is used to equalize the pressure between the front and the back of the eye and to prevent this pressure imbalance from damaging the optic nerve. This treatment requires making a very small hole in the iris (the colored part of the eye), allowing the eye’s natural fluid to easily flow from the back to the front of the eye. This is done for patients with narrow or closed angles.
Trabeculectomy (Filtering Microsurgery) – this is for patients who have not been helped by either eye drops or lasers. A new drainage passage is created by making a small hole and flap in the sclera (the white part of the eye) and creating a collection pouch for the ocular fluids.
Tube Shunt Surgery – this is usually reserved for severe glaucoma cases. A thin, flexible tube (shunt) with a pouch is inserted into the eye to bypass the obstructed drainage system of the eye and lower the eye pressure.

To learn more about the glaucoma services available at Chico Eye Center, please call us today, at 530-895-1727, to schedule an appointment.